Recent perspective on coronary bifurcation intervention: statement of the "Bifurcation Club in KOKURA".
The treatment of coronary bifurcation lesion remains a challenging issue even in the drug-eluting stent era. Frequent restenosis and stent thrombosis have been recently shown to be related not only to geometrical gap or stent structural deformation but also to rheological disturbance. Low wall shear stress at the lateral side of the bifurcation is likely to cause atherosclerotic changes due to easy access of the macrophages that induce chemical mediators. The turbulent flow over stent metal may facilitate accumulation of platelets, which results in thrombosis. The jailed strut and excess metal overlap may increase these risks. Since dramatic changes of the coronary flow pattern at the bifurcation are closely related to the genesis of atherosclerosis, future bifurcation intervention technique should be considered to restore the original physiological state as well as the anatomical structure. This article summarizes the global consensus of the members of the Asian Bifurcation Club and European Bifurcation Club at the KOKURA meeting. It also provides a perspective of basic sciences relating to bifurcation anatomy, physiology, and pathology, in the search for a best strategy for bifurcation intervention.
Murasato
Yoshinobu
Y
Department of Cardiovascular Medicine, Heart Center, New Yukuhashi Hospital, Dojoji, Japan. murasato@shinyukuhashihospital.or.jp
Hikichi
Yutaka
Y
Nakamura
Sunao
S
Kajiya
Fumihiko
F
Iwasaki
Kiyotaka
K
Kinoshita
Yoshihisa
Y
Yamawaki
Masahiro
M
Shinke
Toshiro
T
Yamada
Shnichiro
S
Yamashita
Takehiro
T
Choo
Gim-Hooi
GH
Nam
Chang-Wook
CW
Kim
Young-Hak
YH
Jepson
Nigel
N
Ferenc
Miroslaw
M
D000800:Angioplasty, Balloon; D002986:Clinical Trials as Topic; D003226:Congresses as Topic; D003324:Coronary Artery Disease / Q000628:therapy; D003326:Coronary Circulation; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000628:therapy*; D003331:Coronary Vessels / Q000503:physiopathology; D003952:Diagnostic Imaging; D006801:Humans; D008955:Models, Cardiovascular; D019919:Prosthesis Implantation / Q000379:methods; D012039:Regional Blood Flow; D015607:Stents; D013927:Thrombosis / Q000209:etiology