One Versus 2-stent Strategy for the Treatment of Bifurcation Lesions in the Context of a Coronary Chronic Total Occlusion. A Multicenter Registry

• Published in: Revista española de cardiología (English ed.) 2018-05, Vol.71 (5), p.344-350
• Main Authors: Baeza Garzón, Flor, Pan Álvarez-Ossorio, Manuel, Romero Moreno, Miguel Ángel, Martín Palanco, Vanesa, Herrera Arroyo, Concepción, Suárez de Lezo Cruz Conde, José
• Format: Article
• Language: eng ; spa
• Subjects: Aged; Angioplasty, Balloon, Coronary - instrumentation; Angioplasty, Balloon, Coronary - methods; Chronic Disease; Coronary Angiography - methods; Coronary Occlusion - diagnostic imaging; Coronary Occlusion - mortality; Coronary Occlusion - therapy; Drug-Eluting Stents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Propensity Score; Registries; Risk Assessment; Severity of Illness Index; Stents; Survival Rate; Treatment Outcome
• ISSN: 1885-5857
• DOI: 10.1016/j.rec.2017.07.018

There is little evidence on the optimal strategy for bifurcation lesions in the context of a coronary chronic total occlusion (CTO). This study compared the procedural and mid-term outcomes of patients with bifurcation lesions in CTO treated with provisional stenting vs 2-stent techniques in a multicenter registry. Between January 2012 and June 2016, 922 CTO were recanalized at the 4 participating centers. Of these, 238 (25.8%) with a bifurcation lesion (side branch ≥ 2mm located proximally, distally, or within the occluded segment) were treated by a simple approach (n=201) or complex strategy (n=37). Propensity score matching was performed to account for selection bias between the 2 groups. Major adverse cardiac events (MACE) consisted of a composite of cardiac death, myocardial infarction, and clinically-driven target lesion revascularization. Angiographic and procedural success were similar in the simple and complex groups (94.5% vs 97.3%; P=.48 and 85.6% vs 81.1%; P=.49). However, contrast volume, radiation dose, and fluoroscopy time were lower with the simple approach. At follow-up (25 months), the MACE rate was 8% in the simple and 10.8% in the complex group (P=.58). There was a trend toward a lower MACE-free survival in the complex group (80.1% vs 69.8%; P=.08). After propensity analysis, there were no differences between the groups regarding immediate and follow-up results. Bifurcation lesions in CTO can be approached similarly to regular bifurcation lesions, for which provisional stenting is considered the technique of choice. After propensity score matching, there were no differences in procedural or mid-term clinical outcomes between the simple and complex strategies.