Bifurkacje wieńcowe – anatomia, fizjologia i leczenie z wybranymi aspektami bifurkacji pnia lewej tętnicy wieńcow
 
Więcej
Ukryj
1
Department of Cardiology, University Hospital, University of Opole, Poland
 
2
2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
 
 
Autor do korespondencji
Damian Kawecki   

II Katedra i Oddział Kliniczny Kardiologii, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach, ul. Marii Curie-Skłodowskiej 10, 41-800 Zabrze, Polska
 
 
Ann. Acad. Med. Siles. 2021;75:24-32
 
SŁOWA KLUCZOWE
DZIEDZINY
STRESZCZENIE
Bifurkacja wieńcowa jest miejscem szczególnym w obrębie krążenia wieńcowego. Charakterystyczna anatomia oraz cechy przepływu krwi w złożony sposób wiążą się z rozmieszczeniem blaszek miażdżycowych. Wybór strategii leczenia zmian bifurkacji wieńcowych wymaga szczególnej uwagi, gdyż wszelkie powikłania w tym rejonie narażają na niedokrwienie istotnie większy obszar miokardium niż w przypadku pojedynczego naczynia. Niniejsza publikacja stanowi przegląd podstawowych informacji o anatomii, klasyfikacji oraz kolejnych krokach aktualnie zalecanych technik leczenia przezskórnego zmian bifurkacji wieńcowych, poczynając od kwalifikacji, przygotowania, poprzez wybór stentu, po optymalizację efektu zabiegu. Podkreśla kliniczną złożoność problemu leczenia zmian bifurkacji wieńcowych, która wymusza stały rozwój technik zabiegowych. Przedstawione zostały strategie leczenia, wskazania do wyboru techniki z użyciem pojedynczego stentu oraz zamierzonego zastosowania dwóch stentów. Zaprezentowano również zalecane metody obrazowej oraz czynnościowej oceny istotności zmian w obrębie rozwidlenia tętnic wieńcowych. Szczególną uwagę poświęcono odrębnościom bifurkacji pnia lewej tętnicy wieńcowej.
 
REFERENCJE (55)
1.
Legrand V., Thomas M., Zelisko M., De Bruyne B., Reifart N., Steigen T. et al. Percutaneous coronary intervention of bifurcation lesions: state-of-the-art. Insights from the second meeting of the European Bifurcation Club. EuroIntervention 2007; 3(1): 44–49.
 
2.
Wasilewski J., Niedziela J., Osadnik T., Roleder M., Miszalski-Jamka K., Babińska A., Poloński L. Topografia rozmieszczenia zmian miażdżycowych w tętnicach wieńcowych. Efekt mostka mięśniowego. Chor. Serca Naczyń 2015; 12(1): 19–24.
 
3.
Lassen J.F., Holm N.R., Stankovic G., Lefèvre T., Chieffo A., Hildick-Smith D. et al. Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European Bifurcation Club meetings. EuroIntervention 2014; 10(5): 545–560, doi: 10.4244/EIJV10I5A97.
 
4.
Bil J. Przezskórne leczenie zwężeń w bifurkacjach wieńcowych. Anno Domini 2015. Kardiol. Inwazyjna 2015; 10(1); 9–14.
 
5.
Wasilewski J., Kiljański T., Miszalski-Jamka K. Rola naprężeń ścinających i mechanotransdukcji w procesie miażdżycowym. Kardiol. Pol. 2011; 69(7): 717–720.
 
6.
Stankovic G., Darremont O., Ferenc M., Hildick-Smith D., Louvard Y., Albiero R., Pan M., Lassen J.F., Lefèvre T. Percutaneous coronary intervention for bifurcation lesions: 2008 consensus document from the fourth meeting of the European Bifurcation Club. EuroIntervention 2009; 5(1): 39–49, doi: 10.4244/eijv5i1a8.
 
7.
Thomas M., Hildick-Smith D., Louvard Y., Albiero R., Darremont O., Stankovic G. et al. Percutaneous coronary intervention for bifurcation disease. A consensus view from the first meeting of the European Bifurcation Club. EuroIntervention 2006; 2(2): 149–153.
 
8.
Medina A., Suárez de Lezo J., Pan M. A new classification of coronary bifurcation lesions. Rev. Esp. Cardiol. 2006; 59(2): 183.
 
9.
Louvard Y., Thomas M., Dzavik V., Hildick-Smith D., Galassi A.R., Pan M. et al. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter. Cardiovasc. Interv. 2008; 71(2): 175–183, doi: 10.1002/ccd.21314.
 
10.
Banning A.P., Lassen J.F., Burzotta F., Lefèvre T., Darremont O., Hildick-Smith D. et al. Percutaneous coronary intervention for obstructive bifurcation lesions: the 14th consensus document from the European Bifurcation Club. EuroIntervention 2019; 15(1): 90–98, doi: 10.4244/EIJ-D-19-00144.
 
11.
Lassen J.F., Holm N.R., Banning A., Burzotta F., Lefèvre T., Chieffo A. et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention 2016; 12(1): 38–46, doi: 10.4244/EIJV12I1A7.
 
12.
Lefèvre T., Morice M.C., Sengottuvel G., Kokis A., Monchi M., Dumas P. et al. Influence of technical strategies on the outcome of coronary bifurcation stenting. EuroIntervention 2005; 1(1): 31–37.
 
13.
Lassen J.F., Burzotta F., Banning A.P., Lefèvre T., Darremont O., Hildick-Smith D. et al. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EuroIntervention 2018; 13(13): 1540–1553, doi: 10.4244/EIJ-D-17-00622.
 
14.
Neumann F.J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019; 40(2): 87–165, doi: 10.1093/eurheartj/ehy394.
 
15.
Gao X.F., Zhang Y.J., Tian N.L., Wu W., Li M.H., Bourantas C.V. Stenting strategy for coronary artery bifurcation with drug-eluting stents: a meta-analysis of nine randomised trials and systematic review. EuroIntervention 2014; 10(5): 561–569, doi: 10.4244/EIJY14M06_06.
 
16.
Behan M.W., Holm N.R., de Belder A.J., Cockburn J., Erglis A., Curzen N.P. et al. Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study. Eur. Heart J. 2016; 37(24): 1923–1928, doi: 10.1093/eurheartj/ehw170.
 
17.
Park T.K., Lee J.H., Song Y.B., Jeong J.O., Hahn J.Y., Yang J.H. et al. Impact of non-compliant balloons on long-term clinical outcomes in coronary bifurcation lesions: results from the COBIS (COronary BIfurcation Stent) II registry. EuroIntervention 2016; 12(4): 456–464, doi: 10.4244/EIJV12I4A79.
 
18.
Niemelä M., Kervinen K., Erglis A., Holm N.R., Maeng M., Christiansen E.H. et al. Randomized comparison of final kissing balloon dilatation versus no final kissing balloon dilatation in patients with coronary bifurcation lesions reated with main vessel stenting: the Nordic-Baltic Bifurcation Study III. Circulation 2011; 123(1): 79–86, doi: 10.1161/CIRCULATIONAHA.110.966879.
 
19.
Yamawaki M., Muramatsu T., Kozuma K., Ito Y., Kawaguchi R., Kotani J.I. et al. Long-term clinical outcome of a single stent approach with and without a final kissing balloon technique for coronary bifurcation. Circ. J. 2014; 78(1): 110–121, doi: 10.1253/circj.cj-13-0346.
 
20.
Biondi-Zoccai G., Sheiban I., De Servi S., Tamburino C., Sangiorgi G., Romagnoli E. To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions. Heart Vessels 2014; 29(6): 732–742, doi: 10.1007/s00380-013-0416-0.
 
21.
Pan M., Medina A., Suárez de Lezo J., Romero M., Segura J., Martín P. et al. Coronary bifurcation lesions treated with simple approach (from the Cordoba & Las Palmas [CORPAL] Kiss Trial). Am. J. Cardiol. 2011; 107(10): 1460–1465, doi: 10.1016/j.amjcard.2011.01.022.
 
22.
Foin N., Torii R., Mortier P., De Beule M., Viceconte N., Chan P.H. et al. Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: lessons from micro-computed tomography and computational simulations. JACC Cardiovasc. Interv. 2012; 5(1): 47–56, doi: 10.1016/j.jcin.2011.08.019.
 
23.
Ormiston J.A., Webster M.W., Ruygrok P.N., Stewart J.T., White H.D., Scott D.S. Stent deformation following simulated side-branch dilatation: a comparison of five stent designs. Catheter. Cardiovasc. Interv. 1999; 47(2): 258–264, doi: 10.1002/(SICI)1522-726X(199906)47:2<258::AID-CCD27>3.0.CO;2-C.
 
24.
Foin N., Torii R., Alegria E., Sen S., Petraco R., Nijjer S. et al. Location of side branch access critically affects results in bifurcation stenting: Insights from bench modeling and computational flow simulation. Int. J. Cardiol. 2013; 168(4): 3623–3628, doi: 10.1016/j.ijcard.2013.05.036.
 
25.
Derimay F., Souteyrand G., Motreff P., Rioufol G., Finet G. Influence of platform design of six different drug-eluting stents in provisional coronary bifurcation stenting by rePOT sequence: a comparative bench analysis. EuroIntervention 2017; 13(9): e1092–e1095, doi: 10.4244/EIJ-D-16-00863.
 
26.
Koo B.K., Park K.W., Kang H.J., Cho Y.S., Chung W.Y., Youn T.J. et al. Physiological evaluation of the provisional side-branch intervention strategy for bifurcation lesions using fractional flow reserve. Eur. Heart J. 2008; 29(6): 726–732, doi: 10.1093/eurheartj/ehn045.
 
27.
Vranckx P., Valgimigli M., Jüni P., Hamm C., Steg P.G., Heg D. et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018; 392(10151): 940–949, doi: 10.1016/S0140-6736(18)31858-0.
 
28.
Erglis A., Kumsars I., Niemelä M., Kervinen K., Maeng M., Lassen J.F. et al. Randomized comparison of coronary bifurcation stenting with the crush versus the culotte technique using sirolimus eluting stents: the Nordic stent technique study. Circ. Cardiovasc. Interv. 2009; 2(1): 27–34, doi: 10.1161/CIRCINTERVENTIONS.108.804658.
 
29.
Zheng X.W., Zhao D.H., Peng H.Y., Fan Q., Ma Q., Xu Z.Y. et al. Randomized comparison of the crush versus the culotte stenting for coronary artery bifurcation lesions. Chin. Med. J. (Engl.) 2016; 129(5): 505–510, doi: 10.4103/0366-6999.176997.
 
30.
Kervinen K., Niemelä M., Romppanen H., Erglis A., Kumsars I., Maeng M. et al. Clinical outcome after crush versus culotte stenting of coronary artery bifurcation lesions: the Nordic stent technique study 36-month follow-up results. JACC Cardiovasc. Interv. 2013; 6(11): 1160–1165, doi: 10.1016/j.jcin.2013.06.009.
 
31.
Tiroch K., Mehilli J., Byrne R.A., Schulz S., Massberg S., Laugwitz K.L. et al. Impact of coronary anatomy and stenting technique on long-term outcome after drug-eluting stent implantation for unprotected left main coronary artery disease. JACC Cardiovasc. Interv. 2014; 7(1): 29–36, doi: 10.1016/j.jcin.2013.08.013.
 
32.
Chen S.L., Xu B., Han Y.L., Sheiban I., Zhang J.J., Ye F. et al. Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study. J. Am. Coll. Cardiol. 2013; 61(14): 1482–1488, doi: 10.1016/j.jacc.2013.01.023.
 
33.
Ferenc M., Gick M., Kienzle R.P., Bestehorn H.P., Werner K.D., Comberg T. et al. Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions. Eur. Heart J. 2008; 29(23): 2859–2867, doi: 10.1093/eurheartj/ehn455.
 
34.
Burzotta F., Gwon H.C., Hahn J.Y., Romagnoli E., Choi J.H., Trani C., Colombo A. Modified T-stenting with intentional protrusion of the side-branch stent within the main vessel stent to ensure ostial coverage and facilitate final kissing balloon: the T-stenting and small protrusion technique (TAP-stenting). Report of bench testing and first clinical Italian-Korean two-centre experience. Catheter. Cardiovasc. Interv. 2007; 70(1): 75–82, doi: 10.1002/ccd.21194.
 
35.
Foin N., Alegria-Barrero E., Torii R., Chan P.H., Viceconte N., Davies J.E., Di Mario C. Crush, culotte, T and protrusion: which 2-stent technique for treatment of true bifurcation lesions? – insights from in vitro experiments and micro-computed tomography. Circ. J. 2013; 77(1): 73–80, doi: 10.1253/circj.cj-12-0272.
 
36.
Burzotta F., Lassen J.F., Banning A.P., Lefèvre T., Hildick-Smith D., Chieffo A. et al. Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club. EuroIntervention 2018; 14(1): 112–120, doi: 10.4244/EIJ-D-18-00357.
 
37.
El-Menyar A.A., Al Suwaidi J., Holmes D.R. Jr. Left main coronary artery stenosis: state-of-the-art. Curr. Probl. Cardiol. 2007; 32(3): 103–193, doi: 10.1016/j.cpcardiol.2006.12.002.
 
38.
Cheezum M.K., Liberthson R.R., Shah N.R., Villines T.C., O’Gara P.T., Landzberg M.J., Blankstein R. Anomalous aortic origin of a coronary artery from the inappropriate sinus of Valsalva. J. Am. Coll. Cardiol. 2017; 69(12): 1592–1608, doi: 10.1016/j.jacc.2017.01.031.
 
39.
Oviedo C., Maehara A., Mintz G.S., Araki H., Choi S.Y., Tsujita K. et al. Intravascular ultrasound classification of plaque distribution in left main coronary artery bifurcations: where is the plaque really located? Circ. Cardiovasc. Interv. 2010; 3(2): 105–112, doi: 10.1161/CIRCINTERVENTIONS.109.906016.
 
40.
Medrano-Gracia P., Ormiston J., Webster M., Beier S., Young A., Ellis C. et al. A computational atlas of normal coronary artery anatomy. EuroIntervention 2016; 12(7): 845–854, doi: 10.4244/EIJV12I7A139.
 
41.
de la Torre Hernandez J.M., Hernández Hernandez F., Alfonso F., Rumoroso J.R., Lopez-Palop R., Sadaba M. et al. Prospective application of pre-defined intravascular ultrasound criteria for assessment of intermediate left main coronary artery lesions results from the multicenter LITRO study. J. Am. Coll. Cardiol. 2011; 58(4): 351–358, doi: 10.1016/j.jacc.2011.02.064.
 
42.
Dato I., Burzotta F., Trani C., Romano A., Paraggio L., Aurigemma C. et al. Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience. Int. J. Cardiol. 2017; 248: 108–113, doi: 10.1016/j.ijcard.2017.06.125.
 
43.
Modi B.N., van de Hoef T.P., Piek J.J., Perera D. Physiological assessment of left main coronary artery disease. EuroIntervention 2017; 13(7): 820–827, doi: 10.4244/EIJ-D-17-00135.
 
44.
Naganuma T., Chieffo A., Meliga E., Capodanno D., Park S.J., Onuma Y. et al. Long-term clinical outcomes after percutaneous coronary intervention versus coronary artery bypass grafting for ostial/midshaft lesions in unprotected left main coronary artery from the DELTA registry: a multicenter registry evaluating percutaneous coronary intervention versus coronary artery bypass grafting for left main treatment. JACC Cardiovasc. Interv. 2014; 7(4): 354–361, doi: 10.1016/j.jcin.2013.11.014.
 
45.
Brunel P., Lefevre T., Darremont O., Louvard Y. Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter ”TULIPE” study. Catheter. Cardiovasc. Interv. 2006; 68(1): 67–73, doi: 10.1002/ccd.20800.
 
46.
Burzotta F., De Vita M., Sgueglia G., Todaro D., Trani C. How to solve difficult side branch access? EuroIntervention 2010; 6 Suppl J: J72–J80, doi: 10.4244/EIJV6SUPJA12.
 
47.
Burzotta F., Trani C. Jailed balloon protection and rescue balloon jailing techniques set the field for safer bifurcation provisional stenting. Int. J. Cardiol. 2015; 201: 376–377, doi: 10.1016/j.ijcard.2015.06.185.
 
48.
Chen S.L., Zhang J.J., Han Y., Kan J., Chen L., Qiu C. et al. Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial. J. Am. Coll. Cardiol. 2017; 70(21): 2605–2617, doi: 10.1016/j.jacc.2017.09.1066.
 
49.
Chen X., Li X., Zhang J.J., Han Y., Kan J., Chen L. et al. 3-Year Outcomes of the DKCRUSH-V Trial Comparing DK Crush With Provisional Stenting for Left Main Bifurcation Lesions. JACC Cardiovasc. Interv. 2019; 12(19): 1927–1937, doi: 10.1016/j.jcin.2019.04.056.
 
50.
Chen S.L., Xu Bo., Han Y.L., Sheiban I., Zhang J.J., Ye F. et al. Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study. J. Am. Coll. Cardiol. 2013; 61(14): 1482–1488, doi: Interv. 2010; 3(2): 105–112.
 
51.
Van Mieghem C.A., Cademartiri F., Mollet N.R., Malagutti P., Valgimigli M., Meijboom W.B. et al. Multislice spiral computed tomography for the evaluation of stent patency after left main coronary artery stenting: a comparison with conventional coronary angiography and intravascular ultrasound. Circulation 2006; 114(7): 645–653, doi: 10.1161/CIRCULATIONAHA.105.608950.
 
52.
Gil RJ., Bil J., Grundeken M.J., Kern A., Iñigo Garcia L.A., Vassilev D. et al. Regular drug-eluting stents versus the dedicated coronary bifurcation sirolimus-eluting BiOSS LIM® stent: the randomised, multicentre, open-label, controlled POLBOS II trial. EuroIntervention 2016; 12(11): e1404-e1412, doi: 10.4244/EIJY15M11_11.
 
53.
Généreux P., Kumsars I., Lesiak M., Kini A., Fontos G., Slagboom T. et al. A randomized trial of a dedicated bifurcation stent versus provisional stenting in the treatment of coronary bifurcation lesions. J. Am. Coll. Cardiol. 2015; 65(6): 533–543, doi: 10.1016/j.jacc.2014.11.031.
 
54.
Genuardi L., Chatzizisis Y.S., Chiastra C., Sgueglia G., Samady H., Kassab G.S. et al. Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions. Cardiol. J. 2020, doi: 10.5603/CJ.a2020.0024 [Online ahead of print].
 
55.
Burzotta F., Lassen J.F., Lefèvre T., Banning A.P., Chatzizisis Y.S., Johnson T.W. et al. Percutaneous coronary intervention for bifurcation coronary lesions: the 15th consensus document from the European Bifurcation Club. EuroIntervention 2020 Oct 20; EIJ-D-20-00169, doi: 10.4244/EIJ-D-20-00169 [Online ahead of print].
 
eISSN:1734-025X
Journals System - logo
Scroll to top