Calik Ali Nazmi, Cader F Aaysha, Rafflenbeul Erik, Okutucu Sercan, Khan Saidur Rahman, Canbolat Ismail Polat, Sinan Umit Yasar, Alasnag Mirvat A
Department of Cardiology, University of Health Sciences, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul, Turkey.
Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute Dhaka, Bangladesh.
US Cardiol. 2023 Aug 4;17:e10. doi: 10.15420/usc.2022.25. eCollection 2023.
Bifurcated anatomical locations in the arterial tree, such as coronary artery bifurcations, are prone to develop obstructive atherosclerotic lesions due to the pro-atherogenic low wall shear stress. The percutaneous treatment of bifurcation lesions is among the most challenging complex coronary interventions, including different multistep stenting strategies. Even though provisional side branch (SB) stenting is recommended as the primary approach in most cases, the debate continues between provisional SB and upfront two-stent strategies, particularly in complex bifurcations consisting of a significantly diseased SB that supplies a crucial myocardial territory. This review will highlight the importance of understanding the bifurcation philosophy and provide an individual algorithmic approach to find the optimal treatment strategy for each patient with a non-left main coronary bifurcation lesion. Considering the most recent scientific evidence, the advantages and disadvantages of each stenting technique and the role of intracoronary imaging to optimize bifurcation percutaneous coronary intervention outcomes will be discussed.
动脉树中的分叉解剖位置，如冠状动脉分叉处，由于具有促动脉粥样硬化的低壁面切应力，容易形成阻塞性动脉粥样硬化病变。分叉病变的经皮治疗是最具挑战性的复杂冠状动脉介入治疗之一，包括不同的多步骤支架置入策略。尽管在大多数情况下，临时边支（SB）支架置入术被推荐为主要方法，但临时SB支架置入术与预先采用双支架策略之间的争论仍在继续，特别是在由供应关键心肌区域的严重病变SB组成的复杂分叉病变中。本综述将强调理解分叉病变治疗理念的重要性，并提供一种个体化的算法方法，为每位非左主干冠状动脉分叉病变患者找到最佳治疗策略。考虑到最新的科学证据，将讨论每种支架置入技术的优缺点以及冠状动脉内成像在优化分叉病变经皮冠状动脉介入治疗结果中的作用。
