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In percutaneous coronary interventions (PCIs), the treatment of bifurcation lesions is a challenge to the interventional cardiologist. PCI operators, in general, use the term coronary artery bifurcation (from latin furca = fork, branch): (i) when a coronary artery divides into two equally important branches or (ii) when a main branch gives away a side branch, which is large enough to be of haemodynamic significance, whereas when a large coronary artery gives away a small, haemodynamically unimportant side branch, the term bifurcation is less used.There is no consensus on when to use the term bifurcation lesion. Some PCI operators use this term for any lesion in or near a bifurcation, regardless they might be able to successfully stent the lesion using one wire and one stent only, whereas others reserve the term bifurcation lesion for complex lesions requiring two wires and intervention of both distal branches. The risk of PCI in different anatomical subsets has been identified in the American College of Cardiology/American Heart Association Guidelines since many years.1 However, lesion classifications based on severity of characteristics proposed in the past have been principally altered by the present PCI techniques.A number of well-known technical and clinical problems are associated with bifurcation PCI, dependent on the anatomy, the lesions, and on the technique used. Important concerns are (i) plaque shift causing flow problems, (ii) wire trapping and subsequent need of wire replacement, (iii) stent deformation, (iv) stent overlap and large metal burden in the arteries, (v) incomplete lesion coverage, (vi) subacute stent thrombosis, and (vii) restenosis.To overcome some of these problems, several specially designed bifurcation stent devices have been constructed. However, none of these have—so far—been tested in randomized comparisons with conventional stents. An interesting bifurcation device principle is a self-expandable nitinol device (DEVAX AXXESS), which when deployed … *Corresponding author. Tel: +45 35453693; fax: +45 35452705. E-mail address : erikjoergensen{at}rh.hosp.dk

Stent treatment of coronary artery bifurcation lesions