Coronary chronic total occlusions

Abstract

Aim: There are limited data on the mid‐term safety following the use of the guided‐subintimal tracking and re‐entry (guided‐STAR) technique for the treatment of chronic total occlusions (CTO) and concerns have arisen about a potential increased risk of stent thrombosis (ST). Objectives: The aim of this study was to evaluate the mid‐term safety in terms of cardiac death and ST after recanalization using the contrast guided‐STAR technique when compared to conventional anterograde CTO recanalization (CA‐CTO). Methods and Results: This retrospective study analyzed 355 consecutive patients with successful angiographic recanalization (residual stenosis P = 0.004), previous CABG (41.3 vs. 15.7%, P < 0.0001), three‐vessel disease, (62.7 vs. 47%, P = 0.019), right coronary artery CTO (62.7 vs. 41.6%, P = 0.002), stent length (68.15 vs. 54.05 mm, P < 0.0001). A drug‐eluting stent was implanted in the majority of cases (89.2% guided‐STAR vs. 93.5% CA‐CTO). At a median follow‐up of 779 days (IQR 495–1035), there were no significant differences in cardiac survival (97.2 vs. 97.5%, Log‐rank P = 0.912) and cumulative ARC ST rates (2.8 vs. 1.8%, Log‐rank P = 0.610) for guided‐STAR and CA‐CTO patients, respectively. The rate of restenosis was significantly higher in the guided‐STAR group compared to the CA‐CTO group (54 vs. 30%, Log‐rank P < 0.0001). The adjusted Cox proportional‐hazard analysis for procedural technique showed that the only significant independent predictor of restenosis was the stent length (HR, 1.017; 95% CI, 1.008–1.027; P < 0.0001). Conclusion: At mid‐term follow‐up, the guided‐STAR was not inferior to CA‐CTO in terms of safety. The only significant independent predictor of restenosis was the stent length. © 2011 Wiley Periodicals, Inc