During the last TCT meeting, the treatment options of bifurcation lesions were addressed during a joint session of the interventional working groups of Belgium, Austria and Croatia.
G Friedrich ( Austria) reiterated the hazard of the treatment of bifurcation lesions defined as a coronary narrowing involving the origin of a significant side branch : lower procedure success rate, higher incidence of periprocedural adverse outcome and worse long term outcome.
He reported the unsolved issues of the treatment of those lesions : 1 ou 2 stents strategy ; which type of stent (newer generation of DES ) ; the need of adjunctive evaluation (FFR , OCT , IVUS) ; optimal DAPT duration. He insisted on the importance to define the anatomic features of the bifurcation lesion to select the stenting technique. The Medina classification is simple to use but incomplete (angle, side branch lesion length, presence of calcium). Adjunctive evaluation by FFR, IVUS or OCT is recommended. To deal with bifurcation lesions, he reminded us the algorithm proposed par J Bennett and C Dubois ( J Thorac Dis. 2016 Oct;8(10):E1351-E1354.) and described the different two stents techniques ( T , TAP , culotte , crush ), highlighting the importance of the POT.
C Dubois (Belgium) raised the question of the role for dedicated stents or BVS in the treatment of complex bifurcation disease. He reviewed trials using bifurcation dedicated stents (Trypton IDE trial , Axxess clinical programm , Cobra trial , Bioss : pooled analysis of RCT , Bioss vs DES ) and concluded that even if the concept is attractive, the absence of proven clinical benefit, the learning curve, the limited size selection and the overcost ( need of a second or third stent ) contribute to poor adoption. Bioresorbable scaffolds could offer theoretical advantages but strong clinical data are needed to support their use in this context.