Long term Clinical and Angiographic Outcome of the Mini-STAR Technique as a Bail Out Strategy for Percutaneous Coronary Intervention of Chronic Total Occlusion

Background: A promising variant of the subintimal tracking and re-entry (STAR) technique, called "mini-STAR," has been recently described as a successful rescue technique after revascularization failure by conventional techniques for coronary chronic total occlusion (CTO). Methods: The current study enrolled patients with CTO who underwent successful revascularization by the mini-STAR technique as a bailout strategy. Two-year clinical follow-up and angiographic control procedures were performed. Results: From March 2009-September 2011, 100 of 117 patients (mean age, 61.4 ± 10.9 years) underwent successful recanalization of CTO by the mini-STAR technique as a bailout strategy. Drug-eluting stents (DESs) were implanted in all cases. At 2-year follow-up, the major adverse cardiac events (MACE)-free survival was 89.2%, with a target lesion revascularization (TLR) rate of 6.5%. Angiographic follow-up was performed in 72% of patients. CTO target lesion restenosis was observed in 25% of patients, whereas the reocclusion rate was 12.5%. At multivariate Cox analysis, final thrombolysis in myocardial infarction (TIMI) flow < grade 3 was related to occurrence of MACE (hazard ratio, 5.9; 95% confidence interval [CI], 1.4-24.4; P= 0.013). Final TIMI flow < grade 3 (odds ratio [OR], 5.41; 95% CI, 1.05-27.73; P= 0.043) and CTO stent length (OR, 0.96; 95% CI, 0.93-0.99; P= 0.017) were independent predictors of reocclusion. The independent variables related to restenosis were first-generation DESs (OR, 4.10; 95% CI, 1.23-13.64; P= 0.022) and CTO stent length (OR, 0.97; 95% CI,0.95-0.99; P= 0.027). Conclusions: As bailout strategy for CTO revascularization, the mini-STAR technique shows low MACE and TLR rates at long-term follow-up.