title: Treatment of iatrogenic occlusive coronary dissections: a novel approach.
abstract: OBJECTIVE
  Iatrogenic occlusive coronary dissection (IOCD) is a rare but high-risk complication of percutaneous coronary intervention (PCI) with limited data on options for management. The aim of this study was to describe a novel approach to the treatment of IOCD in order to gain access to the true coronary lumen. This technique may be feasible in cases in which conventional methods of PCI have failed.
  
  
  RESULTS
  We performed a retrospective analysis of 11 patients with PCI complicated by IOCD. In all cases, IOCD was treated using the contrast-guided subintimal tracking and re-entry "rescue" (STAR-R) procedure. Angiographic success with TIMI 3 flow was achieved in all patients and stent implantation was performed in 81.8% (n=9). At clinical follow-up (mean 186 ± 79 days), target lesion revascularisation was required in 9% (n=1), with target vessel revascularisation in 27.3% (n=3), and a major adverse cardiac event rate of 27.3% (n=3). Angiographic follow-up was obtained in 81.8% (n=9) with a restenosis rate of 11% (n=1).
  
  
  CONCLUSIONS
  The STAR-R procedure is a feasible option for the treatment of IOCD following failure of conventional techniques of treatment.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. carlino.mauro@hsr.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Rasha
authors.initials: R
authors.lastname: Al-Lamee
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ielasi
authors.forename: Cosmo
authors.initials: C
authors.lastname: Godino
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015331:Cohort Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies