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Outcomes of Percutaneous Coronary Intervention for Chronic Total Occlusion With Bifurcation at Distal Cap

Mayu Sakuma1, Yuji Oikawa1, Koichi Kishi2

  • 1Department of Cardiovascular Medicine, Cardiovascular Institute, Tokyo, Japan.

JACC. Cardiovascular Interventions
|May 14, 2025
PubMed

Insights

Managing bifurcations at the chronic total occlusion (CTO) distal cap using the retrograde approach yields high success rates comparable to lesions without bifurcations. This strategy is effective despite initial concerns regarding bifurcation complexity in CTO percutaneous coronary intervention (PCI).

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Bifurcation at the chronic total occlusion (CTO) distal cap presents a significant challenge in CTO percutaneous coronary intervention (PCI).
  • Understanding procedural outcomes and adverse events related to distal cap bifurcation is crucial for optimizing CTO crossing algorithms.

Purpose of the Study:

  • To analyze procedural outcomes and adverse events associated with managing bifurcation at the CTO distal cap.
  • To evaluate the effectiveness of specific strategies, particularly the retrograde approach, in handling these complex lesions.

Main Methods:

  • Analysis of 11,627 patients from the Japanese CTO-PCI Expert Registry with analyzable CTO distal caps (January 2014 - December 2022).
  • Comparison of procedural outcomes between CTO lesions with and without distal cap bifurcation.
  • Assessment of the utilization and impact of the retrograde approach in bifurcation cases.

Main Results:

  • A distal cap bifurcation was identified in 21.2% of CTO lesions.
  • The retrograde approach was more frequently employed in bifurcation cases (45.1%) compared to non-bifurcation cases (40.5%).
  • While success rates were similar, bifurcation cases experienced longer procedure times, higher contrast volume, and increased fluoroscopy duration.

Conclusions:

  • Distal cap bifurcation in CTO lesions does not preclude high procedural success rates.
  • The combined use of the retrograde approach effectively manages bifurcation at the CTO distal cap, achieving success rates comparable to lesions without bifurcations.
  • These findings support the integration of the retrograde approach into CTO PCI strategies for bifurcation lesions.
Abstract

Keywords:
bifurcation at distal capchronic total occlusionpercutaneous coronary intervention

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