Conclusions
Technically complex PCI procedures, while increasingly performed, remain associated with lower rates of procedural success and higher rates of MACE compared with more straightforward catheter-based interventions. Multivessel and unprotected LMCA disease, fibrocalcific lesions, chronic total occlusions, and bifurcation disease comprise many of the lesion sets requiring additional resource allocation, procedural planning, and sophistication. Bifurcation lesions, in particular, have been the subject of intense systematic study and some degree of controversy. Current consensus supports a simple, single-stent/provisional side branch strategy when possible. Cost considerations in PCI are perhaps most relevant to patients with extensive, multivessel disease in whom CABG may also be a viable therapeutic option. Objective assessment of disease complexity, estimation of technical feasibility, and consideration of medical comorbidities should all factor into the decision regarding optimal revascularization strategy.