Interventions in chronic total occlusions with bifurcation lesions: incidence, treatment, and in-hospital outcome.
Nikolaos V Konstantinidis, Bernard Chevalier, Thomas Hovasse, Philippe Garot, Hakim Benamer, Thierry Unterseeh, Stephane Champagne, Francesca Sanguineti, Antoinette Neylon, Theodoros Moysiadis, Alexandre Avran, Yves Louvard, Thierry Lefèvre
Author Information
Nikolaos V Konstantinidis: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France; Interventional Cardiology Department, St Luke's Hospital, Thessaloniki, Greece.
Bernard Chevalier: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Thomas Hovasse: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Philippe Garot: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Hakim Benamer: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Thierry Unterseeh: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Stephane Champagne: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Francesca Sanguineti: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Antoinette Neylon: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Theodoros Moysiadis: Department of Computer Science, School of Sciences and Engineering, University of Nicosia, 2417, Nicosia, Cyprus.
Alexandre Avran: Department of Cardiology, Centre Hospitalier de Valenciennes, Valenciennes, France.
Yves Louvard: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
Thierry Lefèvre: Département de Cardiologie Interventionnelle, Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France. Electronic address: t.lefevre@icps.com.fr.
INTRODUCTION AND OBJECTIVES: Coronary chronic total occlusions (CTO) involving bifurcation lesions are a challenging lesion subset that is understudied in the literature. This study analyzed the incidence, procedural strategy, in-hospital outcomes and complications of percutaneous coronary interventions (PCI) for bifurcation-CTO (BIF-CTO). METHODS: We assessed data from 607 consecutive CTO patients treated at the Institut Cardiovasculaire Paris Sud (ICPS), Massy, France between January 2015 and February 2020. Procedural strategy, in-hospital outcomes and complication rates were compared between 2 patient subgroups: BIF-CTO (n=245=and non-BIF-CTO (n=362). RESULTS: The mean patient age was 63.2±10.6 years; 79.6% were men. Bifurcation lesions were involved in 40.4% of the procedures. Overall lesion complexity was high (mean J-CTO score 2.30±1.16, mean PROGRESS-CTO score 1.37±0.94). The preferred bifurcation treatment strategy was a provisional approach (93.5%). BIF-CTO patients presented with higher lesion complexity, as assessed by J-CTO score (2.42±1.02 vs 2.21±1.23 in the non-BIF-CTO patients, P=.025) and PROGRESS-CTO score (1.60±0.95 vs 1.22±0.90 in the non-BIF-CTO patients, P<.001). Procedural success was 78.9% and was not affected by the presence of bifurcation lesions (80.4% in the BIF-CTO group, 77.8% in the non-BIF-CTO-CTO group, P=.447) or the bifurcation site (proximal BIF-CTO 76.9%, mid-BIF-CTO 83.8%, distal BIF-CTO 85%, P=.204). Complication rates were similar in BIF-CTO and non-BIF-CTO. CONCLUSIONS: The incidence of bifurcation lesions is high in contemporary CTO PCI. Patients with BIF-CTO present with higher lesion complexity, with no impact on procedural success or complication rates when the predominant strategy is provisional stenting.
