CTO and Bifurcation Lesions

Provisional SB stenting is the recommended approach in the majority of cases: protect the SB early by wiring it, use the 3-diameter rule, avoid dissection and re-entry techniques

A systematic 2-stent approach can be used if needed or sometimes to connect both branches

Retrograde approach can be very useful to save a relevant SB, especially with bifurcation at the distal cap or within the CTO body

Intravascular ultrasound is a very important tool for bifurcations at the proximal or distal cap and sometimes within the CTO segment

Double-lumen and angulated microcatheters are crucial to resolve access difficulties to the SB or main branch