CTO and Bifurcation Lesions: An Expert Consensus From the European Bifurcation Club and EuroCTO Club.

Knowledge in the field of bifurcation lesions and chronic total occlusions (CTOs) has progressively improved over the past 20 years. Therefore, the European Bifurcation Club and the EuroCTO Club have decided to write a joint consensus statement to share general knowledge and practical approaches in this complex field. When percutaneously treating CTOs, bifurcation lesions with relevant side branches (SBs) are found in approximately one-third of cases (35% at the proximal cap, 38% at the distal cap, and 27% within the CTO body). Occlusion of a relevant SB is not rare and has been shown to be associated with procedural complications and adverse outcomes. Simple bifurcation rules are very useful to prevent SB occlusion, and provisional SB stenting is the recommended approach in the majority of cases: protect the SB as soon as possible by wiring it, respect the fractal anatomy of the bifurcation by using the 3-diameter rule, and avoid using dissection and re-entry techniques. A systematic 2-stent approach can be used if needed or sometimes to connect both branches of the bifurcation. The retrograde approach can be very useful to save a relevant SB, especially in the case of a bifurcation at the distal cap or within the CTO body. Intravascular ultrasound is also a very important tool to address the difficulties with bifurcations at the proximal or distal cap and sometimes also within the CTO segment. Double-lumen microcatheters and angulated microcatheters are crucial tools to resolve access difficulties to the SB or the main branch.

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Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Lefèvre has received minor fees from Abbott, Boston Scientific, and Terumo. Dr Pan has received minor lecture fees from Abbott, Asahi Intecc, Terumo, and Boston Scientific. Dr Stankovic has received speaker fees from Medtronic, Abbott, Boston Scientific, and Terumo. Dr Ojeda has received consulting fees from Medtronic and Edwards Lifesciences. Dr Boudou has received consulting honoraria for Asahi Intecc, Terumo, and Boston Scientific. Dr Brilakis has received consulting and speaker honoraria from Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Asahi Intecc, Biotronik, Boston Scientific, the Cardiovascular Innovations Foundation (Board of Directors), Cardiovascular Systems, Elsevier, GE Healthcare, IMDS, Medicure, Medtronic, Siemens, and Teleflex; has received research support from Boston Scientific and GE Healthcare; is an owner of Hippocrates; and is a shareholder in MHI Ventures, Cleerly Health, and Stallion Medical. Dr Garbo has received proctorship and consulting fees from Boston Scientific, Asahi Intecc, Philips, Terumo, Teleflex, and IMDS. Dr Di Mario has received research grants to his institution from Abbott, Amgen, Boston Scientific, Chiesi, Daiichi Sankyo, Edwards Lifesciences, Idorsia, Medtronic, Shockwave, and Volcano. Dr Hildick-Smith has received research funds and speaker fees from Medtronic. Dr Mashayekhi has received consulting, speaker, and proctoring honoraria from Abbott Vascular, Abiomed, Asahi Intecc, AstraZeneca, Biotronik, Boston Scientific, Cardinal Health, Daiichi Sankyo, Medtronic, Shockwave Medical, Teleflex, and Terumo. Dr Werner has received speaker fees from Asahi Intecc, Orbus-Neich, Philips-Volcano, Siemens, Shockwave Medical, and Terumo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.