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New strategies in the treatment of coronary bifurcations

Neue Strategien bei der Behandlung von Läsionen in Koronarbifurkationen

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Abstract

Despite major improvements in stent technology (i.e., drug-eluting stents, DES), treatment of coronary bifurcations is an ever occurring problem of the interventional cardiology. While stenting the main branch with provisional side branch stenting seems to be the prevailing approach, in the era of DES various two-stent techniques emerged (crush) or were re-introduced (V or simultaneous kissing stents, crush, T, culottes, etc.) to allow stenting in the side branch when needed. New techniques in imaging like optical coherence tomography help in better understanding bifurcation anatomy and, thus, have the potential to help us better treat this challenging subset of lesions. In addition, new dedicated bifurcation stents have been proposed in an attempt to overcome limitations associated with current approaches, and they showed promising results in early studies; however, the safety and the efficacy of these devices remain to be seen in the ongoing and upcoming trials. This review focuses on the current approaches and the development of new techniques employed for the treatment of bifurcation disease.

Zusammenfassung

Trotz wesentlicher Verbesserungen in der Stenttechnologie (i. S. medikamentenbeschichter Stents) ist die Therapie von Stenosen in Koronarbifurkationen ein immer wiederkehrendes Problem in der interventionellen Kardiologie. Während die Stenteinlage in den Hauptast mit provisorischer Stenteinlage in den Seitenast der vorherrschende Ansatz zu sein scheint, wurden im Zeitalter beschichteter Stents verschiedene 2-Stent-Techniken entwickelt (Crush-Technik) oder wiedereingeführt („V-“ oder simultane Kissing-Stent-Technik, Crush-, T-, Culotte-Technik usw.), um ggf. die Stenteinlage in den Seitenast zu ermöglichen. Neue bildgebende Verfahren wie die optische Kohärenztomographie tragen zum besseren Verständnis der Bifurkationsanatomie bei und bieten das Potenzial, zu einer besseren Therapie dieser anspruchsvollen Untergruppe von Läsionen zu verhelfen. Darüber hinaus wurden neue geeignete Bifurkationsstents vorgestellt, um die Grenzen der derzeitigen Ansätze zu überwinden, und sie zeitigten in den anfänglichen Studien vielversprechende Ergebnisse; allerdings müssen sich Sicherheit und Wirksamkeit dieser Stents in laufenden und zukünftigen Studien noch erweisen. Die vorliegende Übersicht richtet den Fokus auf die derzeitigen Ansätze und die Entwicklung neuer Verfahren zur Therapie von Bifurkationsläsionen.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Onassis Cardiac Surgery Center, Athens, Greece

    I. Iakovou & A. Andreou

  2. Department of Bioengineering, Imperial College, London, UK

    N. Foin

  3. Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK

    N. Viceconte & C. Di Mario MD, PhD, FESC, FACC, FRCP

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  1. I. Iakovou
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  2. N. Foin
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  3. A. Andreou
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  4. N. Viceconte
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  5. C. Di Mario MD, PhD, FESC, FACC, FRCP
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Correspondence to C. Di Mario MD, PhD, FESC, FACC, FRCP.

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Iakovou, I., Foin, N., Andreou, A. et al. New strategies in the treatment of coronary bifurcations. Herz 36, 198–213 (2011). https://doi.org/10.1007/s00059-011-3459-y

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