Contemporary Management of Isolated Ostial Side Branch Disease: An Evidence-based Approach to Medina 001 Bifurcations

Abstract

The optimal management of bifurcation lesions has received significant interest in recent years and remains a matter of debate among the interventional cardiology community. Bifurcation lesions are encountered in approximately 21% of percutaneous coronary intervention procedures and are associated with an increased risk of major adverse cardiac events. The Medina classification has been developed in an attempt to standardise the terminology when describing bifurcation lesions. The focus of this article is on the management of the Medina 0,0,1 lesion (‘Medina 001’), an uncommon lesion encountered in <5% of all bifurcations. Technical considerations, management options and interventional techniques relating to the Medina 001 lesion are discussed. In addition, current published data supporting the various proposed interventional treatment strategies are examined in an attempt to delineate an evidence-based approach to this uncommon lesion.

One-Stent Double-Kissing Nano Crush— Osdokina Crush—Technique Could be a Game- Changer in the Treatment of Medina 0.0.1 Lesion

“…(5) if we are going to place a stent on the osteal lesion, will we be able to cover this lesion completely without overflowing into the main branch? 5 - 10 In the literature, PCI techniques for Medina 0.0.1 lesions are roughly discussed under 2 main headings: those based on stenting of the osteal lesion and those based on the balloon angioplasty with atherectomy on the osteal lesion. The most important criticism of balloon-based therapies is that not placing a “stent-scaffold” on osteal lesions with a high potential to dissect and recoil may increase the risk of target lesion revascularisation (TLR) and target vessel revascularisation (TVR).…”

Reply to Letter to the Editor: “Single-Stent Double-Kissing Nano-Crush Technique for the Management of Side Branch Ostial Lesions: A Game Changer? Or Just Another Player in the Game?”

“… 3 Stenting the ostial lesion and balloon angioplasty with atherectomy on the ostial lesion are the 2 main types of percutaneous coronary interventional procedures for Medina 0.0.1 lesions in the literature. 4 The biggest argument against balloon-based treatment is that if ostial lesions with a high tendency to dissect and recoil are not covered by a “stentscaffold,” it may increase the risk of target lesion revascularization and target vessel revascularization. 4 The “One Stent DOuble KIssing NAno CRUSH (OSDOKINA) technique,” which we have outlined, has a number of potential advantages.…”

“… 4 The biggest argument against balloon-based treatment is that if ostial lesions with a high tendency to dissect and recoil are not covered by a “stentscaffold,” it may increase the risk of target lesion revascularization and target vessel revascularization. 4 The “One Stent DOuble KIssing NAno CRUSH (OSDOKINA) technique,” which we have outlined, has a number of potential advantages. The ostial lesion is first to be entirely covered with a stent.…”

Reply to Letter to the Editor: “Pros and Cons of a Novel Coronary Stenting Technique for Medina 0.0.1 Lesions: Osdokina Crush”

“… 2 Percutaneous coronary interventions techniques for Medina 0.0.1 lesions are generally divided into 2 categories in the literature: those that involve stenting the ostial lesion and those that involve balloon angioplasty with atherectomy on the ostial lesion. 3 The most significant objection to balloon-based therapy is that it may increase the risk of target lesion revascularization and target vessel revascularization if ostial lesions with a high propensity to dissect and recoil are not covered by a “stent-scaffold”. 3 There are several potential benefits in our described technique, the “OSDOKINA crush technique.” 1 First, a stent is used to completely cover the ostial lesion.…”

“… 3 The most significant objection to balloon-based therapy is that it may increase the risk of target lesion revascularization and target vessel revascularization if ostial lesions with a high propensity to dissect and recoil are not covered by a “stent-scaffold”. 3 There are several potential benefits in our described technique, the “OSDOKINA crush technique.” 1 First, a stent is used to completely cover the ostial lesion. Second, the SB stent is nano-protruding from the main branch.…”