One-stent and two-stent strategies for the treatment of Medina 0.0.1 bifurcation lesions have comparable outcomes, a new analysis shows. These data were reported by Ki Hong Choi, MD, of the Sungkyunkwan University School of Medicine, Seoul, South Korea, and Francesco Bruno, MD, of the Città della Salute e della Scienza, Turin, Italy, and colleagues, in a manuscript published Wednesday online in JACC: Cardiovascular Interventions. Treatment of bifurcation lesions by percutaneous coronary intervention (PCI) is one of the most difficult procedures in interventional cardiology, and patients who undergo PCI for bifurcation lesions have higher rates of ischemic events compared with patients who are treated for nonbifurcation lesions. Patients of the Medina classification 0.0.1 subtype, which only involves the side branch ostium, demonstrated the worst 1-year outcomes in patients with bifurcation lesions. The aim of this study was to compare the clinical outcomes of Medina 0.0.1 bifurcation lesion patients who underwent one-stent and two-stent treatment strategies. The investigators used data from the Combined Insights From the Very Thin Stents for Patients with Left Main or Bifurcation in Real Life (Unified RAIN) and Coronary Bifurcation Stenting (COBIS II, III) registries to create the Extended BIFURCAT registry. Stenting technique, type of implantation and use of other techniques, as well as pharmacotherapy, were up to the operators’ discretion for each procedure. However, all patients were given a standard dose of antiplatelet drugs. Quantitative coronary angiography data were only available in the COBIS II and III registries. A total of 8,343 patients in the BIFURCAT registry underwent PCI, and 345 of them—who had Medina 0.0.1 lesions—were selected to be analyzed in this study. The primary endpoint of the present study was any major adverse cardiac event (MACE), which consisted of a composite of all-cause death, myocardial infarction, target vessel revascularization and stent thrombosis, at 800 days. The one-stent strategy was performed in 209 patients (mean age=66.0±9.9 years, 78.9% male) and the two-stent strategy was performed in 136 patients (mean age=64.3±11.0 years, 74.3% male). The one-stent strategy was more commonly used as time went on (36.0% from 2003-2009, 47.4% from 2010-2014, and 90.4% from 2015-2017, trend p<0.001). The risk of MACE in Medina 0.0.1 lesion patients was not impacted by the one-stent versus two-stent strategy usage (one-stent vs two-stent, 14.3% vs 13.9%; hazard ratio [HR]=1.034; 95% confidence interval [CI]=0.541-1.977; p=0.92). There were also no significant between-group differences when the patients were stratified into three groups (one-stent crossover only, one-stent with a strut opening and two-stent). Some limitations of this study included the lack of data on medically treated patients, and detailed information about previous myocardial infarction or PCI was unavailable for analysis. The study was also limited by the restrictions of an observational, retrospective design, and specifics of the treatment strategies were up to the operators. Finally, the sample size may not be large enough to generalize the information to the larger population. Overall, PCI with the one-stent treatment strategy versus the two-stent treatment strategy did not show significantly different outcomes in patients with Medina 0.0.1 bifurcation lesions. The investigators recommended that future randomized trials continue the research in optimal treatment strategies for Medina 0.0.1 lesions. In an accompanying editorial, Sorin J. Brener, MD, of the New York Presbyterian Brooklyn Methodist Hospital, described the complexity of lesion treatment in interventional cardiology and wrote that this present study should be considered a “how-to manual” for best outcomes in treating Medina 0.0.1 lesions. “How should one interpret these data? Again, ignoring the possibility of not performing percutaneous coronary intervention at all in these lesions or not using stents, the results of this analysis support the consensus of bifurcation treatment in general,” Brener wrote. He concluded by commending the investigators of this study. “Notwithstanding the absence of a control group treated with medical therapy alone and statistical adjustment, I applaud the authors for sharing this information with us and conclude that the jailing system created by stents placed across distal branches is not as dangerous as previously feared.” Sources: Choi KH, Bruno F, Cho Y-K, et al. Comparison of Outcomes Between 1-Stent and 2-Stent Techniques for Medina Classification 0.0.1 Coronary Bifurcation Lesions. JACC Cardiovasc Interv. 2023 Aug. 9 (Article in Press). Brener SJ. How To, Not When To: Treating the Diseased Branch of a Bifurcation Lesion. JACC Cardiovasc Interv. 2023 Aug. 9 (Article in Press). Image Credit: sudok1 – stock.adobe.com