Bifurcation interventions involve advanced percutaneous coronary intervention (PCI) techniques used to treat complex lesions at coronary artery branching points.
What is a Bifurcation Lesion?#
A bifurcation is the area where a coronary artery divides into a main vessel (main branch) and a side branch. Atherosclerotic plaques frequently develop in these areas and require specialized techniques for treatment.
Bifurcation Anatomy:
- Main vessel: Proximal and distal segments
- Side branch: Branch separating from main vessel
- Carina: The ridge structure at the branching point
Bifurcation Classification#
Medina Classification#
Bifurcation lesions are evaluated according to the Medina classification:
| Medina Type | Proximal | Distal | Side Branch |
|---|---|---|---|
| 1,1,1 | Involved | Involved | Involved |
| 1,1,0 | Involved | Involved | Free |
| 1,0,1 | Involved | Free | Involved |
| 0,1,1 | Free | Involved | Involved |
| 1,0,0 | Involved | Free | Free |
| 0,1,0 | Free | Involved | Free |
| 0,0,1 | Free | Free | Involved |
True vs Non-True Bifurcation#
- True bifurcation: Both main vessel and side branch involved (Medina 1,1,1 / 1,0,1 / 0,1,1)
- Non-true bifurcation: Only main vessel or only side branch involved
Bifurcation Intervention Techniques#
1. Provisional Stenting (Preferred)#
The most commonly used and recommended technique:
- Stent placed in main vessel
- Side branch dilated with balloon if needed
- Side branch stent applied only when necessary
Advantages:
- Less stent usage
- Lower complication risk
- Better long-term outcomes
2. Two-Stent Techniques#
May be required for true bifurcation lesions:
Culotte Technique:
- Stent placed in both branches
- Stents pass through each other
- Provides complete carina coverage
Crush Technique:
- Side branch stent crushed by main vessel stent
- DK-Crush modification provides better results
T-Stent and TAP Technique:
- Suitable for 90-degree angle bifurcations
- T-stent with protrusion (TAP) modification
V-Stent (Kissing Stent):
- Both stents join proximally
- Rarely preferred
Imaging in Bifurcation Intervention#
IVUS (Intravascular Ultrasound)#
- Lesion characterization
- Stent placement control
- Optimal expansion assessment
OCT (Optical Coherence Tomography)#
- High-resolution imaging
- Stent strut coverage assessment
- Plaque structure analysis
Procedure Steps#
Pre-Procedure Preparation#
- Dual antiplatelet therapy (Aspirin + P2Y12 inhibitor)
- Lesion assessment with coronary angiography
- IVUS/OCT planning
Procedural Steps#
- Arterial access: Radial or femoral artery
- Wire crossing: Wire placement in both branches
- Predilation: Balloon pre-dilation
- Stent deployment: According to selected technique
- POT (Proximal Optimization Technique): Proximal optimization
- Kissing balloon: Final kissing inflation
- Imaging: Result control with IVUS/OCT
Post-Procedure Care#
- 6-12 months dual antiplatelet therapy
- Regular cardiology follow-ups
- Risk factor management
Bifurcation Intervention Complications#
Possible Complications#
- Side branch loss
- Stent thrombosis
- Restenosis
- Vessel dissection
- Perforation (rare)
Risk Reduction Strategies#
- Experienced operator
- IVUS/OCT utilization
- Appropriate technique selection
- Optimal stent expansion
Bifurcation Intervention Outcomes#
Success Rates#
- Procedural success: >95%
- Side branch patency: >90%
- 1-year MACE (major adverse cardiac events): <10%
Long-Term Follow-Up#
- Regular clinical monitoring
- Stress testing or imaging
- Medication compliance tracking
Frequently Asked Questions#
What is a bifurcation lesion?
Is bifurcation intervention dangerous?
What are bifurcation stenting techniques?
What is recovery like after bifurcation intervention?
What is the success rate of bifurcation intervention?
Appointment and Contact#
To schedule an appointment for bifurcation lesion evaluation and treatment:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content was prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiologist for definitive diagnosis and treatment.
Related Coronary Interventions#
Other coronary treatments related to bifurcation interventions:
- Left Main Coronary Intervention - Left main coronary artery stenting
- CTO Intervention - Chronic total occlusion treatment
- IVUS - Intravascular ultrasound imaging
- FFR - Fractional flow reserve measurement
- Coronary Angioplasty - Balloon and stent treatment