Anatomical classification of chronic total occlusions in coronary bifurcations

Area of Science:

• Interventional Cardiology
• Medical Device Technology
• Clinical Classification Systems

Background:

• Percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in coronary bifurcation lesions (CBL) is advancing with new devices and techniques.
• Standardized classification is needed to homogenize data collection and procedural descriptions in this complex PCI subset.

Purpose of the Study:

• To introduce and describe the Medina-CTO classification system.
• To provide a standardized methodological tool for describing CTO-CBL interventions.

Main Methods:

• The Medina-CTO classification adapts the existing Medina classification for bifurcations.
• It uses a three-digit system (proximal main vessel, distal main vessel, side branch) with values 0 or 1 for stenosis.
• A subscript denotes the occluded segment's cap characteristics: tapered (t), blunt (b), or ambiguous (a).

Main Results:

• The Medina-CTO classification generates 56 basic categories.
• These categories can be further grouped based on study requirements.
• The system allows for detailed description of CTO-CBL anatomy and cap morphology.

Conclusions:

• The Medina-CTO classification offers a structured approach to standardize the description of CTO-CBL.
• This system has potential scientific and educational applications for interventional cardiologists.
• It may facilitate more consistent reporting and comparison of PCI outcomes in complex bifurcations.