title: Incidence, treatment, and in-hospital outcome of bifurcation lesions in patients undergoing percutaneous coronary interventions for chronic total occlusions.
abstract: BACKGROUND
  Bifurcation lesions represent a distinct lesion subset associated with an increased risk of procedural complications. Data on the incidence, treatment, and outcome of bifurcation lesions associated with chronic total occlusions are limited.
  
  
  METHODS
  Among chronic total occlusion procedures performed by a single experienced operator, patients with a bifurcation lesion within the chronic total occlusion vessel and a side branch reference diameter greater than or equal to 2.0 mm were enrolled.
  
  
  RESULTS
  A total of 905 patients (mean age 61.1±9.5 years, men 89.4%) were treated for 922 chronic total occlusion lesions. Among these, 244 bifurcation lesions were observed (26.5%). The procedural time was significantly longer in bifurcation lesions (139±67 vs. 124±68 min; P=0.003), with greater use of contrast load (470±193 vs. 436±227 ml; P=0.04) and higher number of stents (3.1±1.5 vs. 2.9±1.4; P=0.035). Overall, an angiographic success was achieved in 91.1% of cases with a higher rate in nonbifurcation lesions (92.5 vs. 87.3%; P=0.04). Coronary perforations were more often observed in bifurcation lesions (4.9 vs. 1.7%; P<0.001), resulting in more tamponades (2.4 vs. 0.2%; P<0.001). True bifurcations were encountered in the majority of cases (86.8%) and required more two-stent techniques than false bifurcations (50 vs. 18.8%; P=0.001).
  
  
  CONCLUSIONS
  The incidence of bifurcation lesions in chronic total occlusions is higher than that reported in continuous lesions. The presence of a bifurcation lesion increases the complexity of the procedure and may lead to less angiographic success and more periprocedural complications.
authors.affiliation: aCatheterization Laboratory and Cardiovascular Interventional Unit, Department of Medical Sciences and Pediatrics, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy bFaculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia cCardiology Unit, October 6th University, Cairo, Egypt.
authors.forename: Alfredo R
authors.initials: AR
authors.lastname: Galassi
authors.forename: Marouane
authors.initials: M
authors.lastname: Boukhris
authors.forename: Salvatore D
authors.initials: SD
authors.lastname: Tomasello
authors.forename: Francesco
authors.initials: F
authors.lastname: Marzà
authors.forename: Salvatore
authors.initials: S
authors.lastname: Azzarelli
authors.forename: Simona
authors.initials: S
authors.lastname: Giubilato
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamis
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D013927:Thrombosis / Q000628:therapy