A Modified Medina and Movahed (3M) Classification of Coronary Bifurcation Lesions
1Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital, Army Medical University, Chongqing, China
2Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
Anatol J Cardiol 2024; 28(4): 213-214 PubMed ID: 38430114 PMCID: 11017679 DOI: 10.14744/AnatolJCardiol.2023.4019
Full Text PDF

CONTENT

To the Editor,

With great interest we read the article entitled “A Novel Descriptive Coding System for Coronary Bifurcation Lesions’’ published in your journal.1 This paper proposes a new classification method of bifurcation lesions. However, this classification seems also difficult to remember.

We developed a Modified classification of coronary bifurcation lesions based on Medina and Movahed methods (3M classification).2,3 This classification (Figure 1) includes information regarding the location of coronary bifurcation (left main vs. non-left main), angle of bifurcation (“V/Y<70°” or “T≥70°”), percentage of stenosis in proximal, distal main vessel (MV) and side branch (SB), instead of 1 or 0.4,5 In addition, the “Y” bifurcation type represents one unique bifurcation with an angle <70° and a large proximal segment at least as large as two-thirds of the sum of the diameter of both branch vessels, which can accommodate 2 stents.4

For example, LY 9.8.8 means a left main bifurcation with significant stenosis of 90% in the proximal left main, 80% in the left anterior descending, and 80% in left circumflex artery. In such a narrow bifurcation (<70°), with involvement of both side branches, a 2-stent strategy may be indicated. Based on the MADS-2 classification of bifurcation stenting techniques, the simultaneous kissing stent (SKS) is indicated.4 On the other hand, V 8.3.3 means a non-left main bifurcation (<70°) with significant stenosis of 80% in the proximal main branch, 30% in the distal main branch, and 30% in the SB. Therefore, a provisional stenting may be indicated.

Footnotes

Declaration of Interests: Dr. Azzalini received consulting fees from Teleflex, Abiomed, GE Healthcare, Abbott Vascular, Reflow Medical, and Cardiovascular Systems, Inc.; serves on the advisory board of Abiomed and GE Healthcare; and owns equity in Reflow Medical. All Other authors have no conflict of interest to declare.

References

  1. Ağaç MT, Vatan MB, Çakar MA, Tatlı E. A novel descriptive coding system for coronary bifurcation lesions. Anatol J Cardiol. 2023;27(1):10-11. https://doi.org/10.14744/AnatolJCardiol.2022.1960
  2. Medina A, Suárez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006;59(2):183-. https://doi.org/10.1157/13084649
  3. Movahed MR, Stinis CT. A new proposed simplified classification of coronary artery bifurcation lesions and bifurcation interventional techniques. J Invasive Cardiol. 2006;18(5):199-204. https://doi.org/10.1016/j.carrev.2006.03.040
  4. Lunardi M, Louvard Y, Lefèvre T. Definitions and standardized endpoints for treatment of coronary bifurcations. J Am Coll Cardiol. 2022;80(1):63-88. https://doi.org/10.1016/j.jacc.2022.04.024
  5. Legrand V, Thomas M, Zelisko M. Percutaneous coronary intervention of bifurcation lesions: state-of-the-art. Insights from the second meeting of the European Bifurcation Club. EuroIntervention. 2007;3(1):44-49.