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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.