A factor to consider in the treatment of coronary bifurcations is the risk of the patient developing stent thrombosis

A factor to consider in the treatment of coronary bifurcations is the risk of the patient developing stent thrombosis and how large the side branch vessel is compared to the main vessel and if this side branch occlusion is going is significant enough to cause symptoms. As a result of an increased risk of stent thrombosis after bifurcation lesion stenting, intensive (e.g., aspirin and ticagrelor or aspirin and prasugrel) or prolonged ( greater than 12 months) dual antiplatelet therapy may be considered, especially for two-stent bifurcation PCI techniques. When stenting is used, a major question is whether both the main vessel and the side vessel should be stented. Such double stenting is appealing because it produces attractive postprocedural angiographic results.  However, there have been concerns with long-term major adverse cardiac events and, in particular stent thrombosis with adjacent stents. The strategy of provisional side branch stenting is widely accepted for suitable bifurcation lesions and is accompanied by low rates of stent thrombosis. However, it is not applicable to all patients. Stent thrombosis has been associated with high rates of morbidity and mortality rates, often leading to events of cardiac death or nonfatal myocardial infarction4. Stent thrombosis is typically an acute process resulting in acute coronary syndrome (ACS). There are various risk factors that have been associated with stent thrombosis, including a history of diabetes mellitus, ACS, and reduced left ventricular ejection fraction (LVEF). All of these risk factors should be taken into account before stenting a bifurcation lesion, especially if the side branch vessel supplies a small amount of myocardium that is unlikely to cause symptoms if it becomes occluded. The size of the side branch vessel should be a major factor to consider before stenting both the side branch and the main vessel. Patients should be educated following PCI with a DES placement of the risks associated with stent thrombosis in the postoperative period, especially if a bifurcation lesion was treated4. Stent thrombosis, when it occurs acutely, can be fatal if not treated right away.