Introduction on Technical Aspects of Provisional Stenting in Percutaneous Treatment of Complex Bifurcation Lesions
Diseased coronary bifurcations are frequently treated by percutaneous coronary interventions (PCI), and in these complex lesions the adoption of the most suitable treatment technique and the selection of the most appropriate coronary stent are of primary importance. Clinical evidence suggests that drug-eluting stent (DES) implantation using a provisional approach is the gold standard for unselected bifurcated lesions.1,2 In particular, an accumulated body of evidence shows that the systematic adoption of complex techniques with intentional implantation of DES in both main vessel (MV) and side branch (SB) is associated with worse clinical results compared with the provisional approach.3,4 Of note, the double stenting techniques do not appear to be beneficial even in the more challenging anatomies.3 On the other hand, a series of technical issues (DES selection and sequence of procedural steps) may greatly influence the results of provisional stenting and its suitability for complex bifurcation anatomies. In this manuscript we sought to overview the tips and tricks useful to manage coronary bifurcated lesions by systematic provisional stenting.