Since the beginning of the coronary stent era, the clinical relevance of optimal stent implantation with adequate geometrical expansion became clear. Coronary de-novo bifurcation lesions exhibit turbulent flow and a more enhanced propensity for platelet disposition, plaque rupture, and atherothrombosis than non-bifurcation lesions. Till now, despite progress in drug-eluting stent (DES) technology and the availability of more potent antiplatelet drugs, coronary bifurcation still represents a challenging field for percutaneous coronary intervention (PCI) and is one of the major determinants for the lack of achievement of a complete myocardial revascularization. The inherent difficulty of PCI stems from the risk that main vessel (MV) stenting may hamper flow in the side branch (SB), translating into a high rate of target lesion failure (TLF); moreover, reduced elasticity and calcifications of the ostial site often require an aggressive preparation for adequate stent deployment.