الفهرس 
Anatomy of bifurcational lesionOnly 14 pages are availabe for public view
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Abstract
Despite major advancements in stent technology, bifurcation lesions are still challenging for interventional cardiologists and treatment is associated with increased periprocedural myocardial infarction (MI), stent thrombosis, long-term restenosis and cost Bifurcation lesions, by their anatomy, expose the patient to the risk of side branch (SB) damage, defined as worsening of percent stenosis, and in some cases, SB occlusion.Different mechanisms have been suggested to explain SB damage, such as plaque or carina shift, refractory spasm, or dissection of the ostium. In the case of SB occlusion, myocardial necrosis could ensue, being associated with a worse short- and long-term clinical outcome with elevation of both creatine kinase–myocardial band isoform and cardiac troponin levels. Despite the fact that most acutely occluded SBs undergo late spontaneous reperfusion.In the contemporary drug-eluting stent (DES) era of treatment of bifurcation lesions, the provisional side branch (SB) stenting strategy has emerged as the preferred bifurcation treatment strategy, although complex stent implantation still may be beneficial in select patients. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role (6). Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion is effective and accepted technique for the treatment of bifurcation. However, in complex lesion or anatomy, much procedure-time and contrast media are needed to accomplish this technique. When performing PCI for the treatment of coronary bifurcation lesions, final kissing balloon inflation (FKBI) after complex stent implantation is generally considered mandatory [4]. However, concerning prognosis, whether FKBI should be mandatory after simple stent implantation is controversial. Clinical outcomes in the form of follow up for major adverse cardiac events (MACE), ischemic symptoms, and echocardiographic parameters that search for ischemia in the pretreated territory is a useful method to compare the effectiveness of both procedures.The aim of this work was to study a short-term clinical outcome (3-6 months) of provisional versus routine kissing‑balloon technique after main vessel stenting for coronary bifurcation lesions The studies will be included sixty consecutive patients. They will be randomized to receive different side branch (SB) intervention strategies: o Provisional final kissing balloon inflation group (FKBI) (FKI only when SB Flow less than TIMI flow 3) o Routine final kissing balloon inflation group (mandatory FKI with aggressive treatment until SB-residual stenosis less than 50%).