ABSTRACT
INTRODUCTION The randomized controlled trials (RCTs) comparing provisional stenting to elective double stenting (EDS) technique in patients with coronary bifurcation lesions (1-4) cannot be generalized to all patients with bifurcation coronary artery disease. In these trials, operators chose to randomize patients who are candidates for both techniques (see Chap. 1). This means that patients with complex coronary bifurcation anatomy (significant atherosclerosis of a large side branch and/or severely angulated side branch origin) were not well represented in these trials. Therefore, although provisional stenting can be successfully used in the majority of patients with bifurcation lesions, there are approximately 20% to 30% of patients where the EDS technique may be a safer approach (i.e., lower risk of procedural side branch compromise). The decision as to when to utilize the EDS technique depends on patient’s clinical risk profile, bifurcation anatomy, and operator experience.
