If human coronary artery is comparable to live wire , attempting bifurcation (BFL) stenting is akin to tame a live snake .True BFL (with Medina 1, 1, 1) being the most complex of all .The fact is ,we have atleast a dozen strategies for BFL with varying loads of metal abutting the ostia ,side branch and carina.This would essentially Imply we are still struggling with these lesions .
While current science tends to vouch PCI* for most BFLs . . . wisdom might whisper CABG !
Who should do complex PCI ?
Obviously, not every interventional cardiologist can. Confidence is one thing , but , falling short of minimum standard of care is rampant in India. Newer Imaging tools, techniques are promising , unfortunately still the gap between, knowledge , science and reality continue to widen.
* Its true ,some expert Interventionists do a good job !
What is the simplest approach for Bifurcation lesions ?
This was posted almost 10 years ago , much of it might hold good even today. https://drsvenkatesan.com/2008/09/06/what-is-the-simple-approach-to-bifurcation-pci/
Final message
We have come a long way in BFL. Still , some of the lesions can sting like a snake ! I am sure, everyone of us would have lost sleep after a complex BFL PCI !( Praying the humble heparin and DAPT to do the rescue act ! )
How to escape this double headed threat ?
A meticulous assessment of patient & lesion , mindfulness in choosing the hardware & Imaging , diligent usage of anticoagulants & DAPT and . . . finally willingness to listen to your own conscience , will ensure a gratifying result that includes abandoning the procedure !
Reference
Dr.S.Venkatesan MD 
Leave a Reply