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Ahead of print
Experts' Viewpoint
Submitted: 2022-05-28
Accepted: 2022-10-19
Published online: 2022-12-07
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Anatomical classification of chronic total occlusions in coronary bifurcations

Juan Luis Gutiérrez-Chico12, Carlos Cortés3, Niels Ramsing Holm4, Evald Høj Christiansen4, Maciej Lesiak5, Bernward Lauer6, Sylvia Otto6, Francesco Lavarra7, Viktor Sasi8, Yiannis S. Chatzizisis9, Sudhir Rathore10, Kambis Mashayekhi1112
DOI: 10.5603/CJ.a2022.0115
·
Pubmed: 36510793
Affiliations
  1. Bundeswehrzentralkrankenhaus, Koblenz, Germany
  2. Cardio-Care Heart Centre, Marbella, Spain
  3. Miguel Servet University Hospital, Zaragoza, Spain
  4. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  5. 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
  6. Klinik für Innere Medizin I, Universitätsklinikum Jena, Germany
  7. Jilin Heart Hospital, Changchun, China
  8. Department of Internal Medicine, University of Szeged, Hungary
  9. University of Nebraska Medical Center, Omaha, Nebraska, United States
  10. Frimley Health NHS Foundation Trust, Camberley, Surrey, United Kingdom
  11. Division of Cardiology and Angiology II, University Heart Center Freiburg – Bad Krozingen, Germany
  12. MedClin Heart Center Lahr, Department for Internal Medicine and Cardiology, Lahr, Germany

open access

Ahead of print
Experts' viewpoint
Submitted: 2022-05-28
Accepted: 2022-10-19
Published online: 2022-12-07

Abstract

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) in coronary bifurcation lesions (CBL) is undergoing substantial technical progress and standardization, paralleling the evolution of dedicated devices, tools, and techniques. A standard consensus to classify CTO-CBL might be instrumental to homogenize data collection and description of procedures for scientific and educational purposes. The Medina-CTO classification replicates the classical three digits in Medina classification for bifurcations, representing the proximal main vessel, distal main vessel, and side branch, respectively. Each digit can take a value of 1 if it concerns atherosclerosis and is anatomically stenosed, or 0 if it is not. In addition, the occluded segment(s) of the bifurcation are noted by a subscript, which describes key interventional features of the cap: t (tapered), b (blunt), or a (ambiguous). This approach results in 56 basic categories that can be grouped by means of different elements, depending on the specific needs of each study. Medina-CTO classification, consisting of adding a subscript describing the basic cap characteristics to the totally occluded segment(s) of the standard Medina triplet, might be a useful methodological tool to standardize percutaneous intervention of bifurcational CTO lesions, with interesting scientific and educational applications.

Abstract

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTO) in coronary bifurcation lesions (CBL) is undergoing substantial technical progress and standardization, paralleling the evolution of dedicated devices, tools, and techniques. A standard consensus to classify CTO-CBL might be instrumental to homogenize data collection and description of procedures for scientific and educational purposes. The Medina-CTO classification replicates the classical three digits in Medina classification for bifurcations, representing the proximal main vessel, distal main vessel, and side branch, respectively. Each digit can take a value of 1 if it concerns atherosclerosis and is anatomically stenosed, or 0 if it is not. In addition, the occluded segment(s) of the bifurcation are noted by a subscript, which describes key interventional features of the cap: t (tapered), b (blunt), or a (ambiguous). This approach results in 56 basic categories that can be grouped by means of different elements, depending on the specific needs of each study. Medina-CTO classification, consisting of adding a subscript describing the basic cap characteristics to the totally occluded segment(s) of the standard Medina triplet, might be a useful methodological tool to standardize percutaneous intervention of bifurcational CTO lesions, with interesting scientific and educational applications.

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Keywords

percutaneous coronary intervention, coronary heart disease, chronic total occlusion, bifurcation lesion

About this article
Title

Anatomical classification of chronic total occlusions in coronary bifurcations

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Experts' Viewpoint

Published online

2022-12-07

Page views

252

Article views/downloads

151

DOI

10.5603/CJ.a2022.0115

Pubmed

36510793

Keywords

percutaneous coronary intervention
coronary heart disease
chronic total occlusion
bifurcation lesion

Authors

Juan Luis Gutiérrez-Chico
Carlos Cortés
Niels Ramsing Holm
Evald Høj Christiansen
Maciej Lesiak
Bernward Lauer
Sylvia Otto
Francesco Lavarra
Viktor Sasi
Yiannis S. Chatzizisis
Sudhir Rathore
Kambis Mashayekhi

References (11)
  1. Konstantinidis NV, Werner GS, Deftereos S, et al. Euro CTO Club. Temporal trends in chronic total occlusion interventions in Europe. Circ Cardiovasc Interv. 2018; 11(10): e006229.
  2. Galassi AR, Boukhris M, Tomasello SD, et al. Incidence, treatment, and in-hospital outcome of bifurcation lesions in patients undergoing percutaneous coronary interventions for chronic total occlusions. Coron Artery Dis. 2015; 26(2): 142–149.
  3. Gutiérrez-Chico JL, Cortés C, Ayoub M, et al. Subintimal shift as mechanism for side-branch occlusion in percutaneous treatment of chronic total occlusions with bifurcation lesions. Cardiol J. 2021 [Epub ahead of print].
  4. Medina A, Lezo JS, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006; 59(2): 183.
  5. Louvard Y, Thomas M, Dzavik V, et al. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter Cardiovasc Interv. 2008; 71(2): 175–183.
  6. Lassen JF, Holm NR, Banning A, et al. Percutaneous coronary intervention for coronary bifurcation disease: 11th consensus document from the European Bifurcation Club. EuroIntervention. 2016; 12(1): 38–46.
  7. Lunardi M, Louvard Y, Lefèvre T, et al. Definitions and standardized endpoints for treatment of coronary bifurcations. EuroIntervention. 2022; EIJ-E-22-00018.
  8. Ybarra LF, Rinfret S, Brilakis ES, et al. Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations. Circulation. 2021; 143(5): 479–500.
  9. Chen Sl, Ye F, Zhang Jj, et al. Clinical outcomes after recanalization of a chronic total occluded vessel with bifurcation lesions: results from single-center, prospective, chronic total occlusion registry study. Chin Med J (Engl). 2012; 125(6): 1035–1040.
  10. Baystrukov VI, Kretov EI, Boukhris M, et al. A randomized trial of bifurcation stenting technique in chronic total occlusions percutaneous coronary intervention. Coron Artery Dis. 2018; 29(1): 30–38.
  11. Jaguszewski MJ, Cortés C, Gutiérrez-Chico JL. Implantation of magnesium-bioresorbable scaffolds in a bifurcation under optical coherence tomography guidance. Eur Heart J. 2017; 38(25): 2017–2018.

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