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Coronary bifurcations – anatomy, physiology and treatment with selected aspects of left main stem bifurcation
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
Corresponding author
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
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
KEYWORDS
TOPICS
ABSTRACT
Coronary bifurcation remains a unique region of coronary tree. Specific anatomy and blood flow determines complex mechanisms of atherosclerotic plaque localization. The treatment strategy should be chosen with caution, as the failure of PCI may involve larger amount of supplied myocardium that in case of single vessel PCI. In order to understand the complexity of clinical situation in patients after the treatment of coronary bifurcation, and the constantly evolving techniques of the procedure itself, this review presents basic information on anatomy and classification, up-to date step-by-step analysis of optimal technique for PCI, beginning with qualification, planning and preparation for the procedure, through stent selection and final optimization techniques. Different PCI strategies are presented and explained, indications for one- vs. two-stent techniques are evaluated, available and recommended imaging and physiological methods for detailed bifurcation assessment are reviewed. Special attention has been focused on left main stem bifurcation, a special anatomical and physiological spot within the coronary circulation.
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