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Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the

Ilias Nikolakopoulos1, Evangelia Vemmou1, Judit Karacsonyi1

  • 1Minneapolis Heart Institute Foundation and Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.

Hellenic Journal of Cardiology : HJC = Hellenike Kardiologike Epitheorese
|March 5, 2022
PubMed

Insights

Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) involving bifurcations, especially at both proximal and distal caps, is linked to reduced technical success and increased complication risks. Understanding these bifurcation impacts is crucial for improving CTO PCI outcomes.

Area of Science:

  • Cardiovascular Interventions
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Limited research exists on the influence of proximal or distal cap bifurcations during chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
  • This study investigates the impact of bifurcation locations on CTO PCI outcomes using a large global registry.
  • Data from 4,584 CTO PCI cases between 2012 and 2020 were analyzed.

Discussion:

  • The presence of bifurcations in CTO lesions significantly affects PCI complexity and outcomes.
  • Cases with bifurcations at both proximal and distal caps demonstrated higher J-CTO scores, indicating increased lesion difficulty.
  • These complex cases were associated with lower technical success rates and a higher incidence of complications.

Key Insights:

  • Over two-thirds of CTO PCI cases involve a bifurcation.
  • Bifurcations at both proximal and distal caps are associated with significantly higher J-CTO scores compared to single-site or no bifurcations.
  • Technical success rates were lower (79%) and complication rates (pericardiocentesis, emergency CABG) were higher in the 'proximal and distal cap' group.

Outlook:

  • Further research should focus on developing specific strategies for CTO PCI in the presence of bifurcations.
  • Improved imaging and guidewire technologies may help mitigate risks associated with bifurcation lesions.
  • Tailoring procedural techniques based on bifurcation location can potentially enhance patient outcomes in complex CTO PCI.
Abstract

Keywords:
bifurcationchronic total occlusionpercutaneous coronary intervention

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