Management of Medina 0,0,1 Coronary Lesions

Dr. Hakan Erdem

Ankara Etlik City Hosital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Medina 0,0,1 lesions are rare and challenging to manage due to their potential for ostial miss, main vessel protrusion, and the risk of injury or compromise to the main vessel. The lack of high-quality randomized con- trolled studies to guide the interventional treatment of Medina 0,0,1 lesions is noteworthy. Since these lesions typically supply less than 10% of the myocardium, interventions should be performed without posing a risk to the main vessel. Intravascular imaging and physiological assessments play a critical role in accurately identify- ing the bifurcation anatomy and guiding treatment decisions. In Medina 0,0,1 lesions, percutaneous coronary intervention (PCI) is generally considered in cases of acute coronary syndrome or persistent angina that does not respond to medical treatment. If the risks associated with PCI outweigh its potential benefits, medical treatment should be prioritized. In patients with stable coronary artery disease, assessing angina symptoms is crucial. If symptoms are present, ischemia imaging in the artery’s supplied region should guide the choice of treatment. In borderline stenosis cases, additional evaluation using Fractional Flow Reserve (FFR) may be required. PCI is recommended if ischemia imaging is positive, symptoms persist despite medical therapy, or FFR indicates severe stenosis. For patients with negative ischemia imaging and symptom improvement with medical therapy, ongoing medical follow-up is advised. The methods used for these lesions include balloon angioplasty, drug-coated balloon therapy, and various stenting strategies. When stenting is deemed neces- sary, operators must accept the risk of ostial miss or minimal

stent protrusion into the main vessel, especially in cases with bifurcation angles other than 90 degrees. These outcomes can lead to adverse effects on the main vessel, the side branch, or both segments. Recent pub- lications highlight the reverse provisional or crossover technique as the most suitable stenting strategy for achieving full ostial coverage. This technique is relatively safe when the main vessel is at risk and also allows for the placement of a second stent if needed.

Keywords: Medina 0,0,1 lesions; Percutaneus coronary intervention

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