Real-World Experience of Coronary Bifurcation Stenting in a Single Centre in Western India

Background: Coronary bifurcation lesions (CBLs) are recognised as an intricate form of coronary artery disease. The anatomic complexity and variable flow dynamics at branch points pose unique challenges, often contributing to suboptimal outcomes if not managed appropriately. Introduction of drug-eluting stents (DESs) in percutaneous coronary interventions (PCIs) practice had been a major breakthrough. However, there are some concerns in bifurcation coronary stenting like choice of bifurcation stenting technique and issue related to side branch (SB) occlusion. This study aimed to present the single-centre real-world experience with bifurcation stenting, highlighting procedural strategies, outcomes and learning points from routine clinical practice. Methods: This descriptive observational study was carried out at a cardiac centre located in western India. Results: Among the 70 patients who underwent PCI for CBL, 72.8% were male, mean age being 65.6 ± 2.8 years. Most frequently encountered CBL was in left anterior descending (LAD)/diagonal (n=24, 34.3%). Out of 70 patients, most prevalent CBL subtypes were Medina 1,1,1 (n = 26, 37.1%) and Medina 1,1,0 (n=20, 28.6%), reflecting the predominance of complex anatomical involvement. The most common coronary bifurcation technique utilised was provisional stenting (PS) (n=46, 65.7%), followed by Double-Kissing (DK) crush technique (n=12, 17.1%). Major adverse cardiac events (MACE) at one month, six months and one year occurred in 4.3% (95% confidence interval (CI): 1.5-11.9), 7.1% (95% CI: 3.1-15.8) and 7.1% (95% CI: 3.1-15.8) patients, respectively; there was no statistical significance. Conclusion: Coronary bifurcation stenting (COBIS), when guided by lesion anatomy, sound strategy selection and meticulous technique, yielded high procedural success and favourable clinical outcomes.