Definitions and classifications of bifurcation lesions and treatment

This article introduces the new terminology proposed by the European Bifurcation Club in order to simplify the identification, description, localisation and measurement of coronary bifurcation lesions as well as the selection of appropriate treatment strategies. A bifurcation lesion is a coronary artery narrowing occurring adjacent to, and/or involving, the origin of a significant side branch that you do not want to lose. The very simple Medina classification is intended for exchange and clinical research purposes. It is combined with a clear side branch definition and is associated with multiple measurement and imaging modalities, which take into account the complexity of lesions and treatments. Dedicated angiography as well as 3D angiography and multislice computed tomography are absolutely necessary for measurement of the bifurcation angles. The MADS (Main, Across, Distal, Side) classification is based on the final position of the stents in the bifurcation and on the order in which stents are implanted according to a strategy reflecting lesion and technique complexity. Although this classification still seems exhaustive, it does not involve the numerous guide and balloon manoeuvres, which would require a thorough a posteriori electronic classification of all inherent specific technical details.