Coronary interventions

Treatment of coronary bifurcation lesions, part II: implanting two stents. The 16th expert consensus document of the European Bifurcation Club

EuroIntervention 2022;18:457-470. DOI: 10.4244/EIJ-D-22-00166

Jens Lassen
Jens Flensted Lassen1, MD, PhD; Remo Albiero2, MD; Thomas W. Johnson3, MD; Francesco Burzotta4, MD, PhD; Thierry Lefèvre5, MD; Tinen L. Iles6, PhD; Manuel Pan7, MD, PhD; Adrian P. Banning8, MD, PhD; Yiannis S. Chatzizisis9, MD, PhD; Miroslaw Ferenc10, MD, PhD; Vladimir Dzavik11, MD; Dejan Milasinovic12, MD; Olivier Darremont13, MD; David Hildick-Smith14, MD; Yves Louvard5, MD; Goran Stankovic12, MD, PhD
1. Department of Cardiology B, Odense University Hospital & University of Southern Denmark, Odense C, Denmark; 2. Interventional Cardiology Unit, Ospedale Civile di Sondrio, Sondrio, Italy; 3. Department of Cardiology, Bristol Heart Institute, University Hospitals Bristol and Weston NHSFT & University of Bristol, Bristol, United Kingdom; 4. Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy; 5. Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Ramsay Santé, Massy, France; 6. Department of Surgery/Medical School, University of Minnesota, MN, USA; 7. Department of Cardiology, Reina Sofia Hospital. University of Cordoba (IMIBIC), Cordoba, Spain; 8. Cardiovascular Medicine Division, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; 9. Cardiovascular Division, University of Nebraska Medical Center, Omaha, NE, USA; 10. Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany; 11. Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; 12. Department of Cardiology, Clinical Center of Serbia, and Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 13. Clinique St Augustin, Bordeaux, France; 14. Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, United Kingdom

The European Bifurcation Club (EBC) supports a continuous review of the field of coronary artery bifurcation interventions and aims to facilitate a scientific discussion and an exchange of ideas on the management of bifurcation disease. The recent focus of meetings and consensus statements has been on the technical issues in bifurcation stenting, recognising that the final result of a bifurcation procedure and the long-term outcome for our patients are strongly influenced by factors, including preprocedural strategy, stenting technique selection, performance of optimal procedural steps, the ability to identify and correct complications and finally, and most important, the overall performance of the operator. Continuous refinement of bifurcation stenting techniques and the promotion of education and training in bifurcation stenting techniques represent a major clinical need. Accordingly, the consensus from the latest EBC meeting in Brussels, October 2021, was to promote education and training in bifurcation stenting based on the EBC principle. Part II of this 16th EBC consensus document aims to provide a step-by-step overview of the pitfalls and technical troubleshooting during the implantation of the second stent either in the provisional stenting (PS) strategy or in upfront 2-stent techniques (e.g., 2-stent PS pathway and double kissing crush stenting). Finally, a detailed overview and discussion of the numerous modalities available to provide continuous education and technical training in bifurcation stenting techniques are discussed, with consideration of their future application in enhancing training and practice in coronary bifurcation lesion treatment.

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