Karacsonyi J, Kostantinis S, Simsek B, Alaswad K, Karmpaliotis D, Kirtane A, McEntegart M, Jaffer F, Choi J, Poommipanit P, Koutouzis M, Tsiafoutis I, Khatri J, Kandzari D, Chandwaney R, Elbarouni B, Gorgulu S, ElGuindy A, Abi-Rafeh N, Goktekin O, Ungi I, Rangan B, Mastrodemos O, Sandoval Y, Allana S, Burke MN, and Brilakis E. TCT-109 Use of Subintimal Tracking and Reentry Technique in Chronic Total Occlusion Percutaneous Coronary Intervention. J Am Coll Cardiol 2022; 80(12):B44-B45.
J Am Coll Cardiol
Background: There are limited data on the use of the subintimal tracking and reentry (STAR) technique for chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Methods: We analyzed 2,353 CTO PCIs performed using antegrade dissection re-entry (ADR) in the PROGRESS-CTO Registry, between 2012 and June 2022 at 41 centers.
Results: STAR was used in 450 cases (19.1%), primary STAR in 325 (13.8%) and secondary STAR (STAR after other ADR approaches) in 125 (5.3%). The Stingray system was used in 1,048 (44.5%), limited antegrade subintimal tracking (LAST) in 177 (7.5%), and contrast-guided STAR in 31 (1.3%) of re-entry cases. The mean patient age was 65.3 ± 10 years and 86.0% were men. STAR cases were more complex with higher Japan-CTO (3.05 ± 1.08 vs 2.87 ± 1.14, P = 0.002) and PROGRESS (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) CTO (1.58 ± 1.14 vs 1.20 ± 1.04, P < 0.001) scores compared to non-STAR cases. The cases where STAR was used had lower technical (69.3% vs 79.1%, P < 0.001) and procedural (67.7% vs 76.3%, P < 0.001) success compared with cases where STAR was not used. The incidence of major cardiac adverse events was similar (3.70% vs 3.52%, P = 0.858) between STAR and non-STAR cases. Primary STAR was associated with higher technical and procedural success and similar MACE compared with secondary STAR (Figure).
Conclusion: STAR is used in 19.1% of antegrade re-entry CTO PCI cases and is associated with higher angiographic complexity, lower technical and procedural success rates and similar major complication rates compared to antegrade re-entry cases that did not use STAR.
Categories: CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)