Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3840_Библиотеки_им_академика_М_И_Перельмана

The “Tips and Tricks” book dedicated to bifurcation PCI is a unique offering, addressing this important clinical PCI subset. Its importance is supported by the industrial development of novel side branch stents and further emphasizes the common and difficult problem that side branch managementrepresents. Drs. Moussa and Colombo have assembled a unique book dedicated to understanding and managing this critically challenging PCI problem. It is a first of its kind in the interventional world. Because of the numerous configurations of a bifurcation involving the aorto-ostia,the main branch and side branch relationship, as well as the distal left main, the PCI approach requires careful classification, categorization, and technique selection based on the best studies (randomized, multicenter, etc.). Validation of the outcomes from the studies reporting the numerous approaches tothese treatments is hard to come by. Drs.Moussa and Colombo, experts in their own right, have assembled a stellar team of coauthors who cover the universe of bifurcation PCI. For example, in the first section, the reader will be introduced to the evidence and studies on which most initial decisions are based. Moussa and Colombo ask: Are the trials on which we have based our current approaches to this point satisfactory? Are they large enough? Is there enough detail and division of the types of bifurcations studied to appreciate outcomes related to therapy? These questions and more are addressed in detail.

While one cannot generalize these introductory remarks to all bifurcation procedures, the subsequent chapters on the bifurcation anatomy by Drs. Costa, Russell, and Moussa set the groundwork for understanding classifications and hence techniques. The anatomy and phys­iology resulting in unique stress patterns of specific angulations of the side branches provide insight into the role of stenting and carina reconstruction. To understand the anatomy, the rou­tine incorporation of the imaging modalities as well as physiologic assessment is warranted and addressed. Importantly, because obviously not all bifurcations are the same, the left main coronary artery bifurcation is discussed in a separate set of chapters later in the book.

Finally, inthe fourth section,the reader will review bench testingand dedicated studies on focused technology, attempting to improve the delivery of existing stents and the manufacture and development of unique dedicated bifurcation stents. Observations gained from the testing involve insightsinto overlapping metal struts in the wide arrayof combined methodsincluding crush, T, culotte, and V stenting.

There is no topic in Interventional Cardiovascular Medicine where this “disconnect” is morerelevant thanthat ofinterventional treatmentof coronarybifurcation lesions.The narrative that has been propagated in the literature is that provisional stenting (stenting the main vessel, with additional stenting of the side branch only in the case of an unsatisfactory result) is better than elective double stenting of both branches. This narrative states no exceptions to the rule, as it applies to all patients with coronary bifurcation lesions irrespective of bifurcation anatomy. Advocates of thisnarrative base their supposition onthe results ofseveral prospective randomized controlled trials. This narrative, however, overlooks fundamental problems in the design of these clinical trials, which makes its generalizability to all patients with coronary bifurcation lesions problematic.

The goal of this book isto present the reader witha patient-centered approachto technical decision making in the interventional treatment of coronary bifurcation lesions. In doing so, we relied on evidence when it was of high quality and relevant, and we relied on experts’ opinion and judgment when high-quality evidence was lacking. The first section of the book is devoted to the fundamentals of decision making with regard to interpretation of the existing evidence (chapter 1) and understanding the role of bifurcation anatomy in impacting technique choice and outcomes (chapter 2). The subsequent chapters are devoted to technical decision making with regard to tailoring technical approaches to bifurcation anatomy for patients with left main and non–left main coronary bifurcation lesions. A particular emphasis is placed on providing practical tips and tricks to optimize the results and deal with complications, all in the context of actual casepresentations. The last section ofthe book isdevoted to the role of in vitro bifurcation modeling and the current state of dedicated bifurcation stent systems.