Functional PCI in bifurcation lesions

Duk-Woo Park, Seung-Jung Park

In the contemporary practice of percutaneous coronary interventions (PCI), bifurcation lesions account for approximately 20-30% of all coronary lesion subsets. Bifurcation PCI remains one of the most challenging procedures with respect to procedural complexity and relatively high rates of early and long-term adverse cardiac events, as compared to non-bifurcation PCI. Although there have been marked advancements in stents, devices, techniques, and adjunctive drug therapies, the optimal management of bifurcation lesions is still the subject of considerable debate. Despite great interest in this complex lesion subset and a fast growing body of scientific evidence, over the past decade, the management of bifurcation disease has been focused mainly on technical aspects. However, given that adjunctive imaging and functional tools are widely applicable in contemporary practice, an integrated approach combining functional aspects and technical aspects might be helpful to guide treating physicians in their decision making on PCI strategies and procedural optimisation, which are ultimately linked to improvement of the outcomes of patients with such complex lesions. Herein, we highlight the most debated issues and propose our recommendations for a simple and integrated approach while emphasising the functional aspects of bifurcation PCI.

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