Classification of coronary artery bifurcation lesions and treatments: time for a consensus!
BACKGROUND
Percutaneous coronary intervention (PCI) of coronary bifurcation lesions remains a subject of debate. Many studies have been published in this setting. They are often small scale and display methodological flaws and other shortcomings such as inaccurate designation of lesions, heterogeneity, and inadequate description of techniques implemented.


METHODS
The aim is to propose a consensus established by the European Bifurcation Club (EBC), on the definition and classification of bifurcation lesions and treatments implemented with the purpose of allowing comparisons between techniques in various anatomical and clinical settings.


RESULTS
A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch. The simple lesion classification proposed by Medina has been adopted. To analyze the outcomes of different techniques by intention to treat, it is necessary to clearly define which vessel is the distal main branch and which is (are) the side branche(s) and give each branch a distinct name. Each segment of the bifurcation has been named following the same pattern as the Medina classification. The classification of the techniques (MADS: Main, Across, Distal, Side) is based on the manner in which the first stent has been implanted. A visual presentation of PCI techniques and devices used should allow the development of a software describing quickly and accurately the procedure performed.


CONCLUSIONS
The EBC proposes a new classification of bifurcation lesions and their treatments to permit accurate comparisons of well described techniques in homogeneous lesion groups.
Louvard
Yves
Y
Institut Cardiovasculaire Paris Sud, Massy, France. y.louvard@icps.com.fr
Thomas
Martyn
M
Dzavik
Vladimir
V
Hildick-Smith
David
D
Galassi
Alfredo R
AR
Pan
Manuel
M
Burzotta
Francisco
F
Zelizko
Michael
M
Dudek
Darius
D
Ludman
Peter
P
Sheiban
Imad
I
Lassen
Jens F
JF
Darremont
Olivier
O
Kastrati
Adnan
A
Ludwig
Josef
J
Iakovou
Ioannis
I
Brunel
Philippe
P
Lansky
Alexandra
A
Meerkin
David
D
Legrand
Victor
V
Medina
Alfonso
A
Lefèvre
Thierry
T
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography / Q000592:standards; D023921:Coronary Stenosis / Q000145:classification* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D019919:Prosthesis Implantation / Q000379:methods*; D015607:Stents; D009626:Terminology as Topic