Treating chronic total occlusions using subintimal tracking and reentry: The STAR technique

被引:188
作者
Colombo, A
Mikhail, GW
Michev, I
Iakovou, I
Airoldi, F
Chieffo, A
Rogacka, R
Carlino, M
Montorfano, M
Sangiorgi, GM
Corvaja, N
Stankovic, G
机构
[1] EMO Ctr Cuore Columbus, I-20145 Milan, Italy
[2] Hosp San Raffaele, Catheterizat Lab, I-20132 Milan, Italy
[3] Inst Cardiovasc Dis, Belgrade, Serbia
关键词
total occlusions; stents; restenosis;
D O I
10.1002/ccd.20307
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Successful recanalization of coronary total occlusions (CTOs) remains an area where improvements are needed. We propose an approach similar to the one utilized in treating some peripheral artery occlusions and aimed to create a subintimal dissection with distal reentry. A 0.014' hydrophilic wire with a J-configuration is utilized for this purpose. We applied this technique to CTO of native coronaries in 31 patients where previous attempts failed in 21 of them (67%). The right coronary artery (RCA) was the index vessel in 87% of patients. Recanalization of the vessel and of most of distal branches was achieved in 21 patients; patency of at least one major distal branch was achieved in 9 patients. Drug-eluting stents [DESs) were implanted in 53% of patients. Three patients had intraprocedural vessel perforation without consequences. Five patients (16%) had in-hospital non-O-wave myocardial infarction. No other adverse events occurred at a mean follow-up of 5.1 +/- 3.7 months except for one noncardiac death. Angiographic follow-up was performed in 21 (67%) patients and 53% of them developed restenosis. Reintervention on the target vessel was performed in 11 patients (52%). Complete success with the procedure was originally obtained in 8 of the 10 patients who did not develop restenosis and in 8 of them DESs were originally implanted. This technique appears a promising approach to recanalize difficult total occlusions, particularly the ones localize on the RCA, which has the most important side branches located distally. (c) 2005 Wiley-Liss, Inc.
引用
收藏
页码:407 / 411
页数:5
相关论文
共 15 条
[1]   Utility of the safe-cross-guided radiofrequency total occlusion crossing system in chronic coronary total occlusions (Results from the Guided Radio Frequency Energy Ablation of Total Occlusions Registry Study) [J].
Baim, DS ;
Braden, G ;
Heuser, R ;
Popma, JJ ;
Cutlip, DE ;
Massaro, JM ;
Marulkar, S ;
Arvay, LJ ;
Kuntz, RE .
AMERICAN JOURNAL OF CARDIOLOGY, 2004, 94 (07) :853-858
[2]   RECANALIZATION OF FEMORO-POPLITEAL OCCLUSIONS - IMPROVING SUCCESS RATE BY SUBINTIMAL RECANALIZATION [J].
BOLIA, A ;
BRENNAN, J ;
BELL, PRF .
CLINICAL RADIOLOGY, 1989, 40 (03) :325-325
[3]   A randomized trial of elective stenting after balloon recanalization of chronic total occlusions [J].
Höher, M ;
Wöhrle, J ;
Grebe, OC ;
Kochs, M ;
Osterhues, HH ;
Hombach, V ;
Buchwald, AB .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 34 (03) :722-729
[4]  
Ingle H, 2002, J ENDOVASC THER, V9, P411, DOI 10.1583/1545-1550(2002)009<0411:SAOIIV>2.0.CO
[5]  
2
[6]   Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions - Data from a multicenter, prospective, observational study (TOAST-GISE) [J].
Olivari, Z ;
Rubartelli, P ;
Piscione, F ;
Ettori, F ;
Fontanelli, A ;
Salemme, L ;
Giachero, C ;
Di Mario, C ;
Gabrielli, G ;
Spedicato, L ;
Bedogni, F .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (10) :1672-1678
[7]   PERCUTANEOUS REVASCULARIZATION OF CHRONIC CORONARY OCCLUSIONS - AN OVERVIEW [J].
PUMA, JA ;
SKETCH, MH ;
TCHENG, JE ;
HARRINGTON, RA ;
PHILLIPS, HR ;
STACK, RS ;
CALIFF, RM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1995, 26 (01) :1-11
[8]   Percutaneous intentional extraluminal (subintimal) recanalization: how to do it yourself [J].
Reekers, JA ;
Bolia, A .
EUROPEAN JOURNAL OF RADIOLOGY, 1998, 28 (03) :192-198
[9]   Stent implantation versus balloon angioplasty in chronic coronary occlusions: Results from the GISSOC trial [J].
Rubartelli, P ;
Niccoli, L ;
Verna, E ;
Giachero, C ;
Zimarino, M ;
Fontanelli, A ;
Vassanelli, C ;
Campolo, L ;
Martuscelli, E ;
Tommasini, G .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (01) :90-96
[10]   Angioplasty for chronic total occlusion by using tapered-tip guidewires [J].
Saito, S ;
Tanaka, S ;
Hiroe, Y ;
Miyashita, Y ;
Takahashi, S ;
Satake, S ;
Tanaka, K .
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2003, 59 (03) :305-311