Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).
Dipartimento di Scienze Cardiovascolari, Università Cattolica del Sacro Cuore, Rome, Italy (M.K., F.B., S.E., G.B., C.T.).
Circ Cardiovasc Interv. 2021 Mar;14(3):e009872. doi: 10.1161/CIRCINTERVENTIONS.120.009872. Epub 2021 Mar 9.
In humans, the most common anatomic variation of the left main (LM) stem is represented by its distal division in 3 branches (LM trifurcation) instead of 2. LM trifurcation disease accounts for ≈10% to 15% of all LM diseases and is often managed by cardiac surgery. Over the last decades, due to the improvement of interventional material and techniques, percutaneous coronary intervention started gaining acceptance to treat patients with LM disease including those with trifurcated anatomy. Yet, LM trifurcation stenosis with its intrinsic anatomic complexity (3 branches, at least 4 angles, wide variability in branch size and disease) is recognized as a challenging lesion subset for percutaneous coronary intervention. In this review, we summarize available data about LM trifurcation anatomy, its influence on percutaneous coronary intervention feasibility, and the evidence collected regarding the different technical options (including trissing balloon inflation).
在人类中，左主干（LM）的最常见解剖变异表现为其远端分为 3 个分支（LM 三分叉），而不是 2 个。LM 三分叉病变占所有 LM 病变的 ≈10%至 15%，通常由心脏外科手术治疗。在过去几十年中，由于介入材料和技术的改进，经皮冠状动脉介入治疗开始被接受用于治疗 LM 疾病患者，包括那些具有三分叉解剖结构的患者。然而，LM 三分叉狭窄具有内在的解剖复杂性（3 个分支，至少 4 个角度，分支大小和病变的广泛变异性），被认为是经皮冠状动脉介入治疗的具有挑战性的病变亚组。在这篇综述中，我们总结了关于 LM 三分叉解剖结构、其对经皮冠状动脉介入治疗可行性的影响以及关于不同技术选择（包括三分叉球囊扩张）的现有数据。
