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Subintimal tracking and re‐entry technique with contrast guidanc: A safer approach
Author(s) -
Carlino Mauro,
Godino Cosmo,
Latib Azeem,
Moses Jeffrey W.,
Colombo Antonio
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21699
Subject(s) - medicine , restenosis , stent , lesion , radiology , myocardial infarction , target lesion , surgery , blunt , cardiology , percutaneous coronary intervention
Objectives: To assess the procedural and clinical outcomes from a modified subintimal tracking and re‐entry (STAR) procedure performed using contrast guidance. Background: Previous data showed that recanalizing a chronic total occlusion (CTO) with the STAR technique was possible. However, this technique was considered difficult and therefore has only been adopted by a limited number of experienced operators. Methods: Patients ( n = 68) with a CTO of a native coronary artery treated by a single operator with this technique were included. Results: The right coronary artery was involved in 79.4%, the morphology was blunt in 77.9%, and CTO length was longer than 20 mm in 67.6%. Angiographic success rate was 80.9% with a 70.6% rate of complete recanalization. Stent implantation was performed in 82.3% of cases, with drug‐eluting stents (DES) implanted in the majority (92.7%). Procedural complications occurred in 10.3% of cases. There were no episodes of myocardial infarction during follow‐up, with 1 case (1.5%) of cardiac death. There were no cases of definite or probable stent thrombosis, and there was 1 (1.5%) possible stent thrombosis. The overall rate of in‐segment binary restenosis was 44.7%, and target lesion revascularization (TLR) was performed in 25% of lesions. The rate of TLR in lesions treated with DES was 29.4% and in those treated with bare‐metal stents was 50%. Conclusion: The contrast‐guided STAR technique appears to be feasible and relatively safe. However, this procedure is limited by a high rate of restenosis even with DES, and a second procedure may be necessary to obtain a definitive result. © 2008 Wiley‐Liss, Inc.