Raphael Claire E, O'Kane Peter D, Johnson Thomas W, Prasad Abhiram, Gulati Rajiv, Sandoval Yader, Di Mario Carlo, Holmes David R
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Cardiology, Royal Bournemouth Hospital, Bournemouth, United Kingdom.
JACC Cardiovasc Interv. 2021 Nov 8;14(21):2315-2326. doi: 10.1016/j.jcin.2021.08.048.
Bifurcation lesions are frequently encountered, associated with greater procedural complexity and consequently are at higher risk for restenosis and stent thrombosis. Early trials in bifurcation percutaneous coronary intervention favored a provisional stenting approach, but contemporary randomized trials have highlighted potentially superior outcomes using a double-kiss crush technique in unprotected distal left main stem bifurcation lesions. Although the evidence is greatest for double-kiss crush, many operators favor a mini-crush or nano-crush single-kiss approach. In this review, the authors describe the iterations of the crush technique and the evidence for each and review general principles for bifurcation percutaneous coronary intervention.
分叉病变经常遇到，与更高的手术复杂性相关，因此再狭窄和支架血栓形成的风险更高。早期的经皮冠状动脉介入治疗分叉病变试验倾向于采用临时支架置入方法，但当代随机试验强调，在无保护的左主干远端分叉病变中，使用双吻挤压技术可能会有更好的结果。尽管双吻挤压技术的证据最为充分，但许多术者更喜欢采用迷你挤压或纳米挤压单吻方法。在这篇综述中，作者描述了挤压技术的迭代过程及其各自的证据，并回顾了经皮冠状动脉介入治疗分叉病变的一般原则。
