Bifurcation Lesions

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 376

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شناسه ملی سند علمی:

CCMED08_047

تاریخ نمایه سازی: 24 شهریور 1398

چکیده مقاله:

Movahed classification is a recently published classification that can be easily memorized and is comprehensive. This classification includes many other important features of a given coronary bifurcation lesion such as proximal healthy segment size for kissing stent technique and branch angulations. For disease burden, Movahed classification uses 2 if both branch vessel ostia are involved. Otherwise for only one branch vessel involvement, 1m (only main branch ostium is involved) or 1s (only side branch ostium is involved) are used for description of the lesion at the site of bifurcation. In order to improve communications between interventional cardiologists, we developed a simple conversion table from old classifications to Movahed classification as following: (...) Using Movahed classification will make description of a bifurcation lesion easier and at the same time more accurate and comprehensive. For example in the published article entitled Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study, by combining NORDIC 1 and BBC ONE trials, the authors found a higher major cardiac adverse event rate in the complex strategy in regard to bifurcation intervention. This is the first large study to finally separate the so-called true bifurcation lesions (B2 lesions based on the Movahed classification) from others. So-called nontrue bifurcation lesions should not have been enrolled in such a study because they are at very low risk for side branch occlusion. Unfortunately, the authors downplayed the strong trend toward higher true bifurcation lesions enrolled in the complex strategy cohort, with a probability value of 0.058. This fact suggests a strong selection bias against complex strategy that could be the main reason for the higher major cardiac adverse event rate in this arm. In a study of bifurcation intervention that was published in The Journal of the American College of Cardiology 1 week later, the authors found opposite results, with a reduction in major cardiac adverse event, using a complex strategy. However, in this trial, they enrolled only true bifurcation lesions (medina 1, 1, 1, and 0, 1, 1) in 100% of their population, explaining two exactly opposite conclusions made comparing these two trials. The importance of selection bias and significant heterogeneities in the randomized, clinical trials involving coronary bifurcation lesions are very important and are extensively discussed in the two recently published reports. Physicians should choose their strategy on the basis of many other bifurcation lesion characteristics including bifurcation angle, size, and the degree of ostial side branch disease involvement. In a true bifurcation lesion with a very large side branch and a very high risk for side branch occlusion during simple intervention, the operator should follow common sense. Furthermore, Coronary bifurcation lesion intervention is technically challenging with higher complication rates. Many coronary interventional trials have been conducted involving coronary bifurcation lesions in order to compare one-stent with two-stent techniques. However, these trials have major limitation by enrolling all bifurcation lesions, including low-risk lesions so-called not true bifurcation lesions. (Movahed MR J Interven Cardiol 2011; 24:295-301).

نویسندگان

M.R Movahed

MD, Cardiologist