This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.05.080v1 46/8/1446    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Iakovou, I. Articles by Colombo, A. Search for Related Content PubMed PubMed Citation Articles by Iakovou, I. Articles by Colombo, A.

STATE-OF-THE-ART PAPER

Contemporary Stent Treatment of Coronary Bifurcations

Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy

Manuscript received March 17, 2005; revised manuscript received April 23, 2005, accepted May 23, 2005.

^_* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy (Email: info{at}emocolumbus.it).

Treatment of coronary bifurcation lesions represents a challenging area in interventional cardiology. The introduction of drug-eluting stents (DES) reduced restenosis in the main branch (MB). However, restenosis at the ostium of the side branch (SB) remains a problem. Although stenting the MB with provisional SB stenting seems to be the prevailing approach, in the era of DES various two-stent techniques emerged (crush) or were re-introduced (V or simultaneous kissing stents, crush, T, culottes, Y, skirt) to allow stenting in the SB when needed. This review describes in detail various techniques used for implantation of two stents by intention to treat.

Abbreviations and Acronyms   DES = drug-eluting stent   MB = main branch   SB = side branch   SES = sirolimus-eluting stent

This article has been cited by other articles:

				E. Boudriot, H. Thiele, T. Walther, C. Liebetrau, P. Boeckstegers, T. Pohl, B. Reichart, H. Mudra, F. Beier, B. Gansera, et al. Randomized Comparison of Percutaneous Coronary Intervention With Sirolimus-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Stem Stenosis J. Am. Coll. Cardiol., February 1, 2011; 57(5): 538 - 545. [Abstract] [Full Text] [PDF]

				M. Niemela, K. Kervinen, A. Erglis, N. R. Holm, M. Maeng, E. H. Christiansen, I. Kumsars, S. Jegere, A. Dombrovskis, P. Gunnes, et al. Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting: The Nordic-Baltic Bifurcation Study III Circulation, January 4, 2011; 123(1): 79 - 86. [Abstract] [Full Text] [PDF]

				Y. Kinoshita, O. Katoh, T. Matsubara, M. Ehara, K. Nasu, M. Habara, and T. Suzuki First Clinical Experience of "Flower Petal Stenting": A Novel Technique for the Treatment of Coronary Bifurcation Lesions J. Am. Coll. Cardiol. Intv., January 1, 2010; 3(1): 58 - 65. [Abstract] [Full Text] [PDF]

				S. Verheye, P. Agostoni, C. L. Dubois, J. Dens, J. Ormiston, S. Worthley, B. Trauthen, T. Hasegawa, B.-K. Koo, P. J. Fitzgerald, et al. 9-Month Clinical, Angiographic, and Intravascular Ultrasound Results of a Prospective Evaluation of the Axxess Self-Expanding Biolimus A9-Eluting Stent in Coronary Bifurcation Lesions: The DIVERGE (Drug-Eluting Stent Intervention for Treating Side Branches Effectively) Study J. Am. Coll. Cardiol., March 24, 2009; 53(12): 1031 - 1039. [Abstract] [Full Text] [PDF]

				A. R. Galassi, S. D. Tomasello, D. Capodanno, G. Barrano, G. P. Ussia, and C. Tamburino Mini-Crush Versus T-Provisional Techniques in Bifurcation Lesions: Clinical and Angiographic Long-Term Outcome After Implantation of Drug-Eluting Stents J. Am. Coll. Cardiol. Intv., March 1, 2009; 2(3): 185 - 194. [Abstract] [Full Text] [PDF]

				A. V. Kaplan Percutaneous Coronary Intervention Treatment of Bifurcation Lesions--A Work in Progress: The Importance of Single-Center Studies J. Am. Coll. Cardiol. Intv., March 1, 2009; 2(3): 195 - 196. [Full Text] [PDF]

				C. R. Smith Surgery, Not Percutaneous Revascularization, Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis Circulation, February 24, 2009; 119(7): 1013 - 1020. [Full Text] [PDF]

				P. S. Teirstein Percutaneous Revascularization Is the Preferred Strategy for Patients With Significant Left Main Coronary Stenosis Circulation, February 24, 2009; 119(7): 1021 - 1033. [Full Text] [PDF]

				T. Adriaenssens, R. A. Byrne, A. Dibra, R. Iijima, J. Mehilli, O. Bruskina, A. Schomig, and A. Kastrati Culotte stenting technique in coronary bifurcation disease: angiographic follow-up using dedicated quantitative coronary angiographic analysis and 12-month clinical outcomes Eur. Heart J., December 1, 2008; 29(23): 2868 - 2876. [Abstract] [Full Text] [PDF]

				W. Rademacher, A. Knape, J. Schumm, M. Ferrari, A. Lauten, H. Mudra, and H. R. Figulla Acute and long-term outcome of unprotected left main coronary angioplasty compared to the anticipated surgical risk Interact CardioVasc Thorac Surg, October 1, 2008; 7(5): 871 - 877. [Abstract] [Full Text] [PDF]

				A. Latib and A. Colombo Bifurcation Disease: What Do We Know, What Should We Do? J. Am. Coll. Cardiol. Intv., June 1, 2008; 1(3): 218 - 226. [Abstract] [Full Text] [PDF]

				E. S. Brilakis and P. B. Berger Treatment of coronary bifurcations: might less be more? Eur. Heart J., March 2, 2008; 29(6): 704 - 706. [Full Text] [PDF]

				P. S. Teirstein Unprotected left main intervention patient selection, operator technique, and clinical outcomes. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 5 - 13. [Abstract] [Full Text] [PDF]

				A. Colombo and A. Chieffo Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease) Circulation, September 18, 2007; 116(12): 1424 - 1432. [Full Text] [PDF]

				C. A.G. Van Mieghem, A. Thury, W. B. Meijboom, F. Cademartiri, N. R. Mollet, A. C. Weustink, G. Sianos, P. P.T. de Jaegere, P. W. Serruys, and P. de Feyter Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography Eur. Heart J., August 2, 2007; 28(16): 1968 - 1976. [Abstract] [Full Text] [PDF]

				R. Jaffe and B. H. Strauss Late and Very Late Thrombosis of Drug-Eluting Stents: Evolving Concepts and Perspectives J. Am. Coll. Cardiol., July 10, 2007; 50(2): 119 - 127. [Abstract] [Full Text] [PDF]

				K. Tsuchida, A. Colombo, T. Lefevre, K. G. Oldroyd, V. Guetta, G. Guagliumi, W. von Scheidt, W. Ruzyllo, C. W. Hamm, M. Bressers, et al. The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II) Eur. Heart J., February 2, 2007; 28(4): 433 - 442. [Abstract] [Full Text] [PDF]

				N G Bellenger, R Swallow, D S Wald, I Court, A L Calver, K D Dawkins, and N Curzen Haemodynamic significance of ostial side branch nipping following percutaneous intervention at bifurcations: a pressure wire pilot study Heart, February 1, 2007; 93(2): 249 - 250. [Full Text] [PDF]

				T. K. Steigen, M. Maeng, R. Wiseth, A. Erglis, I. Kumsars, I. Narbute, P. Gunnes, J. Mannsverk, O. Meyerdierks, S. Rotevatn, et al. Randomized Study on Simple Versus Complex Stenting of Coronary Artery Bifurcation Lesions: The Nordic Bifurcation Study Circulation, October 31, 2006; 114(18): 1955 - 1961. [Abstract] [Full Text] [PDF]

				D. J. Kereiakes and D. P. Faxon Left Main Coronary Revascularization at the Crossroads Circulation, May 30, 2006; 113(21): 2480 - 2484. [Full Text] [PDF]