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"Inverted" provisional T stenting, a new technique for Medina 0,0,1 coronary bifurcation lesions: feasibility and follow-up.

AIMS
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.


METHODS AND 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.