Coronary Bifurcation Lesion–Management

Coronary bifurcation lesion management is challenging even in this modern era of drug-eluting stents (DES). A debate always exists as to what mode of treatment is better–one-stent or two-stent strategy. As in hospital and major adverse cardiac events (MACE) are more in the follow-up, what improvements in management strategy are required in relation to bifurcation lesions? We have more questions than answers for this type of lesion. In this article, we try to analyze these issues.

Randomised, non-inferiority, controlled procedural outcomes TrIal comParing reverse T And Protrusion versus double-kissing and crush stenting: protocol of the TIP TAP I randomised trial

IntroductionTo assess the impact of ‘reverse T and Protrusion’ (TAP) technique on the outcome after stenting of true bifurcation lesions of the left main (LM) or proximal epicardial vessels as compared with double kissing (DK)-crush technique.Methods and analysis50 consecutive patients with true coronary bifurcation lesion (Medina 1,1,1 or 0,1,1) of the LM or the proximal main vessels, requiring a two-stent technique as first-line strategy at University Medical Center Mainz, are randomised in a 1:1 ratio to reverse TAP or DK-crush stenting. As recommended by best clinical practice, final angiographic result is evaluated and optical coherence tomographic (OCT) intracoronary imaging is performed to assess and optimise the final result. The primary end point is defined as the percentage of stent expansion in the side branch. Secondary end points consist of angiographic and procedural success (assessed until patient’s discharge), procedural parameters (procedural time, fluoroscopy time, use of devices, X-ray dose) and OCT parameters expressing expansion of the stents. Safety parameters include all adverse events up to 6 months after discharge. A clinical, angiographic and intracoronary imaging control at 6 months is planned.Ethics and disseminationThe protocol complies with good clinical practice and the ethical principles described in the Declaration of Helsinki and is approved by the local ethics committee. The results of the trial will be published as original article(s) in medical journals and/or as presentation at congresses.Trial registration numberClinicalTrials.gov Registry (NCT03714750)

Coronary bifurcation stenting: state of the art

The difference between a coronary bifurcation lesion and an ordinary lesion lies in the presence of a side branch (SB). Such branches are particularly instrumental in the development of atheroma because of local bloodflow patterns. The clinical importance of a SB depends on its diameter, which is strongly correlated with its flow and the myocardial mass that it supplies. The diameter of the SB, main branch (MB), and of the proximal segment of the MB are indeed interdependent, as evidenced by Murray’s law. Therefore, a coronary bifurcation should be divided into three segments, each with its own reference diameter. This chapter covers state-of-the-art coronary bifurcation stenting processes, the fundamental aspects of the technique, definitions and classification, and different strategies.