SCAI 2026 Bifurcation PCI Reimagined: Data-Driven Decisions in Complex Anatomy-The Bifurcation Playbook: Best Practices Shaping Tomorrow's Guidelines, Dr. Chatzizsis

The Bifurcation Playbook: Best Practices Shaping Tomorrow's Guidelines, Dr. Chatzizsis

Video Transcription

Video Summary

The talk reviewed practical bifurcation PCI recommendations ahead of future SKY guidelines. Key points: intravascular imaging is Class 1A and should guide decisions. For non-left main bifurcations, provisional stenting is preferred unless the lesion is truly complex: meaningful side branch size, length, and ischemic territory, plus significant stenosis. For complex anatomy, two-stent strategies reduce target vessel failure, though not mortality; simple anatomy generally favors provisional treatment. Proper provisional technique includes distal main-vessel sizing, adequate stent extension, mandatory POT, and selective—not routine—kissing balloon use. For two-stent approaches, anatomy determines technique: T-stenting, T-and-protrusion, culotte, or DK crush, with emphasis on wiring through distal struts except in DK crush where proximal struts are used. Final kissing is mandatory after two-stent techniques; final POT after kissing remains debated. DAPT remains 6 months for stable CAD and 12 months for ACS.

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closed captions are computer-generated

Keywords

bifurcation PCI

intravascular imaging

provisional stenting

two-stent strategy

DK crush