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Utility of coronary physiologic hemodynamics for bifurcation, aorto‐ostial, and ostial branch stenoses to guide treatment decisions

Since the initiation of angioplasty, the treatment of coronary bifurcation lesions remains a technically difficult problem [1,2]. Access to the side branch, minimization of plaque redistribution, as well as simultaneous balloon and/or stent inflations are required to produce best results despite the current near universal usage of intracoronary stents. Use of multiple stents implanted across and in side branches of bifurcation lesions is generally difficult and ultimately unsatisfactory [3]. The kissing balloon technique, as well as debulking techniques for bifurcations and diseased side branches, specifically rotational and directional atherectomy, have been widely used to minimize plaque shifting, but remain technically challenging [4,5]. Approaching a side branch through the stent strut apertures with a balloon or stent as a treatment of choice for reducing the risk of the acute complications is often successful, but the long-term patency of the stented sidebranch ostium often is unimproved despite bare metal stent implantation [2]. Although some improvement is expected with drug-eluting stent (DES) usage, the multiple techniques of treating bifurcation lesions attest to the difficulties and generally poor outcomes of this troubling lesion subset [6]. With improved understanding of blood flow and hemodynamics of branch bifurcation lesions, the use of such measurements may become important for operators in selecting appropriate techniques or medical strategies to enhance long-term outcomes.