The 15th European Bifurcation Club (EBC) meeting was held in Barcelona in October 2019 and the facilitated a renewed consensus on many important aspects of coronary bifurcation lesions (CBL) and unprotected left main (LM) interventions.



A number of recent studies of intracoronary imaging in bifurcations and coronary simulations (in-vitro, ex-vivo and computational) have highlighted their potential to extend our knowledge and understanding of the anatomical and technical issues of CBL interventions. Refinements of bifurcation stenting techniques continue to be developed and tested.



It remains evident that the provisional technique with optional side-branch treatment according to T, T and small protrusion (TAP) or culotte continues to represent a very flexible option that allows safe treatment for the majority of patients.



Inevitably debate regarding the optimal treatment of side branches, including assessment of significance, pre-treatment and stenting strategy persists. When treating complex lesions, especially when involving the distal LM, adoption of a dedicated 2-stent technique should be considered.



Yet, this necessitates a complete understanding of the technique and the potential complications and challenges associated with complex bifurcation PCI since unresolved or unrecognised technical failures may affect clinical outcome.



Beyond the technical considerations of bifurcation stenting, drug-eluting balloon technology may provide novel solutions for the treatment of CBLs and tailored antiplatelet pharmacology may facilitate improved long-term outcomes.



In conclusion, considerable evolution in optimised bifurcation PCI is evident with increased awareness regarding best practices. However, continued advances are required to achieve optimal outcomes for patients with complex CBL.