Left main coronary disease at the bifurcation: should the pendulum swing back towards the provisional stenting approach?

Abstract

This editorial refers to ‘The European Bifurcation Club Left Main Coronary Stent study: a randomized comparison of stepwise provisional vs. systematic dual stenting strategies (EBC MAIN)’, by D. Hildick-Smith et al., doi:10.1093/eurheartj/ehab283. Simplicity, simplicity, simplicity! --Henry David Thoreau, Walden, 1854 Revascularization of severe left main disease is a class I guideline recommendation to improve survival.1 When percutaneous coronary intervention (PCI) is chosen as the method of revascularization, and the lesion involves the left main distal bifurcation, the age-old question remains—one or two stents upfront? In the past decade, Dr Shao-Liang Chen and colleagues have refuted Thoreau’s counsel, demonstrating elegantly in the DKCRUSH-V and DEFINITION II studies that left main bifurcation disease is better treated with an upfront two-stent approach rather than a provisional one-stent approach.2–4 However, these outstanding results were predicated on using the double kiss crush stenting, a technique that requires significant expertise to...