Stenting techniques for patients with bifurcation coronary artery disease.

Atherosclerotic lesions at the bifurcation of coronary arteries are associated with higher rates of restenosis following stenting, and can be technically challenging when performing percutaneous coronary intervention (PCI). Many techniques have arisen for PCI of these lesions, often incorporating the use of multiple balloons and the placement of two or more stents. A technique commonly used for bifurcations is kissing balloon angioplasty, in which two balloons are inflated simultaneously to prevent the shifting of plaque into the side branch. Provisional side branch stenting is the technique of using a stent for the main branch, and stenting the side branch only if necessary. Multiple-stent techniques include T-stenting, crush technique, culotte, simultaneous kissing stents, V-stenting, and Y-stenting; the goal of these techniques is to provide maximal apposition to the vessel wall with effective drug delivery in the case of drug-eluting stents. Additionally, dedicated bifurcation stents also exist, with apertures that allow placement of additional stents. Debulking techniques such as atherectomy can be employed as stand-alone procedures or to debulk lesions prior to bifurcation stenting. Despite these many options for PCI of bifurcation lesions, there are currently inadequate data to indicate which of these techniques is superior, and many trials have found that complex stenting techniques provide no additional benefits when compared with provisional side branch stenting. Additional, well-designed randomized trials evaluating specific stenting techniques are necessary to determine the best practice for bifurcation lesions.