Abstract
The guided-STAR technique is an alternative anterograde approach for treatment of coronary chronic total occlusion (CTO) and it is usually followed by implantation of multiple stents. We describe a case of residual long coronary dissection left unstented after guided-STAR, with good results at 2 months follow-up. This case emphasizes the fact that sometimes even the longest coronary dissections can be left unstented especially in the contest of a CTO.
1
Introduction
The guided-STAR technique is an alternative anterograde approach for treatment of coronary chronic total occlusion (CTO) . It consists in a subintimal dissection that allows the wire to re-enter the true lumen distally to the occlusion, usually followed by implantation of multiple stents.
2
Case report
We describe a case of residual long coronary dissection (CD) left unstented after guided-STAR in a 50-year-old man with CTO of the right coronary artery ( Fig. 1 , panel a 1 –b 2 ). We decided not to implant stents because of the absence of contrast staining at the site of the dissection and because the final coronary flow of the right coronary artery (RCA) was preserved (type B of CD according to NHLBI classification); moreover the risk of stent restenosis is higher after long stenting . At 2 months follow-up (F-U), the patient became asymptomatic for stress angina and the angiography showed a positive remodeling of the CD ( Fig. 1 , panel c 1 –c 2 ). The fractional flow reserve (FFR) was not functionally significant ( Fig. 2 ). Therefore, the decision to not implant stents was confirmed. An IVUS ( Fig. 3 ) and a multidetector computed tomographic coronary angiography ( Fig. 4 ) were also performed and confirmed the angiographic findings.
