A STAR is Reborn: Revalidating a Forgotten Technique in a Patient with Anterior ST-elevation MI

The Subintimal Tracking and Re-entry (STAR) technique is conventionally used during chronic total occlusion percutaneous coronary interventions as a bailout strategy to re-establish flow. This case highlights its use in the setting of primary percutaneous coronary intervention for ST-elevation MI (STEMI). An 80-year-old woman presented with anterior STEMI. The lesion was wire-uncrossable, and the STAR technique was used to successfully re-establish flow. Drug-coated balloon angioplasty was also performed. A follow-up angiogram 3 months later confirmed widely patent left anterior descending sub-intimal drug-coated balloon segments, and definitive stenting was performed. The procedural team faced the daunting challenge of a left anterior descending occlusion with no distal visualisation from collaterals. The STAR technique proved integral in ensuring successful re-establishment of thrombolysis in MI 3 flow. The patent vessel on the interval angiogram reinforces that the STAR technique is a safe and effective method to re-establish flow in STEMI patients with wire-uncrossable lesions.