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2021 | 75 | 24-32
Article title

Coronary bifurcations – anatomy, physiology and treatment with selected aspects of left main stem bifurcation

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PL
Bifurkacje wieńcowe – anatomia, fizjologia i leczenie z wybranymi aspektami bifurkacji pnia lewej tętnicy wieńcowej
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Abstracts
EN
Coronary bifurcation remains a unique region of the coronary tree. The specific anatomy and blood flow determine the complex mechanisms of atherosclerotic plaque location. The treatment strategy should be chosen with caution as the failure of percutaneous coronary interventions (PCI) may expose a significantly larger area of the myocardium to ischemia than in the case of single vessel PCI. In order to understand the complexity of the 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 the anatomy and classification, up-to-date step-by-step analysis of the optimal technique for PCI, beginning with qualification, planning and preparation for the procedure, through stent selection and ending with optimization techniques. Different PCI strategies are presented and explained, the indications for one- vs. two-stent techniques are evaluated, the available and recommended imaging and physiological methods for detailed bifurcation assessment are reviewed. Particular attention has been paid to left main stem bifurcation, a distinctive anatomical and physiological spot within the coronary circulation.
PL
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.
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Year
Issue
75
Pages
24-32
Physical description
Contributors
  • Department of Cardiology, University Hospital, University of Opole, Poland
  • 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
author
  • Department of Cardiology, University Hospital, University of Opole, Poland
  • 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
  • Department of Cardiology, University Hospital, University of Opole, Poland
  • 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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