A clinical consensus statement from the EAPCI of the ESC and the European Bifurcation Club sets out how to use intravascular ultrasound or optical coherence tomography in left main bifurcation PCI. The authors note that American and European guidelines already endorse imaging for guidance in this lesion subset, in both acute and chronic coronary syndromes.
The document is expert consensus. It appraises current evidence and gives practical guidance on planning, guiding and optimising stent placement with imaging, with the stated aim that patient benefit depends on operators actually adopting imaging-guided practice.
Left main disease carries a higher risk of serious late complications than other lesion subsets, which is the rationale for treating imaging as part of the procedure rather than an optional extra. For centres with limited imaging availability, the practical question is cost and access, which the abstract does not address.
- Plan left main bifurcation PCI with intravascular ultrasound or optical coherence tomography, not angiography alone.
- Use imaging again after stenting to check expansion and apposition and to guide optimisation.
- Review whether your cath lab has imaging catheters and trained operators for these cases.
- Document the imaging findings and any optimisation done in the procedure report.
Why it matters
It turns an existing guideline recommendation into working guidance for operators on where imaging adds value in the most complex lesion subset.
Don't overread it
This is an expert consensus statement, not a new trial, and the abstract gives no new outcome data.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for cardiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free