Running Title: The Movahed Coronary Bifurcation Classification
For LM bifurcation
Authors: Mohammad Reza Movahed, MD 1,2
University of Arizona Sarver Heart Center, Tucson,
Arizona,1 University of Arizona,
Phoenix,2
No Conflict of interest
Correspondent:
M Reza Movahed, MD, PhD, FACP, FACC, FSCAI
Clinical Professor of Medicine
University of Arizona Sarver Heart Center
1501 North Campbell Avenue
Tucson, AZ 85724
Email: Rmova@aol.com
Tel: 949 400 0091
Key words: Coronary bifurcation lesion; coronary bifurcation
classification; Movahed classification; Movahed Bifurcation
Classification; Bifurcation Intervention; Coronary Bifurcating lesions
Conflict of interest: None
With great interest, I read the paper published in the JACC Intervention
Journal entitled: “Provisional Strategy for Left Main Stem Bifurcation
Disease: A State-of-the-Art Review of Technique and Outcomes
“1 The authors used the Medina Bifurcation
Classification that unfortunately divides true bifurcation lesions into
three unnecessary groups: 111, 101 and 011. The authors should have used
the Movahed classification which summarizes all true bifurcation
lesions in one simple category called B 2 (B for bifurcation, 2 meaning
both bifurcation ostia are diseased). The basic structure of the Movahed
classification 2,3 simplifies bifurcation lesions into
three categories: If both branches are involved as mentioned above, it
is called a B2 lesion, if only the main branch is involved, is called
B1m (B for bifurcation, 1m meaning only the main branch has disease) and
if only side branch is involved, is called B1s lesion (B for bifurcation
and 1s meaning only side branch has the disease). Another important part
of this bifurcation classification is the fact that additional suffixes
can be added if needed for clinical or research purposes. This comes in
very handy, particularly in the left main bifurcation lesions. As the
best example, the kissing stenting technique in appropriate bifurcation
left main lesions can be performed very safely and quickly but it
requires that the proximal segment be large enough to accommodate 2
stents and has to be at least 2/3 sum of distal bifurcation branches. In
the Movahed classification, this suffix is called L (L for the large
proximal segment) or S (for the small proximal segment). Furthermore,
limitless additional suffixes can be added if needed such as calcium or
bifurcation angle that is completely absent in the Medina
classification.
The widely used Medina bifurcation classification is unfortunately too
complex in describing given true bifurcation lesions in three clinically
irrelevant categories and at the same time lacks important other
anatomical features of a given bifurcation lesion. 4-8
Figure 1 compares the basic structure of the Movahed classification to
the Medina Classification. Figure 2 summarizes a detailed description of
the Movahed classification if additional suffixes are needed.