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

100%

Milejski W., Morawiec B., Sacha J., Nowalany-Kozielska E., Gierlotka M., Kawecki D.

Annales Academiae Medicae Silesiensis

2021

issue 75

24-32

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.

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.

Comorbidities and clinical outcomes of a lung cancer screening trial participants with chronic obstructive pulmonary disease in three-year follow-up

84%

Undrunas A., Bąk A., Kasprzyk P., Dziedzic R., Dziurda D., Rzyman W., Gierlotka M., Kuziemski K.

European Journal of Translational and Clinical Medicine

2022

vol. 5

issue 2

24-30

Background To improve the effectiveness of lung cancer screening using low-dose computed tomography (LDCT), the presence of smoking-related comorbidities that may significantly affect mortality in this group should be taken into account. Material and methods A questionnaire survey and spirometry tests were conducted in a group of 730 respondents as part of a lung cancer screening study between 2016 and 2018. People diagnosed with COPD underwent a three-year follow-up to assess the incidence of medical events. Results Our study confirmed that cardiovascular diseases (CVDs) were the most common comorbidities in patients who were diagnosed with COPD and participated in LDCT lung cancer screening. Among the CVDs, the most common were arterial hypertension (45.8%) and coronary artery disease (12.5%). Tobacco-related diseases (e.g. CVD, lung cancer, and exacerbations of COPD) were the leading causes of emergency department visits and hospitalizations. The number of visits due to COPD in specialized clinics more than doubled in the observed period. Conclusions Properly planned screening tests allow not only for the detection of the disease for which they were designed but also for the assessment of comorbidities. In patients undergoing lung cancer screening, it is justified to extend the diagnostics to include spirometry.

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1 Annales Academiae Medicae Silesiensis

1 European Journal of Translational and Clinical Medicine

1 2022

1 2021

2 Gierlotka M.

1 Bąk A.

1 Dziedzic R.

1 Dziurda D.

1 Kasprzyk P.

1 Kawecki D.

1 Kuziemski K.

1 Milejski W.

1 Morawiec B.

1 Nowalany-Kozielska E.

1 Rzyman W.

1 Sacha J.

1 Undrunas A.

Search results

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

Comorbidities and clinical outcomes of a lung cancer screening trial participants with chronic obstructive pulmonary disease in three-year follow-up