What is the recommended approach for treating a bifurcation lesion?

• A. PTA/stent of primary vessel and major side branch to preserve vessel patency
• B. Stent only the side branch
• C. Bypass surgery for bifurcation lesions
• D. Medical therapy alone

Answer: (A)

In bifurcation lesions, the priority is to preserve patency of both the main vessel and the major side branch by a main-vessel–first PCI approach. Stenting the main vessel first provides a solid scaffold and keeps the primary conduit open, while still allowing access to the side branch. After addressing the main vessel, the side branch is reassessed; if its flow is still at risk or the side-branch ostium is compromised, you can treat it with balloon optimization or selective stenting to maintain that pathway. This strategy minimizes the chance of jailing or occluding the side branch and tends to yield better outcomes than tackling the side branch alone or opting for bypass when PCI is feasible. Bypass surgery is typically reserved for lesions not amenable to PCI or for extensive multivessel disease, and medical therapy alone cannot resolve a mechanical bifurcation obstruction.