![]() No randomized studies have compared PCI with coronary artery bypass grafting (CABG) in a bifurcation-only patient population. PCI is performed to reduce or eliminate symptoms secondary to stable or unstable coronary artery disease (CAD) or ischemic cardiomyopathy. The indications for PCI of coronary bifurcation lesions follow the same general principles for revascularization of nonbifurcation lesions. One distinction is to distinguish “true” or “complex” lesions from “nontrue” or “pseudo-” bifurcation lesions.Ī “true” bifurcation lesion involves significant (>50%) stenosis in both the MB and the SB (i.e., Medina 1,1,1 1,0,1 or 0,1,1), whereas all other lesion types would be classified as “nontrue.” It is important to recognize that angiography may be limited in terms of its ability to appropriately classify bifurcation lesions, and adjunctive modalities such as intravascular ultrasound (IVUS) may be necessary to determine a lesion’s true classification. JACC Cardiovasc Interv 2008 1:218-26.įor example, a lesion involving the proximal and distal MB without any SB involvement is classified as Medina “1,1,0”. Reproduced with permission from Latib et al. Medina Classification for Coronary Bifurcation Lesions. The Medina classification assesses plaque burden based on the presence (“1”) or absence (“0”) of stenosis in the proximal MB, distal MB, and SB (Figure 1). The simplest and most widely used is the Medina classification. Numerous classification schemes have been proposed to characterize coronary bifurcation lesions. The European Bifurcation Club defines a bifurcation lesion as a significant stenosis (i.e., >50%) in a coronary artery adjacent to and/or involving the origin of an SB that is clinically significant. The carina is the inflection point at which the proximal MB bifurcates into the distal MB and SB. Characterizing bifurcation lesions involves assessing the lesion morphology in three important anatomic segments: (1) proximal main branch (MB) (2) distal MB and (3) side branch (SB). A coronary bifurcation lesion occurs at or near a division of a major coronary artery.
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