"Inverted" provisional T stenting, a new technique for Medina 0,0,1 coronary bifurcation lesions: feasibility and follow-up.
OBJECTIVE
Isolated, high-grade coronary bifurcation lesions located at the side branch (SB) ostium (Medina type 0,0,1) are uncommon and their specific treatment has not been described.


RESULTS
We have developed an "inverted" technique for the treatment of these lesions, derived from the usual provisional T stenting. We implant the stent from the proximal main branch through the SB, with reopening of the strut through the distal main branch (DMB) and systematic final kissing balloon. We retrospectively reviewed results in 40 patients. The procedural success was 100%, no failure was observed to rewire the DMB or perform the kissing balloon, and a second sent was implanted in the DMB in only three patients (7.5%). No death, myocardial infarction, stent thrombosis or repeat revascularisation occurred within the first 30 days of follow-up. At a mean of 22+/-14 months, three patients underwent repeat percutaneous coronary intervention (7.5%), with target lesion restenosis (n=2; 5%), other vessel treated (n=1, 2.5%), target lesion revascularisation (n=1; 2.5%), and target vessel revascularisation (n=1, 2.5%).


CONCLUSIONS
The "inverted" provisional T stenting technique was safe and highly effective in the management of Medina 0,0,1 coronary bifurcation lesions. Larger trials are needed before its routine application can be recommended.
Unité de Soins et de Cardiologie Interventionnelle, Nouvelles Cliniques Nantaises, Nantes, France. brunel-philippe@wanadoo.fr
Philippe
P
Brunel
Guillaume
G
Martin
Erwann
E
Bressollette
Bernard
B
Leurent
Yves
Y
Banus
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome