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Percutaneous coronary intervention for bifurcation coronary disease
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  1. Yves Louvard,
  2. Thierry Lefèvre,
  3. Marie-Claude Morice
  1. Institut Cardiovasculaire Paris Sud, Massy, France
  1. Correspondence to:
    Dr Yves Louvard
    Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, 6 avenue du Noyer Lambert, 91300 Massy, France; y.louvardicps.com.fr

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Ever since coronary angioplasty was first undertaken, treatment of coronary bifurcation lesions has posed technical problems.w1 w2 Specific difficulties involving access to the side branch and the snow plough effect, as well as the role of kissing balloon inflation, have been rapidly identified even before the era of near universal stenting. Consequently, until the late 1980s, patients with bifurcation lesions were generally referred for surgery and seldom treated by percutaneous techniques. However, in cases where angioplasty was considered an option, the kissing dilatation technique was widely used in order to avoid recurrent problems of plaque shifting observed when the two branches were dilated separately.w3

The new tools developed in the early 1990s seemed likely at first to facilitate the approach to bifurcation lesions. However, the results achieved with the debulking technique alone (rotative or directional atherectomy) were rather disappointing. Conversely, coronary stenting through its scaffolding properties became the treatment of choice, at least for reducing the risk of acute complications. In the mid 1990s, the question remained as to how to perform optimal stenting of the main branch while preserving the side branch. The data collected from bench test studies proved crucial. They allowed the operators to understand stent behaviour and the effect of empirically implemented strategies, and to develop new concepts such as dedicated stents.

IN VITRO BIFURCATION STENTING

Numerous techniques of stent deployment in bifurcation lesions have been described.1–5w4–w21

These techniques have been indexed6 in our institution and evaluated in vitro in a bench test mimicking coronary bifurcations with diameters of 3.5 mm for the main branch and 3.00 mm for the side branch. The pitfalls of such a model are the absence of stenosis, the constant longitudinal diameter of the main branch, and the impossibility to study other branch diameters.

Nevertheless, the problem of access …

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