Coronary interventions

Treatment of coronary bifurcation lesions, part I: implanting the first stent in the provisional pathway. The 16th expert consensus document of the European Bifurcation Club

EuroIntervention 2022;18:e362-e376. DOI: 10.4244/EIJ-D-22-00165

Remo Albiero
Remo Albiero1, MD; Francesco Burzotta2, MD, PhD; Jens Flensted Lassen3, MD, PhD; Thierry Lefèvre4, MD; Adrian P. Banning5, MD, PhD; Yiannis S. Chatzizisis6, MD, PhD; Thomas W. Johnson7, MD; Miroslaw Ferenc8, MD, PhD; Manuel Pan9, MD, PhD; Olivier Darremont10, MD; David Hildick-Smith11, MD; Alaide Chieffo12, MD; Yves Louvard4, MD; Goran Stankovic13, MD
1. Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy; 2. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 3. Department of Cardiology B, Odense Universitates Hospital & University of Southern Denmark, Odense C, Denmark; 4. Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; 5. Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; 6. Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA; 7. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, United Kingdom; 8. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 9. Department of Cardiology, Reina Sofia Hospital. University of Cordoba (IMIBIC), Cordoba, Spain; 10. Clinique St Augustin, Bordeaux, France; 11. Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, United Kingdom; 12. Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; 13. Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Stepwise layered provisional stenting (PS) is the most commonly used strategy to treat coronary bifurcation lesions (CBL). The term “stepwise layered” emphasises the versatility of this approach that allows the adjustment of the procedure plan according to the CBL complexity, starting with stent implantation in one branch and implantation of a second stent in the other branch only when required. A series of refinements have been implemented over the years to facilitate the achievement of predictable procedural results using this approach. However, despite its simplicity and versatility, operators using this technique require full knowledge of the pitfalls of each procedural step. Part I of this 16th European Bifurcation Club consensus paper provides a detailed step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the first stent using the PS strategy for the treatment of CBL.

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