Kovacevic Mila, Burzotta Francesco, Srdanovic Ilija, Petrovic Milovan, Trani Carlo
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia.
Kardiol Pol. 2022;80(4):417-428. doi: 10.33963/KP.a2022.0078.
Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely adopted strategy to obtain myocardial revascularization in patients with unprotected left main (LM) disease. Although thoroughly investigated across scientific literature, LM PCI offers patient-specific technical options and poses many operative challenges that cannot be fully addressed by the pub-lished studies. Therefore, we have summarized and discussed in this review possible options related to PCI in LM patients. First, functional and imaging assessment for LM is still evolving and requires increased dedication to identify patients requiring revascularization and to enhance the results in the case of PCI performance. Second, specific coronary atherosclerosis patterns of LM involvement (like an isolated ostial disease of one of its bifurcation branches, extensive disease jeopardizing both branches, etc.) pose specific challenges for DES implantation so that careful selection of technical options (stepwise provisional single stent, upfront 2-stent strategy, when and how apply "kissing ballooning") is required. Third, despite improvement of techniques, PCI-related ischemia might not be tolerated by some patients with LM disease so mechanical circulatory support devices may come into play.
采用药物洗脱支架（DES）植入的经皮冠状动脉介入治疗（PCI）是为无保护左主干（LM）疾病患者实现心肌血运重建的一种广泛采用的策略。尽管在科学文献中已对此进行了深入研究，但左主干PCI为患者提供了特定的技术选择，并带来了许多手术挑战，而这些挑战无法通过已发表的研究得到全面解决。因此，我们在本综述中总结并讨论了与左主干患者PCI相关的可能选择。首先，左主干的功能和影像学评估仍在不断发展，需要更多投入以识别需要血运重建的患者，并在进行PCI时提高治疗效果。其次，左主干受累的特定冠状动脉粥样硬化模式（如其一分叉分支的孤立开口病变、危及两个分支的广泛病变等）给DES植入带来了特定挑战，因此需要仔细选择技术选项（逐步临时单支架、预先采用双支架策略、何时以及如何应用“亲吻球囊扩张术”）。第三，尽管技术有所改进，但一些左主干疾病患者可能无法耐受与PCI相关的缺血，因此机械循环支持装置可能会发挥作用。
