EVALUATION OF THE MOST COMMON LOCATION OF BIFURCATION LESION, PREFERRED BIFURCATION STENTING TECHNIQUE AND PREDOMINANT MEDINA CLASSIFICATION SUBTYPES.

Abstract

Background: Coronary bifurcation lesions a subset of complex coronary artery disease where atherosclerotic plaque develops at the division of a main vessel and its side branch. These lesions pose significant challenges in PCI because of risk of complications such as restenosis, side branch occlusion, and stent failure. Bifurcation lesions account for approximately 20% of all PCI cases, making their effective management crucial in interventional cardiology. Various classification systems exist to categorize bifurcation lesions, with the Medina classification being the most widely used. This system evaluates stenosis in the proximal part of the main artery, the distal division of the primary branch, and the side vessel helping guide treatment decisions. Among different treatment approaches, provisional stenting is often preferred due to its simplicity and lower risk of complications in contrast to a more intricate structure. 2 stent techniques. Even so, in certain cases, CABG also the recommended option.

Methods: This cross sectional descriptive study was Carried out at Lady Reading Hospital, Peshawar, with a sample size of 196 patients, calculated using OpenEpi. Data were obtained using a well- designed questionnaire., focusing on the location of bifurcation lesions, preferred treatment strategy, and Medina classification subtypes. The study analyzed bifurcation lesions across major coronary arteries and their branches, including Left Main with LAD and CIRC, LAD with Diagonal, LCX with OM, and RCA with PDA and PLV.

Results: The total frequency of bifurcation lesions in the Left Main with LAD and CIRC was 25 (12.8% of total participants). Among these, 4% had stenosis of 40%-50%, 8% had 50%-60%, 48% had 70%-80%, and 40% had 80%-90%. Bifurcation lesions involving the LAD with Diagonal had a total frequency of 69 (35.2% of total cases). Among these, 7.2% had stenosis in the 40%-50% range, 21.7% in 50%-60%, 27.5% in 70%-80%, and the majority (43.7%) exhibited stenosis ranging from 80%-90%. The most common bifurcation lesion was located at the LCX with the OM branch. The provisional stenting technique emerged the preferred approach among interventional cardiologists. Referral to CABG was the most frequent category, with 115 cases (58.7%). The predominant Medina classification subtype was 1,1,1, indicating significant disease in both  primary branch and the secondary branch..

Conclusion: This study identifies LCX with OM as the most frequent location of Bifurcated plaque formations, with Provisional single-stent technique being the preferred technique. The Medina 1,1,1 subtype was predominant, reflecting the complexity of disease at these sites. These findings emphasize the importance of tailored strategies to improve outcomes in PCI for bifurcation lesions.