![]() According to Medina classification, a diseased artery is defined as having a stenosis of ≥ 50%. subsequently published their classification which assigns a suffix of 1 (diseased) or 0 (not diseased) to the proximal main branch, side branch and distal main branch, respectively. Image is adapted from definition and classification of bifurcation lesions and treatments. Shown below is an image depicting the modified Duke and ICPS classification systems for coronary artery bifurcation. However the absence of intuitive correlations between the various lesion type and associated classifications makes it difficult to remember and apply these classifications in routine clinical practice. The original schemes published by Sanborn, Safian, Lefevre, and Duke are similar in their approach of using numbers or letters to represent various lesion types. Several classifications have been proposed over the years to help better define the anatomy in bifurcation lesions. This determines the ease of access to the side branch, plaque shift, and hence the preferred treatment strategy. The hips of the bifurcation are areas of low shear stress where plaque accumulates.īifurcation lesions are classified according to the angulation of the bifurcation and plaque burden. Intravascular ultrasound indicates that the majority of plaque burden resides in the hips of the lesion and not at the flow divider or carina of the lesion. The consensus view at this time is that if there is adequate flow in the side branch and no evidence of ischemia at the end of the procedure, then further dilations of the side branch are not warranted. In fact, sidebranch stenting may be associated with a higher risk of stent thrombosis. There is no data to suggest that stenting of a side branch improves outcomes over conventional balloon dilation of the side branch origin. The optimal treatment for these lesions is subject to intense debate current practice includes a variety of approaches. Bifurcation lesions in coronary artery disease (CAD) are common, encompassing 15-18% of lesions treated with percutaneous coronary intervention (PCI). A bifurcation is defined as a division of a main, parent branch into two daughter branches of at least 2.0 mm. Associate Editor(s)-In-Chief: Lisa Battaglia, M.D., Xin Yang, M.D., Arzu Kalayci, M.D.īifurcation lesions occur when the atherosclerotic plaque involves the origin of two separate arteries. Technique Quantification of LV Function Quantification of Mitral RegurgitationĮditor-In-Chief: C. Quantitative Coronary Angiography Definitions of Preprocedural Lesion Morphology Irregular Lesion Disease Extent Arterial Foreshortening Infarct Related Artery Restenosis Degenerated SVG Collaterals Aneurysm Bifurcation Trifurcation Ulceration Preprocedural Lesion Morphology Eccentricity Irregularity Ulceration Intimal Flap Aneurysm Sawtooth Pattern Length Ostial location Angulation Proximal tortuosity Degenerated SVG Calcification Total occlusion Coronary Artery Thrombus TIMI Thrombus Grade TIMI Thrombus Grade 0 TIMI Thrombus Grade 1 TIMI Thrombus Grade 2 TIMI Thrombus Grade 3 TIMI Thrombus Grade 4 TIMI Thrombus Grade 5 TIMI Thrombus Grade 6 ![]() TIMI Myocardial Perfusion Grade TMP Grade 0 TMP Grade 0.5 TMP Grade 1 TMP Grade 2 TMP Grade 3ĪCC/AHA Lesion-Specific Classification of the Primary Target Stenosis TIMI Flow Grade TIMI Grade 0 Flow TIMI Grade 1 Flow TIMI Grade 2 Flow TIMI Grade 3 Flow TIMI Grade 4 Flow Pulsatile Flow Deceleration Standard Views Left Coronary Artery Right Coronary Artery Separate Ostia Anomalous Origins Case Example Fistula Appropriate Use Criteria for RevascularizationĬoronary arteries Dominance Right System Left System Left Main Left Anterior Descending Circumflex Median Ramus
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