Calcific lesion preparation for coronary bifurcation stenting.
Calcific lesion preparation for coronary bifurcation stenting.
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DOI：
10.5603/cj.a2019.0094
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发表时间：
2019
影响因子：
2.9
通讯作者：
Zimarino M
中科院分区：
文献类型：
--
作者：
Perfetti M;Fulgenzi F;Radico F;Toro A;Procopio A;Maddestra N;Zimarino M
分叉冠状动脉病变是介入心脏病学中非常常见的挑战，因为其治疗技术复杂，与非分叉病变相比，存在侧分支闭塞风险和总体结局较差。由于器械输送和支架扩张困难以及侧分支闭塞风险增加，钙化的存在代表了进一步的复杂性。旋转和轨道斑块旋切术、评分和切割球囊、冠状动脉碎石术是过去三十年来引入的克服此类问题的可用工具。然而，它们在不同的分叉情况下的应用提出了具体的警告，并且针对比较这些技术的研究从未明确定位于分叉病变的子集。在本文中，我们回顾这些设备和他们的有用性，通过分析一致的数据，从临床试验中，我们提出了一个实用的算法，治疗严重钙化分叉病变，根据其解剖特征。
Bifurcating coronary lesions are a very common challenge in interventional cardiology because of the technical complexity in their treatment, the risk of side branch occlusion and an overall worse outcome when compared to non-bifurcating lesions. The presence of calcifications represents further complexity due to the difficulty in device delivery and stent expansion as well as enhanced risk of side branch occlusion. Rotational and orbital atherectomy, scoring and cutting balloons, coronary lithoplasty are available tools which have been introduced over the last three decades to overcome such issue. Nevertheless, their application in different contexts of bifurcations presents specific caveats and the studies directed at comparing such techniques have never been expressly oriented in the subset of the bifurcating lesion. In this paper, we review these devices and their usefulness in bifurcations by analyzing consistent data from clinical trials, and we propose a practical algorithm for the treatment of severely calcified bifurcating lesions according to their anatomical features.