UPDATE ON CORONARY BIFURCATION CLASSIFICATION AND TECHNIQUES


Mohammad R. Movahed, M.D., Ph.D., The Southern Arizona VA Health Care System, Tucson, AZ, USA

There are many classifications for coronary bifurcation lesions. This talk will focus on most comprehensive classification of bifurcation lesions that is simple, practical and inclusive of other important features of coronary bifurcation lesions that are not mentioned in other classifications. This classification is based on a system composed of a single prefix [prefix B (for Bifurcation lesion) ] to which up to 3 main suffixes are added describing important anatomical features of a given bifurcation lesion. This classification addresses two important technical features of bifurcation lesions: the proximal segment size, and the bifurcation angle. It is known that if the proximal segment is too small, the kissing stenting technique cannot be utilized (small is defined as less than 2/3 of the sum of the diameters of both branch vessels, suffix S for small). Medina classification does not include this important anatomical feature in their classification and this review did not mention this important feature. The second suffix describes the involvement of the disease area of the bifurcation branches, i.e., if both ostia at the bifurcation site are involved, number 2 is used, if the main branch only is involved, 1m is used and if the side branch only is involved, 1s is used. B2 lesions in this classification are a true bifurcation lesion. An algorithmic approach to coronary intervention using this classification.A detailed algorithmic approach based on Movahed’s classification was recently published. Further more new data in regards to new technique and outcome of bifurcation lesions will be discussed such as lack of benefit in two stent technique vs one stent and use of jailed balloon technique in side branch during main branch stenting for side branch protection.