Manuel Pan; Jens  Flensted Lassen; Francesco Burzotta; Soledad Ojeda; Remo Albiero; Thierry Lefèvre; David Hildick-Smith; Thomas Johnson; Alaide Chieffo; Adrian Banning; Miroslaw Ferenc; Olivier Darremont; Yiannis Chatzizisis; Yves Louvard; Goran Stankovic

doi:10.4244/EIJ-D-23-00124

The 17th expert consensus document of the European Bifurcation Club – techniques to preserve access to the side branch during stepwise provisional stenting

Manuel Pan¹, MD, PhD; Jens Flensted Lassen², MD, PhD; Francesco Burzotta³, MD, PhD; Soledad Ojeda¹, MD, PhD; Remo Albiero⁴, MD; Thierry Lefèvre⁵, MD; David Hildick-Smith⁶, MD; Thomas W. Johnson⁷, MD; Alaide Chieffo⁸, MD; Adrian P Banning⁹, MD, PhD; Miroslaw Ferenc¹⁰, MD, PhD; Olivier Darremont¹¹, MD; Yiannis S. Chatzizisis¹², MD, PhD; Yves Louvard⁵, MD; Goran Stankovic¹³, MD, PhD

Abstract

Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. However, the side branch (SB) can become compromised after main vessel (MV) stenting and restoring SB patency can be difficult in challenging anatomies. Angiographic and intracoronary imaging criteria can predict the risk of side branch closure and may encourage use of side branch protection strategies. These protective approaches provide strategies to avoid SB closure or overcome compromise following MV stenting, minimising periprocedural injury. In this article, we analyse the strategies of SB preservation discussed and developed during the most recent European Bifurcation Club (EBC) meetings.

Introduction

Provisional stenting has become the default technique for the treatment of most coronary bifurcation lesions. This strategy has also been called the simple approach; however, sometimes the procedure is not so simple – the side branch (SB) can occlude after main vessel (MV) stenting in up to 6-18% of cases12345. Restoring SB patency can be difficult, and the fear of having to deal with this situation may persuade operators to adopt an...

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