Bifurcation disease accounts for up to 20% of all coronary disease treated by percutaneous coronary intervention (PCI).1 The best approach to manage a bifurcation to achieve optimal procedural outcomes and, more importantly, long-term success with low restenosis rates and low MACE rates is still heavily debated.
This debate has predominantly stemmed from a lack of randomised data, which may explain why therapeutic strategies have been largely based on the personal clinical experiences of highly skilled operators practising in high-volume centres.
Although the treatment strategy for bifurcation lesions has rapidly improved over the years, the lower procedural success, especially as the result of abrupt side branch (SB) closure with single stent strategies, together with the risk of thrombosis and restenosis associated with the complex two stent techniques, remains a predictor of adverse clinical outcome.
The incidence of bifurcation lesions, the technical difficulties inherent in their treatment, the lower success rate, and higher complication and restenosis rates observed in this setting compared with non-bifurcation lesions have prompted intense research activity and have made coronary bifurcation stenting the focus of specific sessions in major interventional cardiology meetings.
The European Bifurcation Club (EBC) was founded in 2004 in order to devise a common terminology for the description and treatment of bifurcation lesions and to exchange ideas on the clinical, technical, and fundamental aspects of the specific treatment strategies implemented in this setting. EBC meetings are held annually.
The fourth meeting was convened in Prague on September 26-27, 2008, with the agenda to reach a consensus on the current state of the art of percutaneous bifurcation treatment. The present report represents a synthesis of the findings from this meeting, and also incorporates a literature review from the field of bifurcation intervention. Topics covered in this consensus document include state-of-the-art in bifurcation stenting techniques, discussions of the anatomical changes at carina level during bifurcation stenting (carina shift) the relationship between bifurcation angle parameters and clinical outcome after intervention and the controversies in the technical approach to 0,1,0 left main lesions and 0,0,1 bifurcation lesions.
Download pdf: 4th EBC Consensus