SPC365

Using calcium modification tools in coronary bifurcations: what changes?

Session: Sessão de Posters 13 - Intervenção coronária avançada: fisiologia, bifurcações e complicações
Speaker: Luís Pedro Dos Santos

Congress: CPC 2026
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Luís Pedro dos Santos; João Gouveia Fiúza; Gonçalo RM Ferreira; Mariana Duarte Almeida; Oliver Kungel; Francisco Rodrigues Santos; Maria Luísa Gonçalves; António Costa
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Introduction: </span></span></strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Calcified coronary bifurcation lesions (CBL) are technically challenging. Advanced calcium modification tools (CMT) (cutting/scoring balloons, intravascular lithotripsy, atherectomy) may improve lesion preparation, yet evidence supporting their use specifically in bifurcation percutaneous coronary intervention (PCI) remains limited.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Purpose: </span></span></strong><span style="font-family:Aptos,sans-serif"><span style="color:black">To evaluate angiographic, procedural, and clinical outcomes of CMT in CBL PCI compared with conventional preparation semi compliant and NC ballons).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Methods:</span></span></strong>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">Single-center retrospective study including consecutive calcified CBL PCI performed between 2019&ndash;2024. Cases treated with CMT were compared with all remaining bifurcation PCI cases in the same period without advanced tools. Endpoints included residual stenosis &gt;20%, final TIMI flow, procedure duration, radiation exposure (PKA, mGy&middot;cm&sup2;), periprocedural complications (either coronary or vascular access), bleeding, target-vessel revascularization, heart-failure (HF) hospitalization, MACE (myocardial infarction and/or stroke), and 1-year all-cause and cardiovascular (CV) mortality. Groups were compared using Mann&ndash;Whitney U for continuous variables and chi-square/Fisher&rsquo;s exact test for categorical variables (two-sided).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Results: </span></span></strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Baseline demographics were similar with a median age of 71 and 91.2% were male sex. There were 37 patients in the CMT group and 43 patients in the standard preparation group. </span></span><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Angiographic outcome:</span></span></strong>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">residual stenosis &ge;20% occurred in 13/43 (30.2%) conventional cases and in 0/37 (0%) CMT cases (p&lt;0.001). Final TIMI flow impairment was uncommon (1/43 [2.3%] vs 0/37 [0%]; Fisher p=1.000). </span></span><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Procedural metrics</span></span></strong><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">:</span></span></strong>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">CMT use was associated with longer procedures (120 [95&ndash;145] vs 93 [74&ndash;117] min; p=0.001) with no difference in radiation exposure (PKA 150,000 [92,725.5&ndash;220,415.5] vs 171,763 [73,838&ndash;259,047] mGy&middot;cm&sup2;; p=0.881). </span></span><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Safety and follow-up:</span></span></strong>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">no significant differences were observed in periprocedural complications (4/43 [9.3%] vs 1/37 [2.7%]; Fisher p=0.366), bleeding (4/43 [9.3%] vs 1/37 [2.7%];&nbsp;p=0.366), target-vessel revascularization (7/43 [16.3%] vs 2/37 [5.4%];&nbsp;p=0.166), heart-failure hospitalization (2/43 [4.7%] vs 1/37 [2.7%];&nbsp;p=1.000), and</span></span>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">MACE (2/43 [4.7%] vs 1/37 [2.7%];&nbsp;p=1.000). At 1 year, all-cause mortality was 2/43 (4.7%) vs 5/37 (13.5%) (Fisher p=0.240) and CV mortality 1/43 (2.3%) vs 5/37 (13.5%) (p=0.090).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">Conclusion</span></span></strong><strong><span style="font-family:Aptos,sans-serif"><span style="color:black">: </span></span></strong><span style="font-family:Aptos,sans-serif"><span style="color:black">In this real-world bifurcation PCI cohort, CMT use was associated with a markedly lower rate of residual stenosis at the cost of longer procedures, without increased radiation exposure or statistically significant differences in periprocedural complications,</span></span>&nbsp;<span style="font-family:Aptos,sans-serif"><span style="color:black">MACE, or 1-year outcomes. These data support considering CMT tools in calcified bifurcation lesions and warrant confirmation in larger prospective studies.</span></span></span></span></span></p>