Alfredo Ruggero Galassi1, Marouane Boukhris2, Salvatore Davide Tomasello3, Francesco Marzà3, Salvatore Azzarelli3, Simona Giubilato3, Hazem Khamis4. 1. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy. Electronic address: argalassi@virgilio.it. 2. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy; Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia. 3. Department of Medical Sciences and Pediatrics, Catheterization Laboratory and Cardiovascular Interventional Unit, Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy. 4. Cardiology Unit, October 6th University Egypt, Cairo, Egypt.
Abstract
BACKGROUND: A promising variant of the subintimal tracking and re-entry (STAR) technique, called "mini-STAR," has been recently described as a successful rescue technique after revascularization failure by conventional techniques for coronary chronic total occlusion (CTO). METHODS: The current study enrolled patients with CTO who underwent successful revascularization by the mini-STAR technique as a bailout strategy. Two-year clinical follow-up and angiographic control procedures were performed. RESULTS: From March 2009-September 2011, 100 of 117 patients (mean age, 61.4 ± 10.9 years) underwent successful recanalization of CTO by the mini-STAR technique as a bailout strategy. Drug-eluting stents (DESs) were implanted in all cases. At 2-year follow-up, the major adverse cardiac events (MACE)-free survival was 89.2%, with a target lesion revascularization (TLR) rate of 6.5%. Angiographic follow-up was performed in 72% of patients. CTO target lesion restenosis was observed in 25% of patients, whereas the reocclusion rate was 12.5%. At multivariate Cox analysis, final thrombolysis in myocardial infarction (TIMI) flow < grade 3 was related to occurrence of MACE (hazard ratio, 5.9; 95% confidence interval [CI], 1.4-24.4; P = 0.013). Final TIMI flow < grade 3 (odds ratio [OR], 5.41; 95% CI, 1.05-27.73; P = 0.043) and CTO stent length (OR, 0.96; 95% CI, 0.93-0.99; P = 0.017) were independent predictors of reocclusion. The independent variables related to restenosis were first-generation DESs (OR, 4.10; 95% CI, 1.23-13.64; P = 0.022) and CTO stent length (OR, 0.97; 95% CI, 0.95-0.99; P = 0.027). CONCLUSIONS: As bailout strategy for CTO revascularization, the mini-STAR technique shows low MACE and TLR rates at long-term follow-up.
BACKGROUND: A promising variant of the subintimal tracking and re-entry (STAR) technique, called "mini-STAR," has been recently described as a successful rescue technique after revascularization failure by conventional techniques for coronary chronic total occlusion (CTO). METHODS: The current study enrolled patients with CTO who underwent successful revascularization by the mini-STAR technique as a bailout strategy. Two-year clinical follow-up and angiographic control procedures were performed. RESULTS: From March 2009-September 2011, 100 of 117 patients (mean age, 61.4 ± 10.9 years) underwent successful recanalization of CTO by the mini-STAR technique as a bailout strategy. Drug-eluting stents (DESs) were implanted in all cases. At 2-year follow-up, the major adverse cardiac events (MACE)-free survival was 89.2%, with a target lesion revascularization (TLR) rate of 6.5%. Angiographic follow-up was performed in 72% of patients. CTO target lesion restenosis was observed in 25% of patients, whereas the reocclusion rate was 12.5%. At multivariate Cox analysis, final thrombolysis in myocardial infarction (TIMI) flow < grade 3 was related to occurrence of MACE (hazard ratio, 5.9; 95% confidence interval [CI], 1.4-24.4; P = 0.013). Final TIMI flow < grade 3 (odds ratio [OR], 5.41; 95% CI, 1.05-27.73; P = 0.043) and CTO stent length (OR, 0.96; 95% CI, 0.93-0.99; P = 0.017) were independent predictors of reocclusion. The independent variables related to restenosis were first-generation DESs (OR, 4.10; 95% CI, 1.23-13.64; P = 0.022) and CTO stent length (OR, 0.97; 95% CI, 0.95-0.99; P = 0.027). CONCLUSIONS: As bailout strategy for CTO revascularization, the mini-STAR technique shows low MACE and TLR rates at long-term follow-up.
Authors: Barbara Anna Danek; Aris Karatasakis; Dimitri Karmpaliotis; Khaldoon Alaswad; Robert W Yeh; Farouc A Jaffer; Mitul Patel; John Bahadorani; William L Lombardi; Michael R Wyman; J Aaron Grantham; Anthony Doing; Jeffrey W Moses; Ajay Kirtane; Manish Parikh; Ziad A Ali; Sanjog Kalra; David E Kandzari; Nicholas Lembo; Santiago Garcia; Bavana V Rangan; Craig A Thompson; Subhash Banerjee; Emmanouil S Brilakis Journal: Int J Cardiol Date: 2016-04-06 Impact factor: 4.164
Authors: Marouane Boukhris; Salvatore Azzarelli; Salvatore Davide Tomasello; Zied Ibn Elhadj; Francesco Marzà; Alfredo R Galassi Journal: J Tehran Heart Cent Date: 2015-10-27
Authors: Leszek Bryniarski; Maksymilian P Opolski; Jarosław Wójcik; Maciej Lesiak; Tomasz Pawłowski; Jakub Drozd; Wojciech Wojakowski; Sławomir Surowiec; Maciej Dąbrowski; Adam Witkowski; Dariusz Dudek; Marek Grygier; Stanisław Bartuś Journal: Postepy Kardiol Interwencyjnej Date: 2021-03-27 Impact factor: 1.426