Coronary bifurcation lesions: Definition, classification and approaches to treatment

Bifurcation coronary lesions still present a difficult challenge to the interventional cardiologist, with a high complication rate in both the long and short term. Definition and classification of bifurcation coronary disease is not straightforward: at the present time there are six different classifications of bifurcation lesions. The MEDINA classification was recently adopted by the European Bifurcation Club as a current standard. In addition, several attempts to classify bifurcation stenting techniques have been made. The newest proposal for classification of bifurcation stenting techniques (MADS) is based on the initial stenting strategy, i.e. implantation of the first stent. The rationale behind this classification is accurate definition of the strategies used, allowing analysis and comparison of clinical results in homogeneous patient populations. In this article we describe the available bifurcation stenting techniques and summarise our proposed approach to bifurcation lesions, with an attempt to give directions regarding SB stenting as 'intention to treat'.