The 17th expert consensus document of the European Bifurcation Club – techniques to preserve access to the side branch during stepwise provisional stenting

EuroIntervention 2023;19:26-36. DOI: 10.4244/EIJ-D-23-00124

Manuel Pan
Manuel Pan1, MD, PhD; Jens Flensted Lassen2, MD, PhD; Francesco Burzotta3, MD, PhD; Soledad Ojeda1, MD, PhD; Remo Albiero4, MD; Thierry Lefèvre5, MD; David Hildick-Smith6, MD; Thomas W. Johnson7, MD; Alaide Chieffo8, MD; Adrian P Banning9, MD, PhD; Miroslaw Ferenc10, MD, PhD; Olivier Darremont11, MD; Yiannis S. Chatzizisis12, MD, PhD; Yves Louvard5, MD; Goran Stankovic13, MD, PhD
1. Department of Cardiology, Reina Sofia Hospital, University of Cordoba (IMIBIC), Cordoba, Spain; 2. Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark; 3. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 4. Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy; 5. Ramsay Générale de Santé - Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France; 6. Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals Trust, Brighton, UK; 7. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, UK; 8. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; 9. Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK; 10. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 11. Clinique Saint-Augustin, Bordeaux, France; 12. Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA; 13. Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. However, the side branch (SB) can become compromised after main vessel (MV) stenting and restoring SB patency can be difficult in challenging anatomies. Angiographic and intracoronary imaging criteria can predict the risk of side branch closure and may encourage use of side branch protection strategies. These protective approaches provide strategies to avoid SB closure or overcome compromise following MV stenting, minimising periprocedural injury. In this article, we analyse the strategies of SB preservation discussed and developed during the most recent European Bifurcation Club (EBC) meetings.

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bifurcationside branch occlusionside branch preservation
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