International Circulation: Along with the development of PCI， unprotected LM bifurcation lesion never be the absolute contraindication， which is increasingly treated with PCI recently. And SYNTAX trial provide more choices to lower risk patients. Could you please introduce the development of LM bifurcation lesion treatment?
《国际循环》：随着导管介入技术的快速发展和技术的不断进步，无保护左主干病变的经皮冠脉介入（PCI）治疗已不再是绝对禁忌，并且逐渐增多。特别是SYNTAX的研究结果让低危患者有了更多治疗选择。纵观左主干病变治疗的多年发展，您认为其中有哪些里程碑？
Dr. Colombo : Thank you very much for this opportunity. Left main bifurcation lesions are not any more a contraindication to PCI. As you said， I think the SYNTAX study with the recently published 5 year results， supports that the outcome is quite good and very comparable to bypass surgery. The problem is not really the left main bifurcation， sometimes it is the additional triple vessel disease that needs to be completely taken care and provide a full revascularization. Total occlusion of the right coronary artery， occlusion of the anywhere else， these are issues that need to be taken care. Of course the left main bifurcation is also important， it is important to select the appropriate technique， not to be afraid to use 2 stents. Very frequently 2 stents need to be used at least 40 to 50% of the time. IVUS guidance is essential and if these guidelines are followed， the results， not only in the short term but also in the long term will be good. Finally I like to mention that the introduction of new generation drug eluting stents will further improve the effectiveness and safeyof this procedure.
Colombo教授：非常感谢《国际循环》提供这样一个交流的机会。左主干分叉病变已经不再是PCI治疗的禁忌证。正如你所说，我认为近期发布的SYNTAX研究5年随访结果显示，左主干分叉病变患者行PCI治疗的结局非常好，与冠脉搭桥手术相当。实际上左主干分叉病变患者治疗的真正难题不是左主干分叉病变本身，而是患者所合并的那些需要仔细关注、照顾并进行完全血运重建的三支血管病变。例如，右冠完全闭塞及其他位置血管闭塞等问题都需要进行关注和解决。当然，左主干分叉病变也非常重要。就左主干分叉病变治疗而言，我们需要选择适当的技术，不要不敢应用双支架。因为至少40%~50%的左主干分叉病变患者介入治疗时需要行双支架术。此外，IVUS对左主干分叉病变介入治疗具有非常重要的指导意义。只要遵循上述原则，左主干分叉病变介入治疗将能获得很好的短期及长期结局。最后，我想强调的是，新一代药物洗脱支架的问世与应用将进一步提高左主干分叉病变患者介入治疗的有效性及安全性。
International Circulation: During the past year， many new trial data and procedures came out. For the therapy be used more appropriate， is there any statement， consensus or guideline on the agenda?
《国际循环》：最近一年，左主干分叉病变治疗方面也出台很多新数据，也有不同治疗术式，为让试验数据合理用于临床，规范应用多种术式，国际组织是否有计划发表相关声明、共识或指南？
Dr. Colombo : But the current guidelines still give a higher mark to surgery for unprotected left main but this does not mean that the PCI is inappropriate. The SYNTAX study has opened the way to give at least a level 2 in the PCI of unprotected left main bifurcation is not a contraindication， most of the time we see bifurcation which can be treated with one stent but as I said， 2 stents if properly placed， are acceptable. The problem is not really in the guidelines for left main but in the guidelines for associated extensive triple vessel disease. If you have very high SYNTAX score then the left main with a very high SYNTAX score becomes a more surgical indication rather than a PCI indication. But as I said， left main per se is an acceptable procedure with PCI with current guidelines.
Colombo教授：就无保护左主干病变而言，现有指南仍对外科搭桥治疗给予更高级别的推荐，但这并不意味着这些患者不能进行PCI。SYNTAX研究已经促使指南不再将无保护左主干分叉病变作为PCI的禁忌证，并将PCI作为治疗无保护左主干分叉病变推荐等级提升至II类。大多数情况下，左主干分叉病变介入治疗时采用一个支架，但正如我刚才所说，只要放置得当，双支架术也是可以接受的。就指南而言，实际上我们需要出台的不是有关左主干病变的指南，而是与之相关的弥漫性三支血管病变指南。若左主干分叉病变患者的SYNTAX评分较高，则更适合行外科搭桥手术而非PCI。但是，正如所刚才所说，从现有指南推荐来看，左主干病变本身是可以进行PCI治疗的。