Why a EuroIntervention supplement on bifurcation stenting

Where we began The first attempts to dilate a coronary bifurcation stenosis were carried out in the 1980s, with kissing balloon techniques being performed via two separate guiding catheters! This technique was associated with a poor outcome as well as high complication and restenosis rates. A broad variety of bifurcation stenting techniques were described in the 90s during the bare metal stent (BMS) era, one of the initial strategies being the placement of the famous PS 153 Cordis stent bridge in front of a side branch. Most of these techniques originated in the creative mind of Antonio Colombo in an attempt to adapt the treatment strategies to the various types of coronary anatomy. Although the use of stents increased the safety of these techniques, high restenosis and re-intervention rates were still reported. Despite the absence of randomised trials, the first clinical and bench studies on stent deployment led to the idea of using a single stent to treat a coronary bifurcation whenever possible. Since 2000, the use of drug-eluting stents (DES) has considerably decreased the risk of restenosis and re-intervention after bifurcation stenting, but this at the price of a potential higher risk of stent thrombosis as in non-bifurcated lesions. The improvement in outcome prompted the development of many new techniques which were designed to address the problem of side branch restenosis by achieving enhanced coverage of the whole bifurcation.