Use of the Limited Antegrade Subintimal Tracking Technique in Chronic Total Occlusion Percutaneous Coronary Intervention

Exploring indicators of success in chronic total occlusion percutaneous coronary intervention with Stingray system‐based antegrade dissection re‐entry: Insights from retrospective analysis

“…Since the inception of the STAR technique, continuous improvements and optimizations have been made to limit the dissection and formation of subintimal hematoma, including the Carlino technique (derived from contrast‐guided STAR), 25 mini‐STAR technique, 26 LAST, 10 device‐based re‐entry (e.g., Stingray ADR), 14,27 and antegrade fenestration and re‐entry (AFR) 4,28 (Figure 4). The Stingray system is preferred because it is more reproducible and does not necessitate skilled wiring expertize 8,10,11 . However, it cannot eliminate the risk of developing subintimal hematomas.…”

“…In a previous study, 16 we demonstrated that after a guidewire‐assisted puncture during Stingray ADR, SPM established with the guidewire in the distal true lumen of CTO can facilitate reattempted CTO PCI (if the stent cannot be implanted because the long guidewire segment is subintima or the CTO segment has a large branch). If Stingray ADR fails and a large extraplaque hematoma forms, the retrograde approach may be the sole alternative 10 …”

“…The Stingray system is preferred because it is more reproducible and does not necessitate skilled wiring expertize. 8,10,11 However, it cannot eliminate the risk of developing subintimal hematomas. But it is noteworthy that reducing the operation time is an effective way to control the development of hematomas.…”

“…8 In the PROGRESS CTO registry study, the technical success rate of Stingray ADR was 89.7%, 9 and Stingray ADR was found to outperform the limited antegrade subintimal tracking (LAST) technique. 10 In another multicenter study, the Stingray system was reported to have better performance (technical success rate, 89%; procedural success rate, 87%) than other ADR techniques (STAR and LAST). 11 At present, the success of Stingray ADR is assessed mostly based on operator experience and the classic, broader conception of ADR, and specific studies reporting on Stingray ADR are lacking.…”

“…In the RECHARGE registry study, the success rate of Stingray ADR was 81%, which was better than that of non‐device‐based ADR (primary and bail‐out ADR) 8 . In the PROGRESS CTO registry study, the technical success rate of Stingray ADR was 89.7%, 9 and Stingray ADR was found to outperform the limited antegrade subintimal tracking (LAST) technique 10 . In another multicenter study, the Stingray system was reported to have better performance (technical success rate, 89%; procedural success rate, 87%) than other ADR techniques (STAR and LAST) 11 …”