Impact of Bifurcation Involvement and Location in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights from the EuroCTO Registry.

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 3948 procedures performed between January and November 2023 were examined (33% with bifurcation involvement). Among bifurcation lesions, 38% and 37% were located within 5mm 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 (1544[836-2819] vs 1298.5[699.1-2386.6]mGy, p<0.001) and contrast volume (230[160-300] vs 190[130-250]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 & distal, p<0.001). On multivariable analysis, the presence of an intralesion bifurcation was independently associated with technical failure (OR 2.19, 95%CI 1.52-3.16, p=0.001). In conclusion, bifurcations are present in approximately one third of CTOs undergoing PCI. PCI of CTOs with bifurcation can be achieved with high success rates except for bifurcations within the occluded segment, that were associated with higher technical failure.

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Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gerald S. Werner reports a relationship with Abbott Vascular Inc that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Asahi Intecc Co Ltd that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Daiichi Sankyo Inc that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with OrbusNeich Medical BV that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Pfizer Inc that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Philips that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Siemens Healthineers that includes: speaking and lecture fees. Gerald S. Werner reports a relationship with Terumo Interventional Systems that includes: speaking and lecture fees. Myron Zaczkiewicz reports a relationship with iVascular SLU that includes: speaking and lecture fees. Myron Zaczkiewicz reports a relationship with AbioMed Inc that includes: funding grants. Alexandre Avran reports a relationship with Boston Scientific Corp that includes: speaking and lecture fees. Alexandre Avran reports a relationship with BIOTRONIK Inc that includes: speaking and lecture fees. Alexandre Avran reports a relationship with Teleflex Inc San Diego that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with Boston Scientific Corp that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with CardiaWave that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with iVascular SLU that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with Neovasc Inc that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with Seven Sons that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with Teleflex Inc that includes: speaking and lecture fees. Pierfrancesco Agostoni reports a relationship with Terumo Interventional Systems that includes: speaking and lecture fees. Alexandre Avran reports a relationship with Vascular therapy that includes: speaking and lecture fees. Alexandre Avran reports a relationship with Abbott Vascular Inc that includes:. Nicolas Boudou reports a relationship with Terumo Interventional Systems that includes: speaking and lecture fees. Myron Zaczkiewicz reports a relationship with Asahi Intecc Co Ltd that includes: speaking and lecture fees. Alexandre Avran reports a relationship with Asahi Intecc Co Ltd that includes: speaking and lecture fees. Nicolas Boudou reports a relationship with Asahi Intecc Co Ltd that includes: speaking and lecture fees. Myron Zaczkiewicz reports a relationship with OrbusNeich Medical BV that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.