İnverted Provizyonel Stentleme
Özet
MEDINA 0,0,1 lezyonları, ana dal hastalığı eşlik etmeksizin sadece yan dal ostiumunda izole darlığın bulunduğu, tüm bifurkasyon lezyonlarının %5’inden azını oluşturan özel klinik durumlardır. Geçmişte spesifik bir endovasküler yöntemi olmayan bu lezyonların tedavisi için klasik provizyonel teknikten türetilen İnverted Provizyonel Stentleme (İPS) tekniği geliştirilmiştir. Bu yöntem, proksimal ana daldan yan dala doğru bir stent yerleştirilmesini, ardından proksimal optimizasyon tekniği (POT) ve distal ana dal akışını yeniden sağlamak için rutin final kissing balon basamaklarını içerir. İPS, yan dal ostiumunun stent ile tam olarak kaplanmasını mümkün kılarken, bifurkasyon açısına bağlı olarak ortaya çıkabilecek osteal kayıp veya sağlam ana daldaki protrüzyon riskini en aza indirmeyi hedefler. Girişimsel karar aşamasında yan dalın prognostik önemi koroner anjiyografi, SNuH skoru veya bilgisayarlı tomografi gibi kriterlerle titizlikle belirlenmelidir. Ana dal diseksiyonu ve stent strutları arasından tekrar telleme zorlukları gibi teknik riskler barındırsa da İPS, yüksek prosedürel başarı ve düşük komplikasyon oranlarıyla MEDINA 0,0,1 lezyonlarında güvenilir ve etkili bir seçenektir.
MEDINA 0,0,1 lesions represent a specific type of coronary bifurcation disease characterized by isolated stenosis in the side branch ostium without main branch involvement, accounting for less than 5% of all bifurcation cases. To address these lesions, which previously lacked dedicated endovascular treatments, the Inverted Provisional Stenting (IPS) technique was developed based on the classic provisional approach. The procedure involves deploying a single stent from the proximal main branch into the side branch, followed by the proximal optimization technique (POT) and mandatory final kissing balloon inflation to restore strut patency toward the distal main branch. IPS allows complete coverage of the side branch ostium while minimizing the risk of ostial loss or main branch protrusion associated with narrow bifurcation angles. Prior to intervention, the prognostic significance of the side branch must be carefully assessed using coronary angiography, the SNuH score, or non-invasive imaging. Despite technical challenges such as main branch dissection risks and complex rewiring through stent struts, the IPS technique offers high procedural success and low complication rates for managing MEDINA 0,0,1 lesions.
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