HOW TO APPROACH BIFURCATION CORONARY LESIONS BY PERCUTANEOUS CORONARY INTERVENTION

Abstract

Introduction: A coronary bifurcation lesion is historically defined as a coronary artery narrowing adjacent to and/ or involving the origin of a significant side branch. It is more susceptible to develop atherosclerotic plaque than any region of the coronary vasculature due to local hemodynamic forces. Medina classification had been adopted as the preferred system to define and these lesions. Bifurcation lesions were once indicating surgery but not anymore, now they will follow the same principles for revascularization of non-bifurcation lesions. However, the challenge remains in whether the lesion will be approached using one stent or two stents. Material and methods: Our work is an observational study about five patients of Ibn sina 's cardiology department A. The primary aim of this study is to raise the particularities of the Left descending artery /Diagonal lesions both anatomically and hemodynamically, and especially the difficulties of the interventional care. Left main bifurcation was excluded in our study. Results and discussion: All of our patients presented chronic coronary syndrome. Radial access is the gold standard with less complications compared to femoral access. All of our patients beneficiated of provisional stenting with no endovascular imaging. Unfortunately, one of our patients died in the intensive care unit of an extensive dissection due to T stenting for Medina 0.0.1 lesion, while another one survived from cardiac arrest but left our department with left ventricle ejection fraction less than 35% after undergoing many complications. Conclusion: This study has highlighted that interventional medical care for bifurcation coronary lesions can be tricky. The main complexity remains in the risk of side branch stenosis especially if it is a significant one