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Left Main Trifurcation and Its Percutaneous Treatment: What Is Known So Far?
Mila Kovacevic1,2, Francesco Burzotta1,2, Sameh Elharty1,2
1Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (M.K., F.B., S.E., G.B., C.A., E.R., C.T.).
Insights
Left main trifurcation is a common coronary artery variation. This review explores percutaneous coronary intervention techniques for treating this complex anatomy, offering an alternative to cardiac surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- The left main (LM) trifurcation, a distal division into three branches, is the most common LM stem anatomic variation.
- LM trifurcation disease constitutes 10-15% of all LM diseases, traditionally managed with cardiac surgery.
Purpose of the Study:
- To review the anatomy of LM trifurcation.
- To assess the feasibility of percutaneous coronary intervention (PCI) for LM trifurcation stenosis.
- To summarize evidence on technical options for PCI in LM trifurcation.
Main Methods:
- Review of existing literature on LM trifurcation anatomy and PCI.
- Analysis of data regarding the challenges and outcomes of PCI in LM trifurcation.
- Discussion of specific interventional techniques, including "trissing balloon inflation".
Main Results:
- LM trifurcation presents significant anatomic complexity, posing challenges for PCI.
- Percutaneous coronary intervention is increasingly accepted for LM trifurcation disease, despite its complexity.
- Various technical strategies exist for managing LM trifurcation stenosis via PCI.
Conclusions:
- LM trifurcation disease is a complex subset of LM disease.
- PCI offers a viable alternative to surgery for selected patients with LM trifurcation stenosis.
- Further evidence on technical approaches is crucial for optimizing PCI outcomes in LM trifurcation.
Abstract:
In humans, the most common anatomic variation of the left main (LM) stem is represented by its distal division in 3 branches (LM trifurcation) instead of 2. LM trifurcation disease accounts for ≈10% to 15% of all LM diseases and is often managed by cardiac surgery. Over the last decades, due to the improvement of interventional material and techniques, percutaneous coronary intervention started gaining acceptance to treat patients with LM disease including those with trifurcated anatomy. Yet, LM trifurcation stenosis with its intrinsic anatomic complexity (3 branches, at least 4 angles, wide variability in branch size and disease) is recognized as a challenging lesion subset for percutaneous coronary intervention. In this review, we summarize available data about LM trifurcation anatomy, its influence on percutaneous coronary intervention feasibility, and the evidence collected regarding the different technical options (including trissing balloon inflation).
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