Mauro Carlino1, Filippo Figini1,2, Neil Ruparelia1,2,3, Barry F Uretsky4, Cosmo Godino1, Azeem Latib1,2, Letizia Bertoldi1, Emmanouil Brilakis5,6, Dimitri Karmpaliotis7, David Antoniucci8, Alberto Margonato1, Antonio Colombo1,2. 1. Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy. 2. Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy. 3. Department of Interventional Cardiology, Imperial College, London, United Kingdom. 4. Department of Interventional Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 5. Department of Interventional Cardiology, VA North Texas Health Care System, Dallas, Texas. 6. Department of Interventional Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. 7. Department of Interventional Cardiology, Presbyterian Hospital/Columbia University Medical Center, New York. 8. Department of Interventional Cardiology, Careggi Hospital, Florence, Italy.
Abstract
OBJECTIVES: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. BACKGROUND: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. METHODS: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. RESULTS: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. CONCLUSIONS: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.
OBJECTIVES: To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique. BACKGROUND: STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting. METHODS: We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis. RESULTS: Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis. CONCLUSIONS: Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR.
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: Luigi Di Serafino; Plinio Cirillo; Tullio Niglio; Francesco Borgia; Bruno Trimarco; Giovanni Esposito; Eugenio Stabile Journal: World J Cardiol Date: 2017-08-26