Department of Cardiology, Aster Hospital, Dubai, United Arab Emirates.
Department of Cardiology, Max Superspeciality Hospital, Bathinda, India.
Indian Heart J. 2022 Nov-Dec;74(6):450-457. doi: 10.1016/j.ihj.2022.10.193. Epub 2022 Nov 5.
When compared to non-bifurcation lesions, percutaneous coronary intervention in coronary bifurcation lesions is technically demanding and has historically been limited by lower procedural success rates and inferior clinical results. Following the development of drug-eluting stents, dramatically better results have been demonstrated. In most of the bifurcation lesions, the provisional technique of implanting a single stent in the main branch (MB) remains the default approach. However, some cases require more complex two-stent techniques which carry the risk of side branch (SB) restenosis. The concept of leaving no permanent implant behind is appealing because of the complexity of bifurcation anatomy with significant size mismatch between proximal and distal MB which may drive rates of in-stent restenosis and the potential impact of MB stenting affecting SB coronary flow dynamics. With the perspective of leaving lower metallic burden, a drug-coated balloon (DCB) has been utilized to treat bifurcations in both the MB and SB. The author gives an overview of the existing state of knowledge and prospects for the future for using DCB to treat bifurcation lesions.
与非分叉病变相比，经皮冠状动脉介入治疗分叉病变在技术上要求较高，并且由于手术成功率较低和临床结果较差，历史上一直受到限制。在药物洗脱支架发展之后，已经取得了显著更好的结果。在大多数分叉病变中，将单个支架暂时植入主干（MB）仍然是默认的方法。但是，有些病例需要更复杂的双支架技术，这会增加边支（SB）再狭窄的风险。由于分叉解剖结构复杂，近端和远端 MB 之间存在明显的大小不匹配，这可能会导致支架内再狭窄的发生率，并可能影响 MB 支架对 SB 冠状动脉血流动力学的影响，因此不留下永久性植入物的概念很有吸引力。考虑到金属支架的负荷较低，药物涂层球囊（DCB）已被用于治疗 MB 和 SB 的分叉病变。作者概述了使用 DCB 治疗分叉病变的现有知识状态和未来前景。
