Medina Classification Modification Proposal. It’s Time for a Step Ahead: the Side Branch Lesion Length Matters More (and Changes our Interventions)

The Medina Classification1, extensively employed in clinical practice and scientific literature, delineates bifurcation lesions (BL) treated with percutaneous coronary interventions (PCIs). When initially introduced, the cases addressed by the PCIs were less intricate, with side branch (SB) lesions predominantly featuring less critical involvement in length compared to the procedures routinely conducted in contemporary catheterization laboratories. The absence of precise quantification pertaining to SB involvement induces interpretative ambiguity in discerning the outcomes and the preferred strategies conveyed by randomized controlled trials dedicated to the treatment of BL. Given the inherent affliction of the main branch in true bifurcation lesions, the pivotal determinant in formulating a 1- or 2-stent strategy and, consequently, influencing procedural outcomes lies in discerning the degree and extension of SB disease from the outset. Consequently, we assert that the integration of a more detailed depiction of SB pathology into the original classification is of paramount importance. We believe that the temporal juncture is ripe for progressive refinement, wherein incorporating the original classification with supplementary descriptive parameters and characteristics as already contemplated in Medina's initial publication. Founded on the revised classification, prospective delineation of a 1- or 2-stent strategy becomes feasible from the outset. Furthermore, through nuanced discrimination among distinct bifurcation populations, the classification facilitates more uniform and dependable comparisons across diverse interventions and techniques. This not only holds relevance for future studies but also ensures retrospective applicability to past publications. Importantly, this iteration preserves the inherent simplicity and user-friendly attributes of the original classification.