European Bifurcation Club Issues Consensus Document on PCI for Coronary Bifurcation Lesions

March 19, 2021—The European Bifurcation Club (EBC) announced the publication of its 15th consensus document, which addresses percutaneous coronary intervention (PCI) for coronary bifurcation lesions (CBL). The document by Francesco Burzotta, MD, et al was published in EuroIntervention (2021;16:1307-1317).

According to the abstract, which EBC has posted on its website, the document was developed from the 15th EBC meeting held in October 2019 in Barcelona, Spain. The meeting facilitated a renewed consensus on CBL and unprotected left main (LM) percutaneous interventions.

The key points of the consensus document are summarized in EuroInterventions as follows:

• Bifurcation stenting techniques continue to be refined, developed, and tested. It remains evident that the provisional approach, with optional side-branch treatment, utilizing T, T and small protrusion, or culotte continue to provide flexible options for the majority of CBL patients.
• Debate persists regarding the optimal treatment of side branches, including assessment of clinical significance and thresholds for bail-out treatment.
• In more complex CBL, especially when involving the LM, adoption of dedicated two-stent techniques should be considered. Operators using such techniques have to be fully familiar with their procedural steps and should acknowledge associated limitations and challenges. When using two-stent techniques, failure to perform a final kissing inflation is regarded as a technical failure, since it may jeopardize clinical outcome.
• The development of novel technical tools and drug regimens deserve attention. In particular, intracoronary imaging, bifurcation simulation, drug-eluting balloon technology, and tailored antiplatelet therapy are identified as promising tools to enhance clinical outcomes.

The consensus document’s summary concludes, “[T]he evolution of a broad spectrum of bifurcation PCI components have resulted from studies extending from bench testing to randomized controlled trials. However, further advances are still needed to achieve the ambitious goal of optimizing the clinical outcomes for every patient undergoing PCI on a CBL.”