Bifurcation lesions in the context of a PCI CTO - insight from Belgrade single center CTO registry

Background/Aim. Chronic total coronary artery occlusions (CTOs) are still one of the most complex procedures in the treatment of coronary arteries. If there is a bifurcation lesion within the CTO, it is certainly one of the biggest challenges for interventional cardiologists. Methods. We present a retrospective analysis of patients from our center who underwent percutaneous coronary intervention (PCI) with a bifurcation lesion within the CTO and a side branch with a diameter of 2 mm or more, in the period from January 2017 to December 2020. Results. Out of a total of 216 patients in the four-year period, 38 (18%) of them had a bifurcation lesion within the CTO. The most common bifurcation lesions were on the left anterior descending (LAD) artery (50%), and the least frequent on the circumflex coronary artery (21%). CTO recanalization was successful in 35 patients (92%). One stent technique was used in 27 patients (77%), while the two stent technique was used in 8 patients (23%). Conclusion. Bifurcation lesions in the context of PCI CTO are a relatively common finding on coronary angiography and represent a special challenge for CTO operators. Provisional technique (one stent technique) is the most common strategy for the treatment of bifurcation lesions in patients with CTO.