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Percutaneous coronary intervention for bifurcation lesions: 2008 consensus document from the fourth meeting of the European Bifurcation Club

2009; European Association of Percutaneous Cardiovascular Interventions; Volume: 5; Issue: 1 Linguagem: Inglês

10.4244/eijv5i1a8

1969-6213

Goran Stanković, Olivier Darremont, Mirosław Ferenc, David Hildick‐Smith, Yves Louvard, Remo Albiero, Manuel Pan, Jens Flensted Lassen, Thierry Lefévre,

Cerebrovascular and Carotid Artery Diseases

The bestapproach to manage a bifurcation to achieve optimal proceduraloutcomes and, more importantly, long-term success with lowrestenosis rates and low MACE rates is still heavily debated. Thisdebate has predominantly stemmed from a lack of randomiseddata, which may explain why therapeutic strategies have beenlargely based on the personal clinical experiences of highly skilledoperators practising in high-volume centres. Although the treatmentstrategy for bifurcation lesions has rapidly improved over the years,the lower procedural success, especially as the result of abrupt sidebranch (SB) closure with single stent strategies, together with therisk of thrombosis and restenosis associated with the complex twostent techniques, remains a predictor of adverse clinical outcome.The incidence of bifurcation lesions, the technical difficultiesinherent in their treatment, the lower success rate, and highercomplication and restenosis rates observed in this setting comparedwith non-bifurcation lesions have prompted intense researchactivity and have made coronary bifurcation stenting the focus ofspecific sessions in major interventional cardiology meetings.The European Bifurcation Club (EBC) was founded in 2004 in orderto devise a common terminology for the description and treatmentof bifurcation lesions and to exchange ideas on the clinical,technical, and fundamental aspects of the specific treatmentstrategies implemented in this setting. EBC meetings are heldannually. The fourth meeting was convened in Prague onSeptember 26-27, 2008, with the agenda to reach a consensus onthe current state of the art of percutaneous bifurcation treatment.The present report represents a synthesis of the findings from thismeeting, and also incorporates a literature review from the field ofbifurcation intervention. Topics covered in this consensusdocument include state-of-the-art in bifurcation stentingtechniques, discussions of the anatomical changes at carina level