Treatment Strategies for Bifurcation Lesions

Percutaneous transluminal angioplasty of coronary artery bifurcations represents a still evolving field of interventional cardiology. The dilatation of stenoses located at the site of coronary bifurcations has been limited by the risk of side branch occlusion with subsequent myocardial infarction and high rates of late restenosis. The initial success rates of conventional balloon dilatation were improved by the introduction of side branch protection using two guidewires as well as the "kissing balloon" technique. The potential advantage of atherectomy techniques, however, was associated with a high incidence of acute complications. While bifurcation stenting promises to allow optimal geometric reconstruction of bifurcation lesions using multiple or single component bifurcation stents, late intimal hyperplasia remains a potential limitation of this interventional approach.