Bifurcation Lesions: Definition and Classification

Assoc. Prof. Dr. Veysel Ozan Tanık1
Dr. Doğukan Yazıcı2

1Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
2Ankara Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

ABSTRACT

Approximately 20% of lesions treated with percutaneous coronary interventions (PCI) are bifurcation lesions. Coronary bifurcation stenting is still a difficult technique, despite the advent of new drug-eluting stents and major technological breakthroughs. Complicated anatomical features, geometric changes during the inter- vention, and a higher risk of restenosis and stent thrombosis all contribute to these difficulties.The use of drug-eluting stents, bioresorbable stents, metallic stents, and coronary angioplasty has expanded in the last few years, resulting in a significant transformation of the cardiology sector. The treatment of coronary bi- furcation lesions continues to be a particularly challenging and contentious issue in this quickly changing environment. However, a range of classification and definitional standards for these lesions, as well as various approaches to therapy, have been established and are currently frequently used in clinical settings.

Keywords: Coronary bifurcation lesions; Medina Classification; MADS

Referanslar

  1. Medina A, Suárez de Lezo J, Pan M. Una clasificación simple de las lesiones coronarias en bifurcación [A new classification of coronary bifurcation lesions]. Rev Esp Cardiol. 2006;59(2):183. [Crossref]  [PubMed]
  2. Foin N, Secco GG, Ghilencea L, Krams R, Di Mario C. Final proximal post-dilatation is necessary after kissing balloon in bifurcation stenting. EuroIntervention. 2011 Sep;7(5):597- 604. [Crossref]  [PubMed]
  3. Lassen JF, Holm NR, Stankovic G, Lefèvre T, Chieffo A, Hildick-Smith D, et al. Percutaneous coronary intervention for coronary bifurcation disease: consensus from the first 10 years of the European Bifurcation Club meetings. EuroInter- vention [Internet]. 2014 Sep 1 [cited 2024 Sep 5];10(5):545-60. [Crossref]  [PubMed]
  4. Lunardi M, Louvard Y, Lefèvre T, Stankovic G, Burzotta F, Kassab GS, et al. Definitions and Standardized Endpoints for Treatment of Coronary Bifurcations. EuroInterven- tion. 2023 Dec 1;19(10):E807-31 https://doi.org/10.4244/ eij-e-22-00018 [Crossref]  [PubMed]  [PMC]
  5. Koo BK, Lee SP, Lee JH, Park KW, Suh JW, Cho YS, et al. Assessment of Clinical, Electrocardiographic, and Phys- iological Relevance of Diagonal Branch in Left Anterior Descending Coronary Artery Bifurcation Lesions. JACC Cardiovasc Interv. 2012 Nov 1;5(11):1126-32. [Crossref]  [PubMed]
  6. Louvard Y, Thomas M, Dzavik V, Hildick-Smith D, Galassi AR, Pan M, et al. Classification of coronary artery bifurca- tion lesions and treatments: Time for a consensus! Cathe- terization and Cardiovascular Interventions [Internet]. 2008 Feb 1 [cited 2024 Aug 25];71(2):175-83. [Crossref]  [PubMed]
  7. Park TK, Park YH, Song YB, Oh JH, Chun WJ, Kang GH, Jang WJ , et al. Long-Term Clinical Outcomes of True and Non-True Bifurcation Lesions According to Medina Classi- fication- Results From the COBIS (COronary BIfurcation Stent) II Registry. Circ J. 2015;79(9):1954-62. [Crossref]  [PubMed]
  8. Medina A, Suárez de Lezo J, Pan M. Una clasificación simple de las lesiones coronarias en bifurcación. Revista Española de Cardiología (English Edition) [Internet]. [Link]
  9. Zlotnick DM, Ramanath VS, Brown JR, Kaplan A V. Classi- fication and treatment of coronary artery bifurcation lesions: putting the Medina classification to the test. Cardiovascular Revascularization Medicine [Internet]. 2012;13(4):228-33. [Crossref]  [PubMed]
  10. Latib A, BCh M, Colombo A, Town C, Africa S. Bifurca- tion Disease: What Do We Know, What Should We Do?JACC Cardiovasc Interv [Internet]. 2008 [cited 2024 Aug 25];1(3):218-26. [Link]
  11. Gobeil F, Lefèvre T, Guyon P, Louvard Y, Chevalier B, Du- mas P, et al. Stenting of bifurcation lesions using the bestent: A prospective dual-center study. Catheterization and Car- diovascular Interventions. 2002;55(4):427-33. [Crossref]  [PubMed]
  12. Papadopoulou SL, Girasis C, Gijsen FJ, Rossi A, Ottema J, Van Der Giessen AG, et al. A CT-based Medina classification in coronary bifurcations: does the lumen assessment provide sufficient information? Catheter Cardiovasc Interv [Inter- net]. 2014 Sep 1 [cited 2024 Aug 25];84(3):445-52. [Crossref]  [PubMed]
  13. Burzotta F, Trani C, et al. Management of coronary bifur- cation lesions: A practical approach. International Jour- nal of Cardiology. 2009;133(1):13-21. [Crossref]
  14. Zack PM, Ischinger T. Experience with a technique for cor-onary angioplasty of bifurcational lesions. Cathet Cardio- vasc Diagn. 1984;10(5):433-43. [Crossref]  [PubMed]
  15. Louvard Y, Lefèvre T, Morice MC. Percutaneous coronary intervention for bifurcation coronary disease. Heart [In- ternet]. 2004 Jun 1;90(6):713. [Crossref]  [PubMed]  [PMC]
  16. Sharma SK, Choudhury A, Lee J, Kim MC, Fisher E, Stein- heimer AM, et al. Simultaneous kissing stents (SKS) tech- nique for treating bifurcation lesions in medium-to-large size coronary arteries. American Journal of Cardiology [Internet]. 2004 Oct 1 [cited 2024 Aug 25];94(7):913-7. [Crossref]  [PubMed]
  17. Shin DH, Park KW, Koo BK, Oh IY, Seo J Bin, Gwon HC, et al. Comparing Two-Stent Strategies for Bifurcation Cor- onary Lesions: Which Vessel Should be Stented First, the Main Vessel or the Side Branch? J Korean Med Sci [Inter- net]. 2011 Aug [cited 2024 Aug 25];26(8):1031. [Crossref]  [PubMed]  [PMC]