Department of Internal Medicine and Systemic Disease, Clinical Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy.
Catheter Cardiovasc Interv. 2012 Jan 1;79(1):30-40. doi: 10.1002/ccd.22998. Epub 2011 Sep 28.
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.
We describe a new technique for the treatment of coronary CTO which utilizes a new generation of polymeric wires.
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.
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.
尽管设备的进步和创新技术的出现，经皮冠状动脉介入治疗（PCI）治疗慢性完全闭塞（CTO）的成功率仍然低于非闭塞血管 PCI。
我们描述了一种治疗冠状动脉 CTO 的新技术，该技术利用了新一代的聚合物导丝。
从 2009 年 3 月至 2010 年 6 月，在 117 例连续 CTO 病变的初始尝试失败后，采用了不同的策略作为“补救”。其中，传统策略（CS）如并行导丝、内膜下跟踪和再进入（STAR）、微通道技术、冠状动脉内超声引导再血管化和锚定球囊等，在 75 例（64.1%）中使用，而在其余病例中，使用了一种新的技术，即“迷你-STAR”。尽管在临床特征和血管造影病变特征的分布方面，两种方法的人群没有明显差异，但迷你-STAR 能够实现更高的手术成功率，与其他 CS 相比（97.6%比 52%，P<0.001），使用更少的造影剂（442±259cm³比 561±243cm³，P=0.01）和更短的手术和透视时间（122±61min 比 157±74min，P=0.009 和 60±31min 比 75±38min，P=0.03）。在围手术期并发症方面，如手术心肌梗死、冠状动脉穿孔和造影剂诱导的肾病，迷你-STAR 和 CS 之间没有差异。
迷你-STAR 技术是治疗 CTO 病变的一种有前途的策略，能够实现高手术成功率和低手术不良事件发生率。
