A Perspective on a Two-stent Approach in Bifurcation Cases

Bifurcation lesions are the cause of 20% of all percutaneous coronary interventions, representing a complex category associated with lower procedure success rates and higher restenosis rates. However, the optimal approach to bifurcation needs further research. This paper aims to determine the optimal method for implementing a two-stent strategy in bifurcation cases. It desires to identify the characteristics that can guide our approach and the outcomes that can be expected. This paper also highlights relevant trials that support the findings.

In nontrue bifurcation cases (Medina 1-1-0, 1-0-0, 0-1-0, 0-0-1), a one stent strategy, eventually with the provisional approach, is preferable. When treating a left main or non-left main bifurcation in a Medina classification of 1-1-1, 1-0-1, or 0-1-1 without meeting at least one major and two minor criteria and of DEFINITION II Classification (simple true bifurcation), the layered provisional approach is the appropriate strategy.

In cases of left main or non-left main complex true bifurcation (Medina 1-1-1, 1-0-1, 0-1-1) meeting the Definition II Classification criteria, a two-stent strategy could be a suitable option in cases where the SB is more than 2.5 mm and has a lesion length of more than 16 mm.