A Novel Descriptive, Intelligible and Ordered (DINO) classification of coronary bifurcation lesions. Review of current classifications.

BACKGROUND: Several classification systems for coronary artery bifurcation lesions (CABL) have been described in the literature, but despite the commendable effort to simplify a difficult subject in interventional cardiology, all of them have certain limitations and shortcomings. METHODS AND RESULTS: The proposed Descriptive, INtelligible and Ordered (DINO) is a new descriptive and clinically oriented system of classifying CABLs. This classification system takes into consideration more details of the side branch angulation relative to the main branch. It uses self-explanatory terms and mnemonic characters (acronyms related to the branches of the bifurcation and the shape of side branch angulation). The DINO classification describes the extent of CABL distribution and designates its localization at the bifurcation region. Moreover, systematized simple and easy to remember terms may form a relevant classification basis for multicenter and meta-analysis investigations. CONCLUSIONS: The DINO is the first verbally anchored, all-inclusive classification system of CABLs. It describes precisely side branch angulation, using self-explanatory and instructive terms that describe both the extent of the lesion's distribution and its localization. The current coronary bifurcation lesion classifications are reviewed.

A novel stenting technique for coronary artery bifurcation stenosis.

A novel stenting technique, using one stent strategy, designed to treat type Medina 1,0,0 coronary bifurcation lesions, is described. The atherosclerotic plaque burden in this category of bifurcation lesions is located in the proximal segment of the main branch (MB) of a coronary bifurcation in which the side branch has a sharp angulation (T- or reverse-shaped) relative to the MB. The advantages of this technique are the accurate placement of the stent tailored to cover solely the bifurcation lesion, shoving the plaque burden away from the side branch ostium during stent expansion and the ability to maintain guide wire access in the branch at highest risk of occlusion obviating the need for more cumbersome and time consuming percutaneous coronary intervention procedure.