Early vs Late Staged PCI After Subintimal Tracking and Re-Entry for Chronic Total Occlusions: A Randomized Trial.

Area of Science:

• Cardiovascular Interventions
• Interventional Cardiology
• Vascular Surgery

Background:

• Subintimal tracking and re-entry (STAR) with staged stenting is a bailout strategy for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
• The optimal timing for staged stenting after STAR remains undetermined.

Purpose of the Study:

• To evaluate the impact of early (5-7 weeks) versus late (12-14 weeks) staged PCI timing after STAR.
• To assess the primary endpoint of partial technical success in staged PCI procedures.

Main Methods:

• 150 patients undergoing CTO PCI with STAR were randomized into early or late staged PCI groups.
• Partial technical success was defined as TIMI flow grade 2-3 with <30% residual stenosis in a distal branch.
• Outcomes were compared using chi-square and Fisher exact tests.

Main Results:

• No statistically significant difference in partial technical success between early (83.6%) and late (71.4%) staged PCI (P = 0.08).
• TIMI flow grade 2-3 in the target vessel at the start of staged procedures was significantly higher in the early group (64.4% vs 44.2%; P = 0.012).

Conclusions:

• High partial technical success rates were observed for staged procedures following STAR with deferred stenting.
• While early staged PCI improved initial vessel patency, it did not lead to statistically significant differences in the overall technical success of the staged procedure.