Evaluation and treatment of coronary bifurcation disease: current strategies and new technologies

Coronary bifurcation lesions make up 15–20% of all percutaneous coronary interventions and remain a therapeutic challenge. Drug-eluting stents are the preferred stent choice for these interventions. Four large randomized trials (NORDIC, CACTUS, BBC One and BBK) have shown the provisional strategy to be the default for the majority of bifurcation lesions. In approximately 20% of cases, the two-stent strategy to bifurcation disease is preferred. The four main two-stent strategies are: T - stent, mini-crush, V - stent/simultaneous kissing stents and culotte. Three main subsets of emerging stent technologies are being developed to address the unique nature of bifurcation lesions. These include stents facilitating access to the side branch after stenting the main vessel, devices designed to stent the side branch first and devices made to specifically scaffold the ostium of the bifurcation. Use of fractional flow measurements, intravascular ultrasound and optical coherence tomography can be of use in the treatment of bifurcation lesions.