ABSTRACT
The 15th European Bifurcation Club (EBC) meeting was held in
Barcelona in October 2019. It facilitated a renewed consensus on
coronary bifurcation lesions (CBL) and unprotected left main (LM)
percutaneous interventions. Bifurcation stenting techniques continue to
be refined, developed and tested. It remains evident that a provisional
approach with optional side branch treatment utilising T, T and small
protrusion (TAP) or culotte continues to provide flexible options for
the majority of CBL patients. Debate persists regarding the optimal
treatment of side branches, including assessment of clinical
significance and thresholds for bail-out treatment. In more complex CBL,
especially those involving the LM, adoption of dedicated two-stent
techniques should be considered. Operators using such techniques have to
be fully familiar with their procedural steps and should acknowledge
associated limitations and challenges. When using two-stent techniques,
failure to perform a final kissing inflation is regarded as a technical
failure, since it may jeopardise clinical outcome. The development of
novel technical tools and drug regimens deserves attention. In
particular, intracoronary imaging, bifurcation simulation, drug-eluting
balloon technology and tailored antiplatelet therapy have been
identified as promising tools to enhance clinical outcomes. In
conclusion, the evolution of a broad spectrum of bifurcation PCI
components has resulted from studies extending from bench testing to
randomised controlled trials. However, further advances are still needed
to achieve the ambitious goal of optimising the clinical outcomes for
every patient undergoing PCI on a CBL.