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Volume 11, Supplement 1 - 2010

Volume 11, Supplement 1 - 2010

Table of Contents

Safety Issues Related to Treating Bifurcation Lesions Treating Bifurcation Coronary Disease
Treating bifurcation lesions is a challenge in interventional cardiology. There is evidence that the anatomic morphology of the lesions plays a role not only in procedural success and complication rates, but also in the selection of stenting technique. Bifurcation angle, assessment of lesion severity, and acute stent thrombosis all pose a challenge to the interventionist. Safety issues related to treatment of bifurcation coronary disease is discussed. Assessment of lesions both before and after stenting using intravascular ultrasound in addition to quantitative coronary angiography may result in fewer complications.[Rev Cardiovasc Med. 2010;11(suppl 1):S3-S10 doi: 10.3909/ricm11S1S0002]
Bifurcation Classification Schemes: Impact of Lesion Morphology on Development of a Treatment Strategy Treating Bifurcation Coronary Disease
A number of bifurcation lesion classification schemes exist in which capital letters or Roman numerals categorize various types of bifurcation lesions. Unfortunately, these classification schemes are confusing and difficult to remember because of the lack of association between the numbers or letters and various anatomic abnormalities of bifurcation lesions. Recently, the Medina classification was proposed as a simpler, easier-to-remember scheme that labels bifurcation lesions by plaque involvement in 3 anatomic segments (proximal main segment, distal segment of main branch, and side branch). However, this classification also has limitations because it doesn’t include important descriptive features of bifurcation lesions that could be important in determining optimum stent treatment strategy. The Movahed classification overcomes these limitations by including bifurcation angle and proximal vessel size in its scheme. The impact of these various classification schemes on stent treatment strategies and more recent clinical trial results is discussed.[Rev Cardiovasc Med. 2010;11(suppl 1):S11-S16 doi: 10.3909/ricm11S1S0001]
Contemporary Bifurcation Treatment Strategies: The Role of Currently Available Slotted Tube Stents Treating Bifurcation Coronary Disease
Treatment of coronary bifurcation lesions remains complicated and fraught with procedural challenges. Although numerous techniques have been proposed for treating bifurcations, no approach completely circumvents the limitations of the current stent platforms. This article discusses management strategies currently available for treating bifurcation lesions, including techniques to optimize deployment and outcomes.[Rev Cardiovasc Med. 2010;11(suppl 1):S17-S26 doi: 10.3909/ricm11S1S0005]
Dedicated Bifurcation Devices Treating Bifurcation Coronary Disease
Coronary bifurcation lesions are a common challenge for interventional cardiologists, for which there is no clear consensus on optimal treatment. The side branch (SB) ostium has become the focus of new treatment strategies because it is a common site of restenosis. In comparison, restenosis and reintervention rates in the main branch are acceptably low, reflecting improved techniques and greater use of drug-eluting stents. Many different companies are evaluating dedicated bifurcation devices that are designed to offer easy access to the SB, but that differ in concept and in the degree of coverage provided to the SB ostium. Some are bare metal stents, whereas several are drug-eluting iterations based on platforms used in conventional stents. The promise of these dedicated bifurcation devices is illustrated by early results from single-arm clinical studies.[Rev Cardiovasc Med. 2010;11(suppl 1):S27-S37 doi: 10.3909/ricm11S1S0004]
The Side Branch Ostium: Understanding the Achilles Heel of Treating Bifurcation Coronary Disease Treating Bifurcation Coronary Disease
Angioplasty of lesions involving a bifurcation remains one of the most challenging lesion subsets in the field of coronary intervention. A general approach to dealing with bifurcation lesions is to avoid intervention of the side branch (SB) if possible. Angiographic or flow criteria are used to determine SB intervention; however, angiographic evaluation alone can be inaccurate. Performing intravascular ultrasound prior to intervention is a useful strategy. This aids the interventional cardiologist in determining whether main branch stenting alone is sufficient or if stenting of the SB is also warranted.[Rev Cardiovasc Med. 2010;11(suppl 1):S38-S42 doi: 10.3909/ricm11S1S0003]