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Bifurcation PCI Strategy — EECC MCQ

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HardCoronary Artery DiseaseBifurcation PCI StrategyEECC

A 66-year-old man undergoes elective PCI to a calcified bifurcation lesion (LAD/diagonal). The operator deploys a DES in the LAD across the diagonal ostium using a provisional single-stent strategy. Post-stenting, the diagonal has TIMI 3 flow but an ostial pinch of 60%. Kissing balloon inflation is performed. What is the evidence base for this approach?

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Correct answer: A — The provisional single-stent strategy with kissing balloon optimisation is the recommended default for most bifurcation lesions based on the EBC TWO and Nordic Bifurcation studies

For most coronary bifurcation lesions, the provisional single-stent strategy (stenting the main branch only, with side branch intervention only if needed) is the recommended default approach based on the EBC TWO, Nordic Bifurcation, and DKCRUSH-II studies. These trials showed that routine two-stent techniques do not improve outcomes compared with provisional stenting and may increase procedural complications. Kissing balloon inflation (simultaneous inflation of balloons in both the main and side branch through the stent struts) optimises the side branch ostium when there is significant ostial compromise. Two-stent techniques (culotte, mini-crush, DK-crush, T-stenting) are reserved for large side branches with significant ostial disease or dissection.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes; EBC Consensus