CAD: Bifurcation Blockage

Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis.

Atherosclerosis is the buildup of cholesterol, fatty and inflammatory deposits (called plaque) on the inner walls of the arteries that restrict blood flow to the heart. Without adequate blood flow, the heart becomes starved of oxygen and vital nutrients it needs to work properly.

What is a bifurcation blockage?

It is often useful to think of the heart arteries like a tree with branches. At the site where a side-branch vessel comes off of the main coronary artery, plaque and fatty build-up are more likely to develop because of forces related to changes in blood flow. Stenoses, or narrowing, located in a main coronary artery and an adjoining side-branch vessel is called a bifurcation blockage or bifurcation lesion. Bifurcation blockages are somewhat more challenging for cardiac interventionalists to treat than blockages that do not involve side-branch vessels, because current stents do not come in a "Y" configuration.

Experienced interventionalists have developed a specialized approach to individualize patient treatment for these blockages, but the treatment procedure is sometimes technically demanding.

To optimize results with current technology, our treatment approach for bifurcation blockages includes:

• Trying to avoid the use of more than one stent, if possible (except under certain situations). If more than one stent is used to treat the blockage, there is an increased risk of blood clot formation on the stents. Therefore, the patient’s blood thinning regimen (anticoagulant medication) often needs to be modified.
• In addition to the usual guide wire that is placed in the main vessel, the interventionalist places a second guide wire through the stent in the main vessel and performs a side-by-side or "kissing balloon" dilatation after the first stent has been placed.

These techniques are continually being refined. Promising research with stents specifically designed for placement at branch point stenoses is under development and is being tested at major cardiovascular centers around the country, including the Cleveland Clinic.

Each patient is evaluated to determine the best treatment option, based on the type of cardiovascular disease, the location of disease, the patient’s age and co-existing medical conditions.