Coronary bifurcation lesions.

Coronary bifurcations are prone to develop atherosclerotic plaque due to turbulent blood flow and high shear stress. These lesions amount to 15-20% of the total number of interventions. The true bifurcation lesion consist of >50% diameter obstruction of the main vessel (MV) and of the side branch (SB) in an inverted "Y" fashion. Treatment of coronary bifurcation lesions represents a challenging area in interventional cardiology but recent advances in percutaneous coronary interventions (PCI) have led to the dramatic increase in the number of patients successfully treated percutaneously. When compared with non-bifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs, longer hospitalization and a higher clinical and angiographic restenosis. Introduction of drug-eluting stents (DES) has resulted in a lower event rate and reduction of main vessel (MV) restenosis in comparison with historical controls. However, side branch (SB) ostial residual stenosis and long-term restenosis remains a problem. Although stenting the MV with provisional SB stenting seems to be the prevailing approach, in the era of DES various two-stent techniques have emerged to allow stenting of the large side branch.