Optimal Management of Bifurcation Coronary Disease: Current Evidence and Future Directions

Purpose of Review: To explore the cumulative evidence of various strategies to percutaneously manage bifurcation coronary artery disease including procedural planning, technical considerations and secondary prevention therapies. Recent Findings: Numerous clinical trials have now demonstrated that use of adjuvant quantitative data, such as from intracoronary imaging, quantitative coronary angiography and compute tomography angiography, can aid procedural planning and improve outcomes in bifurcation percutaneous coronary intervention (PCI). Trials exploring technical approaches to bifurcation PCI generally highlight that a provisional, single-stent approach is associated with better outcomes than the routine use of dedicated two-stent approaches. However, an evidence-based treatment pathway to identify which individual may benefit from an up-front two-stent approach is lacking. The role of dedicated bifurcation stents and drug coated balloons in bifurcation PCI remains to be seen. Individuals with bifurcation coronary disease demonstrate some of the highest rates of recurrent cardiovascular events, highlighting the need for improved secondary prevention therapies. Dedicated clinical trials evaluating the role of escalated secondary prevention therapies and optimal antiplatelets and antithrombotic therapies are lacking. Summary: The current state of evidence in bifurcation PCI highlights the importance of procedural planning using quantitative assessments andpreserving simplicity of bifurcation PCI whenever possible. Despite technical improvements in bifurcation PCI, this does not obfuscate the need for improved secondary prevention therapies in this population.

Duke Scholars

Author Jennifer Anne Rymer Medicine, Cardiology