ABSTRACT

IS THERE A NEED FOR DEDICATED BIFURCATION STENT SYSTEMS? Defining the clinical need for dedicated bifurcation stent systems is not a straightforward exercise. If one were to adopt the results of the randomized controlled trials (RCTs) (1-5) that evaluated provisional versus elective double stenting in bifurcation lesions as reflective of real world clinical practice, there would hardly be a compelling reason to develop expensive dedicated bifurcation stent systems! In these trials, provisional stenting appeared simple to use, carried minimal procedural risks, was associated with good long-term outcome, and was inexpensive! Considering all these attributes of a “simple” stenting technique, why would any operator need a dedicated bifurcation stent system? The simple answer to this question is that patients recruited into the RCTs had low-risk coronary bifurcation anatomy where investigators thought that a provisional approach would have high chances of success. Therefore, it would be inappropriate to generalize the results of these trials to patients with complex bifurcation coronary disease (Chaps. 1 and 2).