Bifurcation Lesion Management Strategies: Contemporary Techniques, Clinical Outcomes, and Future Perspectives

doi:N/A

Bangaldesh Journal of Cardivascular Medicine

2023, Volume 1, Issue 3 : 1-8

Research Article

Bifurcation Lesion Management Strategies: Contemporary Techniques, Clinical Outcomes, and Future Perspectives

Michael R. Anderson

Sarah T. Bennett

Ahmed K. Rahman

Priya Sharma

⁴

David L. Cooper

⁵

Department of Cardiology, Heart Institute of North America, Chicago, USA

Division of Interventional Cardiology, Royal Cardiovascular Centre, London, UK

Department of Cardiovascular Medicine, International Medical Research University, Dubai, UAE

⁴

Department of Cardiology, South Asian Heart Institute, New Delhi, India

⁵

Department of Clinical Research, Global Cardiovascular Sciences Center, Toronto, Canada

Abstract

Background

Coronary bifurcation lesions represent one of the most challenging subsets encountered during percutaneous coronary intervention (PCI), accounting for approximately 15–20% of all coronary interventions. Despite advances in stent technology, imaging modalities, and procedural techniques, optimal treatment strategies remain debated.

Objective

To review contemporary bifurcation lesion management strategies, evaluate procedural and clinical outcomes associated with different stenting techniques, and discuss future directions in bifurcation PCI.

Methods

A comprehensive narrative review was conducted utilizing major clinical trials, registries, consensus documents, and contemporary guideline recommendations published between 2010 and 2025. Single-stent and two-stent strategies, intracoronary imaging guidance, physiological assessment, and emerging technologies were evaluated.

Results

Provisional stenting remains the preferred strategy for most bifurcation lesions due to procedural simplicity and favorable clinical outcomes. However, complex bifurcation lesions involving large side branches may benefit from planned two-stent approaches such as DK-crush, culotte, TAP, and nano-crush techniques. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) improve procedural optimization and reduce adverse outcomes. Physiological assessment further refines lesion selection and treatment decisions.

Conclusion

Modern bifurcation PCI has evolved significantly through advances in procedural techniques, imaging, and physiological assessment. Tailored strategies based on lesion complexity and anatomical characteristics offer the best clinical outcomes. Future developments involving artificial intelligence, computational modeling, and next-generation stent platforms may further improve treatment success.

Keywords

Bifurcation lesions

PCI

DK-crush

Provisional stenting

IVUS

OCT

Coronary intervention

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