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

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• 作者：Soledad Ojeda^a ; ^{soledad.ojeda18@gmail.com} ; Manuel Pan^a ; Alejandro Gutié ; rrez^b ; Miguel Romero^a ; Jorge Chavarrí ; a^a ; Javier Suá ; rez de Lezo^a ; Francisco Mazuelos^a ; Laura Pardo^a ; Francisco Hidalgo^a ; Francisco Carrasco^a ; José ; Segura^a ; Enrique Durá ; n^a ; Carlos Ferreiro^a ; José ; J. Sá ; nchez^a ; Sara Rodrí ; guez^a ; Jesú ; s Oneto^b ; Jose Suá ; rez de Lezo^a
• 关键词：Bifurcation intervention ; Chronic total coronary occlusion ; Percutaneous coronary intervention ; Drug-eluting stent
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：432-438
• 全文大小：1054 K
• 卷排序：230

文摘

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 resultsBLs with a side branch (SB) ≥ 2.0 mm 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)ConclusionsBLs 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.