title: Subintimal tracking and re-entry technique with contrast guidance: a safer approach.
abstract: OBJECTIVE
  To assess the procedural and clinical outcomes from a modified subintimal tracking and re-entry (STAR) procedure performed using contrast guidance.
  
  
  BACKGROUND
  Previous data showed that recanalizing a chronic total occlusion (CTO) with the STAR technique was possible. However, this technique was considered difficult and therefore has only been adopted by a limited number of experienced operators.
  
  
  METHODS
  Patients (n = 68) with a CTO of a native coronary artery treated by a single operator with this technique were included.
  
  
  RESULTS
  The right coronary artery was involved in 79.4%, the morphology was blunt in 77.9%, and CTO length was longer than 20 mm in 67.6%. Angiographic success rate was 80.9% with a 70.6% rate of complete recanalization. Stent implantation was performed in 82.3% of cases, with drug-eluting stents (DES) implanted in the majority (92.7%). Procedural complications occurred in 10.3% of cases. There were no episodes of myocardial infarction during follow-up, with 1 case (1.5%) of cardiac death. There were no cases of definite or probable stent thrombosis, and there was 1 (1.5%) possible stent thrombosis. The overall rate of in-segment binary restenosis was 44.7%, and target lesion revascularization (TLR) was performed in 25% of lesions. The rate of TLR in lesions treated with DES was 29.4% and in those treated with bare-metal stents was 50%.
  
  
  CONCLUSIONS
  The contrast-guided STAR technique appears to be feasible and relatively safe. However, this procedure is limited by a high rate of restenosis even with DES, and a second procedure may be necessary to obtain a definitive result.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002908:Chronic Disease; D002983:Clinical Competence; D003287:Contrast Media; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging* / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D018579:Patient Selection; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D008670:Metals