Classification and treatment of coronary artery bifurcation lesions: putting the Medina classification to the test

BackgroundCoronary bifurcation lesions are common, difficult to treat, and associated with poorer outcomes compared to non-bifurcation lesions. The Medina classification has been widely adopted as the preferred system to classify bifurcation lesions, however there have been little efforts to characterize this metric. The objective of this study was to characterize the inter-observer variability of the Medina classification and examine its contribution to treatment selection strategy.Methods and materialsWe invited 150 interventional cardiologists from the United States and Europe to complete an online survey evaluating 12 freeze frame coronary angiograms of bifurcation lesions. Each respondent was asked to characterize the bifurcation lesions using the Medina classification and other metrics including side branch vessel size and angle. Respondents were asked to designate either a provisional (1 stent) or dedicated (2 stent) treatment strategy. ‘Complex’ lesions were defined as Medina scores 1.1.1, 0.1.1, or 1.0.1.ResultsA total of 49 interventional cardiologists responded. In 7 of the 12 angiograms evaluated, there was > 75% agreement regarding lesion classification using the Medina system. There was moderate inter-observer agreement when using Medina to classify lesions as ‘Complex’ vs. ‘non-Complex’. ‘Complex’ bifurcation designation and side branch size were predictive of selection of a dedicated treatment strategy, whereas side branch angle was not.ConclusionsThe Medina classification is a useful tool in characterizing coronary bifurcation lesions. For the majority of the angiograms evaluated there was good inter-observer agreement in lesion classification using the Medina system. ‘Complex’ bifurcation designation and side branch size were predictive of selection of a dedicated treatment strategy.     

血管内超声在分叉病变介入中的价值

即使在药物支架时代和采用多种术式,如Crush技术、Culotte支架术和V支架术等,无论手术成功率还是长期主要心血管事件、靶病变重建、再狭窄和支架内血栓方面,分叉病变的介入治疗目前仍充满挑战,目前必要支架术策略为术者广泛接受,但是对于分支血管严重狭窄的患者,双支架术仍然必需。血管内超声可以精确提供血管和管腔的大小、粥样斑块空间定位和几何学特征,所以血管内超声在术前评估斑块负荷、指导经皮冠状动脉介入治疗和随访期间理解支架失败具有重要作用,现综述血管内超声在分叉病变介入治疗中的价值。     

A novel stenting technique for coronary artery bifurcation stenosis

A novel stenting technique, using one stent strategy, designed to treat type Medina 1,0,0 coronary bifurcation lesions, is described. The atherosclerotic plaque burden in this category of bifurcation lesions is located in the proximal segment of the main branch (MB) of a coronary bifurcation in which the side branch has a sharp angulation (T‐ or reverse‐shaped) relative to the MB. The advantages of this technique are the accurate placement of the stent tailored to cover solely the bifurcation lesion, shoving the plaque burden away from the side branch ostium during stent expansion and the ability to maintain guide wire access in the branch at highest risk of occlusion obviating the need for more cumbersome and time consuming percutaneous coronary intervention procedure. © 2009 Wiley‐Liss, Inc.     

冠状动脉分叉病变特点、分型和治疗策略

分叉病变始终是冠状动脉介入治疗的一个难点,尽管药物洗脱支架减少了介入术后主支的再狭窄,但分支血管的术中急性闭塞风险和术后再狭窄和支架内血栓问题仍值得关注。现回顾冠状动脉分叉病变的定义、分类和各种治疗方法,以期对冠状动脉介入治疗有一个较全面的认识。     

Progress in percutaneous management of coronary bifurcation lesions

Bifurcation lesions have been recognized as one of the most important challenges facing the interventional cardiologist since the beginnings of percutaneous coronary intervention (PCI). The potential of periprocedural occlusion of the side branch was discovered to be significant, leading to early attempts at protecting the side branch with a second guide wire and kissing balloon inflation in order to minimize this risk and thus improve the procedural and short-term success of the procedure. The advent of stenting significantly improved the safety of the procedure, although, side branch success continued to be a challenge. A variety of single as well as double stenting techniques were developed that improved the safety and short-term results of percutaneous coronary intervention involving side branches. Long-term success, however, continued to elude, due to an increased need for target lesion revascularization (TLR) and higher major adverse cardiac event (MACE) rates following PCI of bifurcation lesions. Of the techniques, main vessel stenting and balloon inflation of the side branch, T-stenting, and permutations of Y-stenting including the Culotte, emerged. The introduction of drug-eluting stents appears to have brought bifurcation PCI to a new level of long-term efficacy. Specialty bifurcation stents have been developed to provide easy access to the side branch, however, these have to date had little impact on practice and have not been adopted widely. New techniques such as crush stenting and its several permutations, and simultaneous kissing stenting developed specifically for drug-eluting stents have been developed. Debate continues as to which is the most efficacious technique. True randomized comparisons are, however, lacking. It is likely that all of the currently utilized techniques have a place in the interventional cardiologist's quiver and that each is appropriate in a particular anatomical scenario. Nonetheless, well-designed randomized trials evaluating the various bifurcation techniques especially in complex bifurcation lesions are needed.     

单纯药物涂层球囊策略治疗冠状动脉分叉病变分支血管的临床观察

目的观察单纯应用药物涂层球囊治疗冠状动脉分叉病变的安全性及有效性。方法入选我院心内科31例分叉病变患者(主支狭窄50%,分支开口狭窄70%;分支血管参考直径≥2mm),单纯应用药物涂层球囊处理分支血管,观察手术成功率、分支血管血流情况及并发症发生率,术后9个月行冠状动脉造影检查,记录随访过程中不良心血管事件(MACE)的发生情况。结果 31例患者33个分叉病变中位于前降支/对角支占57.58%,回旋支/钝缘支占30.30%,右冠状动脉/后降支或左室后支占12.12%。31例患者均成功完成分叉病变介入治疗,手术成功率100%,并且全部患者均经桡动脉途径完成。其中2列患者出现分支血管夹层(1例TIMI血流2级)进行补救性药物洗脱支架植入。围手术期及术后临床随访(门诊或电话随访),无死亡或心肌梗死等主要心脏不良事件发生。74.19%的患者完成了冠状动脉造影复查,仅1例行靶病变再次血运重建(TLR)。分支晚期管腔丢失(LLL)为(0.13±0.25)mm。结论单独药物涂层球囊策略处理冠状动脉分叉病变分支血管是安全有效的。     

A modified provisional stenting approach to coronary bifurcation lesions: clinical application of the "jailed-balloon technique"

Objectives: To demonstrate the application of a novel provisional side branch (SB) stenting strategy for coronary bifurcation lesions using a “jailed‐balloon” technique (JBT). Background: Adverse cardiac events are higher for percutaneous coronary intervention (PCI) of bifurcation lesions. Recent studies support the use of provisional SB stenting, but a risk of SB closure and a higher rate of target lesion revascularization (TLR) remain important limitations. Methods: From December 2007 to August 2010, 100 patients with 102 bifurcation lesions underwent PCI using the JBT. Baseline and postprocedural quantitative coronary angiography (QCA) analysis were performed. Procedural and immediate clinical outcomes were reviewed. Results: The majority of patients presented with acute coronary syndrome (68%) and had Medina class 1,1,1 bifurcation lesions (91%). TIMI 3 flow was established in 100% of main branch and 99% of SB lesions. QCA revealed preservation of the bifurcation angle after PCI (pre‐PCI: 59.6 ± 30.0; post‐PCI: 63.3 ± 26.8, P = 0.41). Nine patients (9%) had lesions that required rewiring and two patients (2%) required provisional stenting of the SB. SB loss occurred in one patient (1%). The jailed‐balloon or wire was not entrapped during any PCI. One patient (1%) suffered a periprocedural myocardial infarction (MI). Conclusions: Provisional stenting of complex coronary bifurcation lesions using a JBT is associated with a high procedural success rate, improved SB patency, and a low rate of immediate cardiac events. Further study is warranted to evaluate the role of JBT in improving long‐term clinical outcomes in PCI of complex bifurcation lesions. (J Interven Cardiol 2012;25:289–296)     

Stenting of bifurcation lesions using the Bestent: a prospective dual-center study.

Treatment of bifurcation lesions remains a technical challenge. Among 13 stents previously tested in a bench study, the Bestent seemed of particular interest in this indication as it provided good access to the side branch after stent implantation in the main branch associated with a satisfactory coverage of the lesion after kissing balloon inflation. The use of Bestent implanted in the main branch or both branches for treatment of bifurcation lesions involving a side branch > or = 2.2 mm in diameter was prospectively evaluated in a dual-center prospective study with a prospective 6-month clinical follow-up. All angiographic documents were analyzed by an independent corelab (CORISIS). Between 11 September 1997 and 21 February 1998, 96 patients were consecutively included (mean age, 63.7 +/- 11.4 years; 81.3% male; 58.3% with unstable angina and 6.3% acute myocardial infarction). The lesion involved the left anterior descending-diagonal coronary bifurcation in 55% of cases, left circumflex-marginal 23%, posterior descending-postero-lateral 12%, distal left main 6%, and others 4%. The main branch (proximal reference diameter: 3.43 +/- 0.45 mm) was stented in 98% of cases and the side branch (2.72 +/- 0.38 mm) in 38% (both branches in 34% of cases). T-stenting or provisional T-stenting was used in 88% of cases and final kissing balloon inflation was performed in 78% of cases. Procedural success was obtained in 100% of cases in the main branch and 98% in both branches. Major cardiac and cerebral events (MACCE) during hospitalization occurred in 4.2% of cases, non-Q-wave myocardial infarction (MI) in 3.1%, Q-wave MI in 1.0%, repeat PTCA in 2.1%; there were no major access site complication, no emergency coronary artery bypass grafting operation, no death. At 6-month follow-up, total MACCE rate was 14.6% (Q-wave MI, 3.1%; non-Q-wave MI, 3.1%; target vessel revascularization, 9.4%; death, 2.1%). Patients with target vessel revascularization (TVR) had restenosis of both branches in 22.2% of cases, main branch in 22.2%, and side branch in 55.6%. This study shows that using a simple strategy of provisional T-stenting of the side branch in the majority of cases, the Bestent can be used for treating bifurcation lesions with a high rate of success and an acceptable rate of TVR at 6-month follow-up.     

Intravascular ultrasound predictors of side branch occlusion in bifurcation lesions after percutaneous coronary intervention.

BACKGROUND: Percutaneous coronary intervention (PCI) of bifurcation lesion has been associated with a low success rate and a high incidence of procedural complications, including side branch occlusion and myocardial infarction. It remains controversial whether preintervention intravascular ultrasound (IVUS) findings can help to identify side branches likely to occlude after PCI of bifurcation lesions. METHODS AND RESULTS: From our IVUS database we identified 81 bifurcation lesions in 72 patients. Side branches were classified into 2 groups: group 1 had ostial side branch stenosis due to atherosclerotic plaque only in the main vessel (n=61), and group 2 had plaque truly involved in the side branch ostium (n=20). There was no significant difference between the 2 groups in the extent of ostial stenosis as assessed by angiography. After PCI, 7 side branches occluded in group 2, compared with 5 side branches occluded in group 1 (35% vs 8%, p=0.003). CONCLUSION: Ostial plaque distribution as assessed by IVUS may be one of the consistent predictors of side branch occlusion after PCI.     

Present status of coronary bifurcation stenting

Percutaneous coronary intervention (PCI) for bifurcation lesions is technically limited by the risk of side branch occlusion. In comparison with nonbifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs and a higher rate of clinical and angiographic restenosis. The recent introduction of drug-eluting stents (DES) has resulted in reduced incidence of main vessel restenosis compared with historical controls. However, side-branch ostial residual stenosis and long-term restenosis still remain problematic. In the era of DES, techniques employing two stents have emerged that allow stenting of the large side branch in addition to the main artery. Stenting of the main vessel with provisional side branch stenting seems to be the prevailing approach. This paper reviews outcome data with different treatment modalities for this complex lesion with particular emphasis on the use of DES as well as potential new therapeutic approaches.     

Dedicated bifurcation stents – Mechanistic,hardware, and technical aspects

Percutaneous coronary intervention (PCI) in bifurcation lesions is associated with lower success rate, higher acute complication rates and higher event rates in follow-up.The reason for this higher than usual complication rate relates to the relationship between anatomy, flow, and atheroma distribution in bifurcation lesions.Further, stenting these lesions can be a prolonged procedure and can be technically more demanding. The most common complication is the loss of significant side branch (SB). Main vessel (MV) stenting may enhance the carina displacement and atheroma shift across the SB ostium leading to SB ostium narrowing.Finally, complications, if they occur, are more difficult to manage. Dedicated bifurcation stent has been developed to overcome the number of limitations associated with conventional bifurcation PCI. The main advantage of most dedicated bifurcation stents is to allow the operator to perform the procedure on a bifurcation lesion without the need to rewire the SB.     

Detection and characterization of coronary bifurcation lesions with 64-slice computed tomography coronary angiography.

AIMS: To compare the performance of 64-slice computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) in the detection and classification (according to the Medina system) of bifurcation lesions (BLs). METHODS AND RESULTS: We studied 323 consecutive patients undergoing 64-slice CTCA prior to ICA. All coronary segments >or=2 mm in diameter were evaluated for the presence of a significant (>or=50% diameter reduction on quantitative coronary angiography) BL. Evaluation of BL by CTCA included the assessment of significant lumen obstruction in both main and side branch vessels. Forty-one out of 43 patients (46/48 lesions) with significant BL were identified by CTCA. Excluding coronary segments with non-diagnostic image quality (5%), the sensitivity, specificity, and positive and negative predictive values of CTCA for detecting significant BL were 96, 99, and 85 and 99%, respectively. In 39 of these 41 patients, CTCA assessment was concordant with the Medina lesion classification on ICA. CONCLUSION: Sixty-four-slice CTCA allows accurate assessment of complex BL.     

Validity and variability in visual assessment of stenosis severity in phantom bifurcation lesions: a survey in experts during the fifth meeting of the European Bifurcation Club

Objectives : To investigate the adequacy of visual estimate regarding the percent diameter stenosis (DS) in bifurcation lesions. Background: Quantitative coronary angiography (QCA) is more accurate and precise compared to visual estimate in assessing stenosis severity in single‐vessel lesions. Methods: Thirty‐six experts in the field of bifurcation PCI visually assessed the DS in cine images of five precision manufactured phantom bifurcation lesions, experts being blinded to the true values. Expert DS estimates were compared with the true values and they were also used to define the Medina class of each individual bifurcation. Results were pooled together both for proximal main vessel (PMV), distal main vessel (DMV) and side‐branch (SB) segments and for vessel segments with similar DS values. Results: Individual performance was highly variable among observers; pooled values and range of accuracy and precision were 2.79% (?6.67% to 17.33%) and 8.69% (4.31–16.25%), respectively. On average, DS was underestimated in the PMV (?1.08%, P = 0.10) and overestimated in the DMV (3.86% P < 0.01) and SB segments (5.58%, P < 0.01). Variability in visual estimates was significantly larger in lesions of medium severity compared to the clearly obstructive ones (P < 0.01); the latter were consistently overestimated. Inter‐observer agreement was moderate (κ = 0.55) over the entire number of estimates. However, if the segments with true DS = 0% were excluded, agreement was diminished (κ = 0.27). Inter‐observer agreement in Medina class was rather low (κ = 0.21). True bifurcation lesions were misclassified as non‐true ones in 14/180 estimates. Conclusions: Visual assessment by experts is more variable and less precise in the analysis of bifurcation lesions compared to bifurcation QCA software. © 2011 Wiley Periodicals, Inc.     

应用切割球囊结合支架术治疗冠状动脉分叉处病变89例

目的 :评价经皮冠状动脉腔内切割球囊成形术 （PTCBA）结合支架术治疗冠脉分叉处病变的安全性及疗效。方法 :对 89例冠心病患者主支病变应用 PTCBA预扩张后置入支架、分支病变单行 PTCBA而不置入支架 ,观察其冠脉病变特点、手术过程相关因素、手术成功率、并发症和近、中期随访结果。结果 :89例患者中分叉处病变位于前降支 /对角支占 71% ,回旋支 /钝圆支占 2 5 % ,右冠脉 /后降支或后侧支占 4%。对分支血管行 PTCBA后 1例因残余狭窄 >5 0 %而植入支架 ,1例因并发轻度钙化且分支成角较大切割球囊未通过 ,改用常规 PTCA球囊扩张成功。病变 PTCBA成功率达 97.8% ;无院内死亡、急性心肌梗死 （AMI）、急性心包填塞及急诊冠脉搭桥术等严重并发症。对手术成功的 87例术后临床随访 3～ 2 6个月 ,无死亡及 AMI等心脏事件发生。临床心绞痛复发率 17.2 %。复查冠脉造影 （CAG）率 5 6.3 % ,示 49处分叉病变主支支架内再狭窄率 14.3 % ,分支血管再狭窄率 18.4%。结论 :PTCBA结合支架术治疗冠脉分叉处病变是一种安全、有效的介入治疗技术 ,其成功率高、并发症少 ,近、中期疗效满意     

Clinical applications of fractional flow reserve in bifurcation lesions

Percutaneous coronary intervention (PCI) for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the functional significance of bifurcation lesions. The fractional flow reserve (FFR) is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.     

Drug‐eluting stents in bifurcation lesions: To stent one branch or both?

OBJECTIVES: The objective of this study was to compare two techniques to treat bifurcation lesions: a single drug-eluting stent (DES) implanted in the main branch combined with balloon dilatation for the side branch vs. stenting of both branches (double stent). BACKGROUND: Percutaneous coronary intervention in coronary bifurcation lesions remains challenging. Although DES reduce restenosis in lesions, the double stent procedure has not shown clear advantages over a single stent with balloon dilation. METHODS: Fifty-three symptomatic patients with true bifurcation lesions were treated using either the double stent technique (n = 25) or one stent in the parent vessel plus balloon angioplasty of the side branch (n = 28). Procedural results and major adverse cardiac event rates (MACE: cardiac death, myocardial infarction, target vessel revascularization (TVR)) were compared. RESULTS: Angiographic procedural success (residual stenosis <30% in both branches) was 75% in the single stent group and 100% in the double stent group (P = 0.01). All differences were due to residual stenosis of the side branch. Clinical follow-up (6-18 months) was available for all patients; 90.5% of patients had a coronary angiography or nuclear stress test. Three patients (11%) in the single stent group and two (8%) in the double stent group had ischemia-driven TVR (P = NS). Asymptomatic angiographic restenosis (>50% diameter stenosis) in the ostium of the side branch was seen in two patients in the double-stent group. At 6 months, MACE-free was comparable between groups (89.3% vs. 88%, P = 0.7). CONCLUSIONS: When treating bifurcation lesions with sirolimus-eluting stents, restenosis following a single stent procedure is comparable to stenting both parent and side branch vessels. Thus, stenting the main-branch lesion, coupled with balloon angioplasty in the side branch, produces a high success rate and good clinical outcomes at 6 months.     

A Novel guide extension assisted stenting technique for coronary bifurcation lesions

A challenging technical scenario frequently encountered in a percutaneous coronary intervention of a coronary bifurcation lesion(CBL) is stent implantation of only the stenosed segment without compromising the other two normal segments in non-true bifurcation lesions. Another is precise stent implantation covering the side branch ostium without leaving excessive stent metal at the other two segments of a bifurcation lesion in complex true bifurcation lesions. The aim of this study was to describe a novel stenting technique for both non-true and true CBLs by using a guide extension catheter(GuideLiner). With the assistance of a guide extension catheter mounted on both the main and the side-branch guidewires and with its intubation down to the bifurcation carina, a stent can be implanted in the side branch segment or distal main segment of the bifurcation lesion appropriately without compromising the other two segments of the coronary bifurcation. Stent implantation is described in three bifurcation lesions in three cases and shown in detail with illustrative figures. The technique facilitates side-branch only stenting in side-branch mono-ostial(medina 0, 0, 1) CBL or only the distal main segment in distal mono-ostial(medina 0, 1, 0) CBL without compromising the other two remaining segments when using the onestent technique in non-true CBLs without leaving unnecessary excessive stent metal at the bifurcation site and when using a two-stent technique in complex true bifurcation lesions(tri-ostial or medina 1, 1, 1). Consequently, through optimizing stent deployment, the technique may have the potential to reduce the risk of subacute stent thrombosis and future in-stent restenosis. The most appropriate lesions suitable for the technique, and some other practical tips are also described.     

Drug eluting stenting in bifurcation coronary lesions long-term results applying a systematic treatment strategy

Objectives : To explore the long‐term results following implantation of drug‐eluting stents (DES) in bifurcation lesions according to contemporary “real world” practice. Background : Limited information is available on the long‐term outcomes of patients with bifurcation lesions who are treated using DES. A systematic approach for bifurcation lesion management was applied, using either a “provisional” single stent technique or a dedicated two stents strategy according to the side‐branch diameter and severity of its ostial stenosis. Methods : Four hundred one consecutive patients underwent bifurcation percutaneous coronary intervention (PCI) using DES and were included in our prospective registry. All adverse events were recorded up to 2 years and distinguished according to the planned PCI strategy (e.g., one versus two stents technique). Results : A planned two stents strategy was used in 141 patients (35% of patients). In 260 patients (65%), the planned treatment involved stenting of the main branch only with “provisional” stenting of the side‐branch according to procedural course. Thus, 24 patients (9.2%) needed additional stenting at the side‐branch to complete the PCI. Cumulative major adverse cardiac event rate at 1 and 2 years was similar for both groups (11.4% vs. 14.8% at 1 year and 19.4% vs. 25.7% at 2 years for the single vs. two stents groups, accordingly, P = NS for both). Likewise, there was no difference in mortality, cardiac mortality, myocardial infarction, need for target lesions or target vessel revascularization, or definite stent thrombosis rate between the two groups at 6, 12, and 2 years follow‐up. The rate of angiographically confirmed (i.e., definite) stent thrombosis did not differ between the two groups during follow‐up. Conclusions : Our study revealed favorable long‐term clinical results following DES implantation using a systematic, rather simplified approach towards bifurcation stenting and using either a single or double stenting technique. © 2011 Wiley Periodicals, Inc.     

Stenting of bifurcation lesions: a rational approach

The occurrence of stenosis in or next to coronary bifurcations is relatively frequent and generally underestimated. In our experience, such lesions account for 15%-18% of all percutaneous coronary intervention > (PCI). The main reasons for this are (1) the coronary arteries are like the branches of a tree with many ramifications and (2) because of axial plaque redistribution, especially after stent implantation, PCI of lesions located next to a coronary bifurcation almost inevitably cause plaque shifting in the side branches. PCI treatment of coronary bifurcation lesions remains challenging. Balloon dilatation treatment used to be associated with less than satisfactory immediate results, a high complication rate, and an unacceptable restenosis rate. The kissing balloon technique resulted in improved, though suboptimal, outcomes. Several approaches were then suggested, like rotative or directional atherectomy, but these techniques did not translate into significantly enhanced results. With the advent of second generation stents, in 1996, the authors decided to set up an observational study on coronary bifurcation stenting combined with a bench test of the various stents available. Over the last 5 years, techniques, strategies, and stent design have improved. As a result, the authors have been able to define a rational approach to coronary bifurcation stenting. This bench study analyzed the behavior of stents and allowed stents to be discarded that are not compatible with the treatment of coronary bifurcations. Most importantly, this study revealed that stent deformation due to the opening of a strut is a constant phenomenon that must be corrected by kissing balloon inflation. Moreover, it was observed that the opening of a stent strut into a side branch could permit the stenting, at least partly, of the side branch ostium. This resulted in the provocative concept of "stenting both branches with a single stent." Therefore, a simple approach is currently implemented in the majority of cases: stenting of the main branch with provisional stenting of the side branch. The technique consists of inserting a guidewire in each coronary branch. A stent is then positioned in the main branch with a wire being "jailed" in the side branch. The wires are then exchanged, starting with the main branch wire that is passed through the stent struts into the side branch. After opening the stent struts in the side branch, kissing balloon inflation is performed. A second stent is deployed in the side branch in the presence of suboptimal results only. Over the last 2 years, this technique has been associated with a 98% angiographic success rate in both branches. Two stents are used in 30%-35% of cases and final kissing balloon inflation is performed in > 95% of cases. The in-hospital major adverse cardiac events (MACE) rate is around 5% and 7-month target vessel revascularization (TVR) is 13%. Several stents specifically designed for coronary bifurcation lesions are currently being investigated. The objective is to simplify the approach for all users. In the near future, the use of drug-eluting stents should reduce the risk of restenosis.     

冠状动脉分叉病变的定义、分类和治疗策略

目前,冠状动脉分叉病变定义、分类和治疗策略,国内尚未见系统报道。研究现状:冠状动脉分叉病变的介入治疗极具挑战性且仍存争议,分叉病变的分类、治疗策略命名繁复,而且缺乏统一描述治疗策略手段。研究用途:现结合欧洲分叉俱乐部五次会议共识,旨在系统报道分叉病变的定义、分类和治疗策略最新进展,以"MADS"四种术式为中心,对每一种术式及其变异进行详细介绍,并不失其可记忆性及临床指导意义,最后提出了逐步描述支架治疗策略互动电子表格。