Treating chronic total occlusions using subintimal tracking and reentry: the STAR technique.

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Biology

Background:

• Coronary total occlusions (CTOs) present a significant challenge in interventional cardiology.
• Existing recanalization techniques have limitations, necessitating novel approaches.
• Subintimal dissection with distal reentry is an established method for peripheral artery occlusions.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel subintimal dissection with distal reentry technique for treating coronary total occlusions (CTOs).
• To assess the feasibility of this approach in patients with previously failed recanalization attempts.
• To determine the procedural success rates and clinical outcomes associated with this technique.

Main Methods:

• A 0.014-inch hydrophilic wire with a J-configuration was used to create a subintimal dissection and achieve distal reentry.
• The technique was applied to 31 patients with native coronary artery CTOs, including 21 with prior failed attempts.
• Drug-eluting stents (DESs) were implanted in a subset of patients, and follow-up included angiography and clinical assessment.

Main Results:

• Successful recanalization was achieved in 21 out of 31 patients (67.7%).
• Patency of at least one major distal branch was achieved in 9 patients.
• In-hospital complications included minor vessel perforation (3 patients) and non-Q-wave myocardial infarction (5 patients).
• At a mean follow-up of 5.1 months, 53% of patients developed restenosis, and 52% required reintervention.

Conclusions:

• The subintimal dissection with distal reentry technique is a promising approach for recanalizing complex coronary total occlusions, especially in the right coronary artery.
• The technique demonstrated acceptable safety and efficacy, although restenosis remains a concern.
• Further research is warranted to optimize this technique and improve long-term outcomes.