Forum on bifurcation coronary lesions

This session is dedicated to discussing bifurcation lesions in terms of imaging and technical issues, the role of DES, prognositc impact on clinical outcomes and emerging technologies. There are three parts to today’s session, each of which will discuss distinct issues associated with these lesions and also contain a "How should I treat" discussion.

The first part of the session will examine imaging diagnostics, discussing topics such as why quantitative angiography is important as well as the role of IVUS, OCT, FFR and VH. Discussion of the various dedicated software systems will take place, examining their added value in determining the nature of bifurcation lesions before treatment and their role in examining the success of treatment such as correct stent apposition, full stent deployment, whether post dilatation is necessary etc.

In part two, the focus will be on lesion management, outcomes and techniques employed. Optimisation of lesion management is critical to success in treating these difficult lesions. This is achieved by looking at lesion anatomy, reference diameter, the angle of the side-branch and measuring patient clinical characteristics against the technical characteristics and data available for various devices. The advantages and disadvantages of various devices will be discussed with reference to these criteria, particularly data from well conducted randomised clinical trials.

The third part of the session today will examine very specific aspects of bifurcation lesion management including distal left main bifurcation, where the risk is high and there are still unanswered questions! SYNTAX showed comparable safety between PCI and CABG for treating Left main bifurcations and this is significant.

The main outcomes from today′s session are expected to be that case selection requires an individual approach to the individual patient; the selection of an optimal stent strategy depends on the patient and lesion characteristics and finally that complete knowledge of available devices and techniques is necessary before making a treatment decision up-front.