We know right from our pathology days in medical school , Atherosclerosis , the killer human vascular disease has a predilection for branch points. It’s no surprise around 30-40% of coronary stenosis has some degree of involvement of branch points .
PCI essentially involves palliative metal bracketing of this inflammatory cum degenerative process of the vessel wall.Tackling bifurcation lesions (BFL) requires special expertise , hardware and technique as carina and two ostia (In fact three !) are exposed to complex hemo-rheological stress de-nova and more so after the metal invasion.
The complication rate as well as long- term patency are considerably more in BFL than regular lesions. This is why a “4S strategy “ (simple single stent strategy ) is the preferred default strategy in most BFL.
There are about dozen strategies to tame the BFL with stents.One such modality is dedicated BFL stent.Various designs have been proposed in both balloon and self expansion platform.
The ACCSEES is a prototype dedicated BFL stent with DES and a self expanding system