Vol 26, No 5 (2019)
Review articles — Interventional cardiology
Published online: 2019-09-25
Calcific lesion preparation for coronary bifurcation stenting
1, 2, 2, 2, 2, 2, 31
Abstract
Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the
technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome
when compared to non-bifurcating lesions.
The presence of calcifications represents further complexity due to the difficulty in device delivery and
stent expansion as well as enhanced risk of side branch occlusion.
Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools
which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion.
In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data
from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating
lesions according to their anatomical features.
Keywords: bifurcationcalcified lesionplaque modificationrotational atherectomycoronary lithoplasty
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