We appreciate Dr. Y-Hassan’s comments with regard to our recently published manuscript and would like to take the opportunity to respond .

Several coronary bifurcation classification systems have been proposed in the literature including the DINO classification developed by Dr. Y-Hassan’s group . Of these systems, the Medina Classification has become the most widely adopted because of its simplicity and, currently, is endorsed by the European Bifurcation Club as the preferred classification system . Dr. Y-Hassan correctly points out that the Medina classification fails to include additional lesion characteristics such as lesion length, calcification, and side branch angle, all of which erode the simplicity of this system. Furthermore, the major limitation of other classification schemes that include additional descriptive variables is their complexity which is the main reason for their limited clinical use.

In his letter, Dr. Y-Hassan lists angiographic features which many of us associate with procedural complications and proposes specific techniques to address these ‘high-risk’ lesions. Unfortunately, the association of lesion characteristics and treatment strategies with outcomes have not been adequately vetted, requiring the clinician to make lesion assessment and formulate treatment strategies based primarily on anecdote and intuition. The first step to building an adequate literature is the establishment of a commonly understood and easy-to-utilize classification system. The Medina classification has emerged as the accepted system. We believe that the data presented in our study provide additional understanding of the Medina classification so that it can be effectively utilized in research going forward.