Iakovou I, Foin N, Andreou A, Viceconte N, Di Mario C
Onassis Cardiac Surgery Center, Athens, Greece.
Herz. 2011 May;36(3):198-212. doi: 10.1007/s00059-011-3459-y.
Despite major improvements in stent technology (i.e., drug-eluting stents, DES), treatment of coronary bifurcations is an ever occurring problem of the interventional cardiology. While stenting the main branch with provisional side branch stenting seems to be the prevailing approach, in the era of DES various two-stent techniques emerged (crush) or were re-introduced (V or simultaneous kissing stents, crush, T, culottes, etc.) to allow stenting in the side branch when needed. New techniques in imaging like optical coherence tomography help in better understanding bifurcation anatomy and, thus, have the potential to help us better treat this challenging subset of lesions. In addition, new dedicated bifurcation stents have been proposed in an attempt to overcome limitations associated with current approaches, and they showed promising results in early studies; however, the safety and the efficacy of these devices remain to be seen in the ongoing and upcoming trials. This review focuses on the current approaches and the development of new techniques employed for the treatment of bifurcation disease.
尽管支架技术有了重大改进（即药物洗脱支架，DES），但冠状动脉分叉病变的治疗仍是介入心脏病学中一个一直存在的问题。虽然采用临时边支支架术对主支进行支架置入似乎是主流方法，但在DES时代，出现了各种双支架技术（挤压术）或重新引入了一些技术（V型或同步亲吻支架术、挤压术、T型、裤裙式支架术等），以便在需要时对边支进行支架置入。像光学相干断层扫描这样的新型成像技术有助于更好地了解分叉病变的解剖结构，因此有可能帮助我们更好地治疗这一具有挑战性的病变亚组。此外，人们还提出了新型专用分叉支架，试图克服现有方法的局限性，并且这些支架在早期研究中显示出了有前景的结果；然而，这些装置的安全性和有效性仍有待在正在进行和即将开展的试验中观察。本综述重点关注当前用于治疗分叉病变的方法以及新技术的发展。
