Garibaldi Salvatore, Godino Cosmo, Carlino Mauro, Mussardo Marco, Latib Azeem, Costanzo Luca, Tomasello Davide, Lo Schiavo Armando E, Evola Rosario, Tamburino Corrado, Galassi Alfredo R, Colombo Antonio
U.O. di Cardiologia, Ospedale San Vincenzo, Taormina.
G Ital Cardiol (Rome). 2010 Jul-Aug;11(7-8):584-9.
Previous data showed that recanalization of chronic total occlusions (CTO) with the subintimal tracking and reentry (STAR) technique is feasible. However, this technique is challenging and requires skilled operators to be performed. The aim of this study was to evaluate procedural and clinical outcomes of patients undergoing a contrast-guided STAR procedure.
All consecutive patients (n=121) with coronary CTO treated with the contrast-guided STAR technique in three Italian centers were included in this study, after failure of conventional CTO approaches.
The right coronary artery was involved in 76.8%, with blunt morphology in 62.8%. Angiographic and procedural success rates were 82.6% and 64.4%, respectively, with a 69.4% rate of complete recanalization. Stent implantation was performed in 81.8% of cases, using drug-eluting stents in 94.4%. Procedural complications occurred in 7.4% of cases. During follow-up no episodes of myocardial infarction were observed, but one cardiac death (0.8%). No definite or probable stent thrombosis was reported. The overall rate of target lesion revascularization was 21.4%.
This study demonstrated that the contrast-guided STAR technique appears to be a feasible and relatively safe procedure when performed as rescue technique after failure of conventional CTO approaches. However, this procedure is limited by a high rate of target lesion revascularization and a second procedure may be necessary to obtain a definitive result.
既往数据显示，采用内膜下追踪和重回真腔（STAR）技术实现慢性完全闭塞病变（CTO）再通是可行的。然而，该技术具有挑战性，需要熟练的操作者来实施。本研究的目的是评估接受造影剂引导下STAR手术患者的手术及临床结局。
在三个意大利中心，所有经传统CTO治疗方法失败后采用造影剂引导下STAR技术治疗的连续性冠状动脉CTO患者（n = 121）纳入本研究。
右冠状动脉受累比例为76.8%，钝圆形态比例为62.8%。血管造影成功率和手术成功率分别为82.6%和64.4%，完全再通率为69.4%。81.8%的病例进行了支架植入，其中94.4%使用药物洗脱支架。7.4%的病例发生手术并发症。随访期间未观察到心肌梗死事件，但有1例心源性死亡（0.8%）。未报告明确或可能的支架血栓形成。靶病变血运重建的总发生率为21.4%。
本研究表明，造影剂引导下的STAR技术在传统CTO治疗方法失败后作为补救技术使用时似乎是一种可行且相对安全的手术。然而，该手术受到靶病变血运重建率较高的限制，可能需要二次手术才能获得确切结果。
