Complex Better Than Simple for Distal Left Main Bifurcation Lesions: Lots of Data But Few Crushing Operators.

Abstract

On the basis of many randomized clinical trials and multiple meta-analyses, a provisional stenting or simple approach has been considered the preferred technique for the percutaneous treatment of bifurcation lesions. This recommendation, established more than 15 years ago, has been maintained in many expert consensus statements and previous clinical guidelines. However, a late-breaking trial presentation during the 2017 Transcatheter Cardiovascular Therapeutics meeting (simultaneously published in the Journal of the American College of Cardiology) by Chen et al. appeared to challenge and completely change this long-held belief. Indeed, it was concluded from this randomized clinical trial that “a planned double crush 2-stent strategy resulted in a lower rate of target lesion failure at 1 year compared to a provisional stent strategy in patients with true distal left main bifurcation lesions.” These results were further confirmed in a recent evaluation of clinical outcomes at 3-year follow-up.