Simplified Practical Approach to Percutaneous Coronary Intervention for Bifurcation Lesions: Bridging Complexity and Clarity

Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains one of the most technically challenging procedures in interventional cardiology due to the complex anatomy and diverse lesion characteristics. These lesions account for approximately 15–25% of all PCI cases and are associated with higher rates of restenosis and adverse clinical outcomes compared to non-bifurcation lesions. Despite advancements in stent technology and procedural techniques, managing bifurcation lesions requires a tailored strategy that considers patient factors, lesion morphology, operator expertise, and outcome goals. This review introduces the Patient, Lesion, Operator, Technique, and Outcomes (PLOTO) framework, an innovative, algorithmic, and systemic approach to bifurcation PCI. Emphasis is placed on lesion assessment, including Medina classification, bifurcation angle, calcification, and imaging guidance, and the choice between provisional and two-stent strategies. Practical recommendations and evidence from contemporary studies are integrated to guide optimal procedural planning and execution, aiming to simplify complexity while enhancing clinical results.