title: Review of percutaneous therapy for bifurcation lesions in the era of drug-eluting stents.
abstract: Although recent advances in percutaneous coronary interventions (PCI) have led to dramatic expansions in procedural complexity, bifurcation lesions (BL) remain a serious challenge for the interventionalist. Turbulent flow dynamics and high shear stress likely predispose coronary bifurcations to development of atherosclerotic plaques. These lesions comprise 15% to 20% of the total number of coronary interventions. When compared with non-BL interventions, BL interventions demonstrate lower procedural success rates, higher procedural costs, longer hospitalizations, and higher clinical and angiographic restenosis rates. The recent introduction of drug-eluting stents (DES) has resulted in lower incidences of target lesion/ vessel revascularization and reduction of main branch restenosis in this anatomic subset, when compared to historical bare metal stent (BMS) controls. Nonetheless, DES have not resolved the bifurcation PCI problem; and several techniques employing either 1 or 2 stents have emerged. Stenting of the main vessel with provisional side branch stenting seems to be the prevailing approach. While no definitive single BL-PCI technique has been identified, the optimal approach is likely lesion-specific. This paper reviews different treatment modalities for this complex lesion subset, with particular emphasis on the use of DES, as well as new potential therapeutic approaches.
authors.affiliation: Saint Joseph's Translational Research Institute, Saint Joseph's Hospital of Atlanta, Atlanta, GA 30342, USA.
authors.forename: L
authors.initials: L
authors.lastname: Pendyala
authors.forename: R
authors.initials: R
authors.lastname: Jabara
authors.forename: D
authors.initials: D
authors.lastname: Hou
authors.forename: T
authors.initials: T
authors.lastname: Shinke
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: R
authors.initials: R
authors.lastname: Gadesam
authors.forename: K
authors.initials: K
authors.lastname: Robinson
authors.forename: N
authors.initials: N
authors.lastname: Chronos
authors.forename: J P
authors.initials: JP
authors.lastname: Chen
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome