Improvement of ischemia by subintimal tracking and re-entry in chronic total occlusion percutaneous coronary intervention

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Abstract

A 56-year-old male truck driver with history of percutaneous coronary intervention (PCI) to the left circumflex artery presented for worsening angina. A nuclear stress test showed a moderate reversible defect of the inferior wall. A chronic total occlusion of the mid right coronary artery with patent circumflex stent was documented by coronary angiography. After unsuccessful attempts with anterograde and retrograde wiring and dissection re-entry techniques, the subintimal tracking and re-entry (STAR) technique was utilized to advance the guidewire in an extraplaque fashion into the posterior descending artery and posterolateral branch with kissing balloon angioplasty at the bifurcation. A repeat stress test, as required by the state Department of Transportation, demonstrated a resolution of the previous reversible ischemia defect. The patient's symptoms also improved after STAR. Our case highlights an objective improvement of ischemia after STAR.

在慢性全闭塞经皮冠状动脉介入治疗中通过内膜下跟踪和再通路改善缺血状况
一名 56 岁的男性卡车司机因心绞痛恶化前来就诊,他曾接受过左侧环状动脉经皮冠状动脉介入治疗(PCI)。核应力测试显示下壁有中度可逆缺损。冠状动脉造影显示,右冠状动脉中段慢性全闭塞,周动脉支架通畅。在尝试了前行、逆行布线和夹层再入路技术未果后,患者采用了内膜下追踪和再入路(STAR)技术,将导丝以斑块外的方式推进至后降支和后外侧支,并在分叉处进行了吻合球囊血管成形术。根据州交通部的要求,再次进行的压力测试表明,之前的可逆性缺血缺陷已经消除。STAR 术后,患者的症状也得到了改善。我们的病例强调了 STAR 术后缺血的客观改善。
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