Percutaneous coronary interventions of bifurcation lesions

Coronary bifurcation lesions are frequently encountered in daily clinical practice by interventional cardiologists and account for 20% of all coronary lesions treated by percutaneous coronary intervention (PCI). Although clinical outcomes have been improved with drug-eluting stents (DES) in contemporary clinical practice, PCI of bifurcation lesions remains to be associated with adverse clinical outcomes, compared to non-bifurcation lesions. Part A of this thesis evaluates current treatment of coronary bifurcation lesions: the use of second generation DES in bifurcations and hydrophilic guidewires. Part B evaluates the use of a dedicated bifurcation stent: the Tryton Side Branch Stent. In this part observational clinical data, randomized clinical data and data from intravascular imaging studies are presented. Part C deals with how the development of dedicated bifurcation quantitative coronary angiography (QCA) software overcomes the shortcomings of conventional QCA software in bifurcation lesions. Part D evaluates the use of bioresorbable vascular scaffolds (BVS) in simple and complex lesions. The ABSORB II randomized trial shows that the use of Absorb BVS is safe and feasible in relative simple lesions. However, we also showed that the use of Absorb BVS results in less favorable outcomes in more complex lesions such as bifurcation lesions. Finally, we investigate how the results could be improved in the side branches of bifurcation lesions.