Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome

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Nikolaos V Konstantinidis1, Bernard Chevalier2, Thomas Hovasse2

  • 1Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Interventional Cardiology Department, St Luke's Hospital, Thessaloniki, Greece.

Revista Espanola De Cardiologia (English Ed.)
|May 28, 2023
PubMed

Insights

Percutaneous coronary intervention for coronary chronic total occlusions (CTO) involving bifurcation lesions (BIF-CTO) is common. Higher complexity in BIF-CTO does not impact procedural success or complication rates with provisional stenting.

Area of Science:

  • Interventional Cardiology
  • Cardiovascular Research

Background:

  • Coronary chronic total occlusions (CTO) represent a complex subset of coronary artery disease.
  • CTO lesions involving bifurcations (BIF-CTO) are particularly challenging and less studied.
  • Percutaneous coronary intervention (PCI) is a key revascularization strategy for CTO.

Purpose of the Study:

  • To analyze the incidence of BIF-CTO in contemporary PCI procedures.
  • To evaluate procedural strategies, in-hospital outcomes, and complications associated with BIF-CTO PCI.
  • To compare outcomes between BIF-CTO and non-BIF-CTO patient groups.

Main Methods:

  • Retrospective analysis of 607 consecutive CTO patients treated between January 2015 and February 2020.
  • Comparison of procedural strategies, outcomes, and complications between BIF-CTO (n=245) and non-BIF-CTO (n=362) subgroups.
  • Assessment of lesion complexity using J-CTO and PROGRESS-CTO scores.

Main Results:

  • Bifurcation lesions were present in 40.4% of CTO PCI procedures.
  • BIF-CTO patients exhibited higher lesion complexity (higher J-CTO and PROGRESS-CTO scores).
  • Procedural success rates (78.9% overall) were similar between BIF-CTO (80.4%) and non-BIF-CTO (77.8%) groups, irrespective of bifurcation site. Complication rates were comparable.

Conclusions:

  • Bifurcation involvement is frequent in modern CTO PCI.
  • Despite increased complexity, BIF-CTO PCI achieves comparable procedural success and complication rates to non-BIF-CTO.
  • The predominant provisional stenting strategy is effective for BIF-CTO, regardless of lesion complexity.
Abstract

Keywords:
BifurcaciónBifurcationBifurcation-CTOChronic total occlusionIntervención coronaria percutáneaOCT en bifurcaciónOclusión crónica totalPercutaneous coronary interventionProvisional stenting strategyStent condicional

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