Editorial

Bifurcaciones

Dr. Mario Araya Hormazábal

Cardiólogo Intervencionista, Laboratorio de Hemodinamia Hospital San Juan de Dios y Clínica Alemana de Santiago, Chile; Director Jornadas SOLACI; Editor Asociado Boletín ProEducar Nro.112 Chile

Estimados amigos:

Los invitamos a revisar el siguiente boletín SOLACI - ProEducar dedicado al tratamiento de las bifurcaciones. En los últimos años y gracias al avance de técnicas de angioplastia, de mejores stents y de estudios randomizados, ha aumentado el número de pacientes con este subtipo de lesión tratados por vía percutánea (incluida la bifurcación de tronco común izquierdo). Se reconoce al tratamiento de una bifurcación como un procedimiento de mayor complejidad técnica y de resultados a largo plazo inferiores con respecto a lesiones no bifurcadas. Por lo mismo, es importante una correcta caracterización de la anatomía y funcionalidad de una bifurcación para así planificar una estrategia adecuada para cada caso.

El doctor Ignacio Batista de Uruguay nos resume las generalidades, clasificaciones anatómicas y los tratamientos posibles en las estenosis de bifurcación, en una visión amplia del tema que nos convoca. La doctora Ana María Dussaubat de Chile profundiza en la técnica más utilizada que es el  tratamiento con un stent y eventual stent provisional, con claves y consejos prácticos para la óptima realización de ésta. 

Posteriormente, los doctores Carlos Uribe y Mauricio Zuñiga de Colombia, en base a conceptos técnicos  básicos a tener en cuenta, nos sugieren algoritmos de decisiones para el uso de la técnica de dos stents, así como los puntos a considerar para elegir la mejor opción entre las diferentes técnicas con dos stents o provisional.

Los doctores César Vargas, Pablo Ramirez y Mario Araya de Chile realizan un resumen de las claves y aspectos prácticos en el uso de la fisiología intracoronaria (FFR-iFR) y la imagenología con IVUS u OCT-OFDI,  para una mejor interpretación y un uso racional. Elementos imprescindibles en la caracterización y tratamiento de las bifurcaciones más complejas.

Los doctores Luis Gutiérrez-Jaikel  y Jorge Chavarría Viquez de Costa Rica ilustran, en un caso clínico desafiante, una planificación detallada del tratamiento de un paciente con bifurcación compleja.

Creemos que esta información es un aporte al estudio y aprendizaje de la técnica de angioplastia de bifurcación y esperamos sea un estímulo para seguir ampliando nuestros conocimientos, buscando los textos sugeridos como bibliografía y generando la correcta discusión en nuestros grupos para la mejor selección y tratamiento  de nuestros pacientes.

Dr. Mario Araya Hormazábal
Staff Cardiología Intervencionista
Hospital San Juan de Dios y Clínica Alemana de Santiago, Chile
Director Jornadas SOLACI
Editor Asociado Boletín ProEducar Nro.112

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