Abstract：
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 3,948 procedures performed between January and November 2023 were examined (33% with bifurcation involvement). Among bifurcation lesions, 38% and 37% were located within 5 mm 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 (1,544 [836 to 2,819] vs 1,298.5 [699.1 to 2,386.6] mGy, p <0.001) and contrast volume (230 [160 to 300] vs 190 [130 to 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 and distal, p <0.001). On multivariable analysis, the presence of an intralesion bifurcation was independently associated with technical failure (odds ratio 2.04, 95% confidence interval 1.24 to 3.35, p = 0.005). In conclusion, bifurcations are present in approximately one-third of CTOs who underwent PCI. PCI of CTOs with bifurcation can be achieved with high success rates except for bifurcations within the occluded segment, which were associated with higher technical failure.
摘要：
靠近闭塞段或在闭塞段内的分叉受累给慢性完全闭塞（CTO）-经皮冠状动脉介入治疗（PCI）带来了越来越大的困难。然而,这一变量在基于血管造影的CTO评分系统中没有被考虑,在大型多中心系列中也没有被广泛研究.因此，我们分析了涉及92个欧洲中心的CTO-PCI注册，以探索发病率，血管造影和手术特征，以及涉及分叉的CTO-PCI的特定结果。共检查了2023年1月至11月期间进行的3948例手术（33％涉及分叉）。在分叉病变中，38%和37%位于近端和远端帽的5mm内，分别,16%的CTO成员，在9％的病例中，近端和远端分叉共存。与无分叉病变相比，CTO分叉病变具有较高的复杂性（J-CTO2.33±1.21vs2.11±1.27，p<0.001），并且与更多使用其他设备有关（双腔微导管占27.6%vs8.4%，p<0.001，血管内超声在32.2%和21.7%，p<0.001)。辐射剂量（1544[836-2819]vs1298.5[699.1-2386.6]mGy，p<0.001）和对比剂体积（230[160-300]vs190[130-250]ml，p<0.001)也更高。技术成功相似(91.5%有分叉参与vs90.4%无分叉参与,p=0.271）。然而,与其他分叉位置亚组相比，CTO段内的分叉病变（内部）与较低的技术成功率相关（83.7％vs93.3％近端，远端93.4%,近端和远端为89.0%，p<0.001)。在多变量分析中，分支内分叉的存在与技术故障独立相关(OR2.19,95CI1.52-3.16,p=0.001).总之,在接受PCI的CTO中大约有三分之一存在分叉。除了闭塞段内的分叉外，具有分叉的CTO的PCI可以获得很高的成功率。与更高的技术故障有关。
