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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:432-9 - Vol. 71 Num.06 DOI: 10.1016/j.rec.2017.09.003

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

Soledad Ojeda a,, Lorenzo Azzalini b, Jorge Chavarría a, Antonio Serra c, Francisco Hidalgo a, Susanna Benincasa b, Livia L. Gheorghe c, Roberto Diletti d, Miguel Romero a, Barbara Bellini b, Alejandro Gutiérrez e, Javier Suárez de Lezo a, Francisco Mazuelos a, José Segura a, Mauro Carlino b, Antonio Colombo b, Manuel Pan a

a Unidad de Cardiología Intervencionista, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides para la Investigación en Biomedicina de Córdoba (IMIBIC), Córdoba, Spain
b Division of Interventional Cardiology, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
c Unidad de Cardiología Intervencionista, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
d Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
e Departamento de Cardiología, Hospital Puerta del Mar, Cádiz, Spain

Refers to

Free article“Everything Should be Made as Simple as Possible but Not Simpler”
Thierry Lefevre, Yves Louvard
Rev Esp Cardiol. 2018;71:418-9
Full text - PDF


Bifurcations lesions. Coronary chronic total occlusion. Percutaneous coronary intervention.


Introduction and objectives

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 ≥ 2 mm 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.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved