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(Circulation. 2009;120:e64.)
© 2009 American Heart Association, Inc.

Correspondence

Response to Letter Regarding Article, "Randomized Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations: The CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study"

Antonio Colombo, MD; Azeem Latib, MD; Flavio Airoldi, MD

Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy

Ezio Bramucci, MD

Department of Cardiology, Policlinico S. Matteo, Pavia, Italy

Salvatore Saccà, MD

Department of Cardiology, P.O. di Mirano, Mirano, Italy

Roberto Violini, MD

Department of Cardiology, Ospedale S. Camillo, Rome, Italy

Corrado Lettieri, MD; Roberto Zanini, MD

Department of Cardiology, A.O. Carlo Poma, Mantova, Italy

Imad Sheiban, MD

Department of Cardiology, A.O. Molinette, Torino, Italy

Leonardo Paloscia, MD

Department of Cardiology, Ospedale Santo Spirito, Pescara, Italy

Eberhard Grube, MD

Interventional Cardiology Unit, Helios Heart Center, Siegburg, Germany

Joachim Shofer, MD

Interventional Cardiology Unit, Hamburg University Cardiovascular Center, Hamburg, Germany

Leonardo Bolognese, MD

Azienda USL 8, Arezzo, Italy

Mario Orlandi, MD

Department of Cardiology, Azienda Ospedaliera di Lodi, Lodi, Italy

Giampaolo Niccoli, MD

Department of Cardiology, Policlinico A. Gemelli, Rome, Italy

An extract of the first 100% of the full text is provided, because this article has no abstract.

We thank Dr Movahed for his interest in our study¹ and for raising the issue of the classification of coronary bifurcations. The problem of finding a suitable classification of coronary bifurcations is highlighted by the fact that there are now at least 6 classifications of bifurcation lesions according to plaque distribution: Duke,² Sanborn, Safian, Lefevre,³ the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) study⁴ and Medina.⁵

If we now add the classification proposed by Dr Movahed, the number becomes 7. Unfortunately, there is no limit to being comprehensive, and we will be able to find limitations in almost any classification. Besides not reporting the angle of the bifurcation, the Medina classification does not report the extent of the disease on the side branch, which is another important variable that may affect the selection of the technique used to stent the bifurcation and may possibly affect the outcome. Nevertheless, we need to recognize that the main advantages of the Medina classification are its simplicity, the easy mnemonic, and the fact that it is now accepted by most investigators.⁶

Disclosures

None.

1. Colombo A, Bramucci E, Sacca S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation. 2009; 119: 71–78.[Abstract/Free Full Text]

2. Popma J, Leon M, Topol EJ. Atlas of Interventional Cardiology. Philadelphia, Pa: Saunders; 1994.

3. Lefevre T, Louvard Y, Morice MC, Dumas P, Loubeyre C, Benslimane A, Premchand RK, Guillard N, Piechaud JF. Stenting of bifurcation lesions: classification, treatments, and results. Catheter Cardiovasc Interv. 2000; 49: 274–283.[CrossRef][Medline] [Order article via Infotrieve]

4. Sianos G, Morel MA, Kappetein AP. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. Eurointervention. 2005; 1: 219–227.[Medline] [Order article via Infotrieve]

5. Medina A, Suarez de Lezo J, Pan M. A new classification of coronary bifurcation lesions. Rev Esp Cardiol. 2006; 59: 183–183.[CrossRef][Medline] [Order article via Infotrieve]

6. Louvard Y, Thomas M, Dzavik V, Hildick-Smith D, Galassi AR, Pan M, Burzotta F, Zelizko M, Dudek D, Ludman P, Sheiban I, Lassen JF, Darremont O, Kastrati A, Ludwig J, Iakovou I, Brunel P, Lansky A, Meerkin D, Legrand V, Medina A, Lefèvre T. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter Cardiovasc Interv. 2008; 71: 175–183.[CrossRef][Medline] [Order article via Infotrieve]