Lessons for the treatment of bifurcation lesions: from nowadays to the future

The use of drug-eluting stents in clinical practice has altered the treatment perspective for bifurcation lesions; however, relatively high rates of stent thrombosis and restenosis are still observed. All bifurcations are unique; therefore, a crucial issue in bifurcation angioplasty regards the selection of the most appropriate strategy for an individual bifurcation. When stenting is used, a major question to address is whether both the main vessel and the side branch should be stented. Moreover, plaque debulking in conjuction with directional coronary atherectomy or modification with a scoring device before stent deployment could minimize arterial injury and subsequent neointimal proliferation and prevent restenosis formation. Dedicated bifurcation stents represent an alternative treatment option for restenosis. We believe that biodegradable stents will replace metal stents leaving behind only the healed natural vessel.