Predictors of restenosis following contemporary subintimal tracking and reentry technique: The importance of final TIMI flow grade
Corresponding Author
Mauro Carlino MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Correspondence to: Mauro Carlino, Interventional Cardiology Unit, San Raffaele Scientific Insitute, Milan, Italy. E-mail: [email protected]Search for more papers by this authorFilippo Figini MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorNeil Ruparelia DPhil, MRCP
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Department of Interventional Cardiology, Imperial College, London, United Kingdom
Search for more papers by this authorBarry F. Uretsky MD
Department of Interventional Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Search for more papers by this authorCosmo Godino MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAzeem Latib MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorLetizia Bertoldi MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorEmmanouil Brilakis MD, PhD
Department of Interventional Cardiology, VA North Texas Health Care System, Dallas, Texas
Department of Interventional Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorDimitri Karmpaliotis MD, PhD
Department of Interventional Cardiology, Presbyterian Hospital/Columbia University Medical Center, New York
Search for more papers by this authorDavid Antoniucci MD
Department of Interventional Cardiology, Careggi Hospital, Florence, Italy
Search for more papers by this authorAlberto Margonato MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAntonio Colombo MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorCorresponding Author
Mauro Carlino MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Correspondence to: Mauro Carlino, Interventional Cardiology Unit, San Raffaele Scientific Insitute, Milan, Italy. E-mail: [email protected]Search for more papers by this authorFilippo Figini MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorNeil Ruparelia DPhil, MRCP
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Department of Interventional Cardiology, Imperial College, London, United Kingdom
Search for more papers by this authorBarry F. Uretsky MD
Department of Interventional Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Search for more papers by this authorCosmo Godino MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAzeem Latib MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorLetizia Bertoldi MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorEmmanouil Brilakis MD, PhD
Department of Interventional Cardiology, VA North Texas Health Care System, Dallas, Texas
Department of Interventional Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
Search for more papers by this authorDimitri Karmpaliotis MD, PhD
Department of Interventional Cardiology, Presbyterian Hospital/Columbia University Medical Center, New York
Search for more papers by this authorDavid Antoniucci MD
Department of Interventional Cardiology, Careggi Hospital, Florence, Italy
Search for more papers by this authorAlberto Margonato MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Search for more papers by this authorAntonio Colombo MD
Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
Department of Interventional Cardiology, EMO-GVM Centro Cuore Columbus, Milan, Italy
Search for more papers by this authorConflict of interest: Dr Latib is a Consultant for Medtronic.
Abstract
Objectives
To identify predictors of restenosis after recanalization of chronic total occlusions (CTOs) with the Subintimal Tracking And Reentry (STAR) technique.
Background
STAR is associated with high rates of restenosis but the associated factors are not clear. Understanding the underlying mechanisms may be important to improve STAR outcomes and possibly other contemporary CTO recanalization techniques utilizing extensive subintimal dissection and stenting.
Methods
We retrospectively analyzed 211 lesions that underwent a STAR procedure (between 2002 and 2013) with a final Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3. One-hundred and nineteen lesions that received drug eluting stents (DES) and underwent follow-up angiography were included in the final analysis.
Results
Of the 119 lesions treated with DES following STAR, 75 restenoses were observed (63.0%). Utilizing multivariate analysis, TIMI flow grade in the recanalized artery following stent implantation at the end of the index procedure was the only independent predictor of restenosis.
Conclusions
Following recanalization of a CTO with STAR, final TIMI flow predicted future restenosis or reocclusion. As a bailout technique, STAR resulted in a high acute success rate with good safety and acceptable long-term results. When poor flow is observed following recanalization, and prior to stent implantation, a two-step strategy whereby a second procedure is performed at an interval to maximize coronary flow at the end of the procedure may be considered with the goal to reduce the risk of future restenosis or total vessel occlusion following STAR. © 2015 Wiley Periodicals, Inc.
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