Balloon angioplasty for distal SVG anastomotic stenoses has low restenosis rates,724 so stenting is commonly reserved at this location for subop- timal balloon angioplasty results or restenosis. Routine GP IIb/IIIa inhibitor therapy has not proven beneficial in SVG PCI.720 Fibrinolytic therapy is no longer used for thrombus- containing lesions, but rheolytic or manual aspiration throm- bectomy is sometimes employed. 5.8.3. Bifurcation Lesions: Recommendations Class I 1. Provisional side-branch stenting should be the initial approach in patients with bifurcation lesions when the side branch is not large and has only mild or moderate focal disease at the ostium.726 729 (Level of Evidence: A) Class IIa 1. It is reasonable to use elective double stenting in patients with complex bifurcation morphology involving a large side branch where the risk of side-branch occlusion is high and the likelihood of successful side-branch reaccess is low.730 733 (Level of Evidence: B) Side-branch occlusion or severe stenosis after stenting the main artery in coronary bifurcation PCI occurs in 8% to 80% of unselected patients.732,734 The frequency of side-branch occlusion is related to complex bifurcation morphology (severe and/or long side-branch ostial stenosis, large plaque burden in the side-branch ostium, and/or unfavorable side- branch angulation).732,735,736 Side-branch occlusion after PCI is associated with Q-wave and non Q-wave MI.734,735 There- fore, preservation of physiologic flow in the side branch after PCI is important.736 There are 2 bifurcation PCI strategies: provisional stenting (stenting the main vessel with additional balloon angioplasty or stenting of the side branch only in the case of an unsatisfactory result) and elective double stenting of the main vessel and the side branch. 