Quantitative angiographic methods for bifurcation lesions: a consensus statement from the European Bifurcation Group. Shortcoming of the Medina classification as a preferred classification for coronary artery bifurcation lesions in comparison to the Movahed classification.

摘要

With great interest we read the recently published manuscript entitled: "Quantitative angiographic methods for bifurcation lesions: a consensus statement from the European Bifurcation Group" [1]. This club has been very active and successful to advance our understanding in the field of coronary artery bifurcation lesions and interventions. However, persistent exclusive use of the Medina classification as the preferred coronary bifurcation classification limits their ability to link their important message to a meaningful, clinically oriented and easy to memorize classification that contains all necessary elements in regards to bifurcation lesions. This paper indirectly admits this dilemma. For example, the importance of bifurcation angle on outcome is recognized in this paper. They correctly cited Dzavik et al. [2] paper about the effect of bifurcation angel on outcome. Furthermore, they developed two separate imaging systems for different bifurcation angels. One for T shape and the other for V (Y) shape bifurcation angels. In their entire manuscript, they do not utilize the Medina classification at all but recommend the Medina classification for reporting. The impracticability of the Medina classification in regards to choosing specific technique for a given bifurcation lesion and failure to include bifurcation angel and other important features of a given bifurcation anatomy in the classification is the main reason why this classification has not been useful as a guide for choosing specific interventional techniques in the setting of coronary bifurcation intervention. Recently published Movahed classification [3,4] clearly overcomes these limitations by including bifurcation angel and other important features of coronary bifurcation lesions in this classification and at the same time markedly improving memorization and clinical relevancy of bifurcation classification.