Bifurcation lesions involved in the recanalization process of coronary chronic total occlusions: Incidence, treatment and clinical implications

Abstract

Background: The presence of a bifurcation (BL) in the context of a coronary chronic total occlusion (CTO) represents an additional difficulty. This study analyzes the incidence of BLs in CTO recanalization, the treatment, predictors of bifurcation technical success and their clinical impact.

Methods and results: BLs with a side branch (SB) ≥2.0mm located proximally, distally or within the occluded segment were observed in 130 (33%) of 391 CTO. Provisional stenting was the strategy more frequently used (94%). Bifurcation success (stenosis <30% in main vessel and TIMI flow III in both branches) was achieved in 105 patients (81%). In the remaining 25 (19%), the TIMI flow at the SB was <III. Predictors of bifurcation success were baseline SB wiring (OR 0.01, 95% CI: 0.001-0.09; p<0.01), the absence of dissection across the bifurcation (OR 0.10, 95% CI: 0.02-0.49; p<0.01) and non-true BLs (OR 0.16, 95% CI: 0.04-0.68; p<0.05). Regarding in-hospital results, patients with final TIMI flow <III at the SB had a higher incidence of periprocedural MI (32% vs 4.8%; p<0.01). Subsequently, the rate of MI was higher in patients with CTO-BLs than in those without BLs. At follow-up, there were no differences in the event rate between CTO-BLs and non CTO-BLs (7.7% vs 9.5%, p=ns) CONCLUSIONS: BLs in CTO is a frequent finding and could be approached as regular bifurcations. The primary success was low and this was associated with a higher incidence of periprocedural MI. Baseline SB wiring was a powerful predictor of technical success.

Keywords: Bifurcation intervention; Chronic total coronary occlusion; Drug-eluting stent; Percutaneous coronary intervention.