title: Mini-STAR as bail-out strategy for percutaneous coronary intervention of chronic total occlusion.
abstract: BACKGROUND
  Although the advancement of the equipment and the presence of innovative techniques, percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to be affected by lower procedural success in comparison with non occluded vessel PCI.
  
  
  OBJECTIVE
  We describe a new technique for the treatment of coronary CTO which utilizes a new generation of polymeric wires.
  
  
  RESULTS
  From March 2009 to June 2010 different strategies were adopted as "bail out" after an initial attempt failed in 117 consecutive CTO lesions. Among these, conventional strategies (CS) such as parallel wire, sub-intimal tracking and re-entry (STAR), microchannel technique, intracoronary ultrasound guided revascularization and anchor balloon, were used in 75 cases (64.1%), while in the remaining a new technique, the "mini-STAR," was used (39.9%). Although no substantial differences were observed regarding the distribution of clinical features and angiographic lesions characteristics between the populations, mini-STAR was able to achieve a higher rate of procedural success in comparison with other CS (97.6% vs. 52%, P < 0.001) with lower contrast agent use (442 ± 259 cm(3) vs. 561 ± 243 cm(3), P = 0.01) and shorter procedural and fluoroscopy times (122 ± 61 vs. 157 ± 74 min, P = 0.009 and 60 ± 31 min vs. 75 ± 38 min, P = 0.03, respectively). No differences were observed in term of peri-procedural complications such as procedural myocardial infarction, coronary perforations, and contrast-induced nephropathy between mini-STAR and CS.
  
  
  CONCLUSIONS
  The mini-STAR technique is a promising strategy for the treatment of CTO lesions, achieving a high procedural success rate and low occurrence of procedural adverse events.
authors.affiliation: Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy. argalassi@virgilio.it
authors.forename: Alfredo Ruggero
authors.initials: AR
authors.lastname: Galassi
authors.forename: Salvatore Davide
authors.initials: SD
authors.lastname: Tomasello
authors.forename: Luca
authors.initials: L
authors.lastname: Costanzo
authors.forename: Maria Barbara
authors.initials: MB
authors.lastname: Campisano
authors.forename: Giombattista
authors.initials: G
authors.lastname: Barrano
authors.forename: Masafumi
authors.initials: M
authors.lastname: Ueno
authors.forename: Antonio
authors.initials: A
authors.lastname: Tello-Montoliu
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D057785:Catheters; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries; D054855:Drug-Eluting Stents; D004867:Equipment Design; D005260:Female; D006335:Heart Injuries / Q000209:etiology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome