1. Impact of Bifurcation Involvement and Location in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the EuroCTO Registry.
- Author
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Moroni A, Ayoub M, Gorgulu S, Werner GS, Kalay N, Zaczkiewicz M, Wójcik J, Goktekin O, Tuner H, Woitek F, Arenz J, Gasparini GL, Drozd J, Boudou N, Schölzel BE, Diletti R, Avran A, Di Mario C, Mashayekhi K, and Agostoni P
- Subjects
- Humans, Male, Female, Aged, Europe epidemiology, Chronic Disease, Middle Aged, Ultrasonography, Interventional methods, Treatment Outcome, Coronary Vessels diagnostic imaging, Percutaneous Coronary Intervention methods, Registries, Coronary Occlusion surgery, Coronary Occlusion diagnosis, Coronary Angiography
- Abstract
Bifurcation involvement close to or within the occluded segment poses increasing difficulties for chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). However, this variable is not considered in the angiography-based CTO scoring systems nor has been extensively investigated in large multicenter series. Accordingly, we analyzed a CTO-PCI registry involving 92 European centers to explore the incidence, angiographic and procedural characteristics, and outcomes specific to CTO-PCIs with bifurcation involvement. A total of 3,948 procedures performed between January and November 2023 were examined (33% with bifurcation involvement). Among bifurcation lesions, 38% and 37% were located within 5 mm of the proximal and distal cap, respectively, 16% within the CTO body, and in 9% of cases proximal and distal bifurcations coexisted. When compared with lesions without bifurcation involvement, CTO bifurcation lesions had higher complexity (J-CTO 2.33 ± 1.21 vs 2.11 ± 1.27, p <0.001) and were associated with higher use of additional devices (dual-lumen microcatheter in 27.6% vs 8.4%, p <0.001, and intravascular ultrasound in 32.2% vs 21.7%, p <0.001). Radiation dose (1,544 [836 to 2,819] vs 1,298.5 [699.1 to 2,386.6] mGy, p <0.001) and contrast volume (230 [160 to 300] vs 190 [130 to 250] ml, p <0.001) were also higher. Technical success was similar (91.5% with bifurcation involvement vs 90.4% without bifurcation involvement, p = 0.271). However, the bifurcation lesions within the CTO segment (intralesion) were associated with lower technical success than the other bifurcation-location subgroups (83.7% vs 93.3% proximal, 93.4% distal, and 89.0% proximal and distal, p <0.001). On multivariable analysis, the presence of an intralesion bifurcation was independently associated with technical failure (odds ratio 2.04, 95% confidence interval 1.24 to 3.35, p = 0.005). In conclusion, bifurcations are present in approximately one-third of CTOs who underwent PCI. PCI of CTOs with bifurcation can be achieved with high success rates except for bifurcations within the occluded segment, which were associated with higher technical failure., Competing Interests: Declaration of competing interest Dr. Werner: speaker honoraria from Abbott Vascular, ASAHI Intecc, Daiichi-Sankyo, Orbus-Neich, Pfizer (New York, NY, United States), Philips-Volcano, and Siemens-Healthineers. TerumoWerner: speaker honoraria from Abbott Vascular, ASAHI Intecc, Daiichi-Sankyo, Orbus-Neich, Pfizer (New York, NY, United States), Philips-Volcano, Siemens-Healthineers, and Terumo. Myron Zaczkiewicz: speaker honoraria from Orbus-Neich, Medtronic, iVascular. Proctoring for Orbus-Neich and Asahi Intecc. Institutional: Abiomed. Dr. Boudou: minor fees as consultant from ASAHI Intecc and Terumo. Dr. Avran: proctoring for Boston Scientific, Biotronik, Vascular Therapy, ASAHI Intecc, Abbott Vascular, and Teleflex. Dr. Agostoni: consulting fees from Boston Scientific, CardiaWave, iVascular, Neovasc, Seven Sons, Teleflex, and Terumo. The remaining authors have no competing interests to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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