Treatment of iatrogenic occlusive coronary dissections: a novel approach

Aims: Iatrogenic occlusive coronary dissection (IOCD) is a rare but high-risk complication of percutaneous coronary intervention (PCI) with limited data on options for management. The aim of this study was to describe a novel approach to the treatment of IOCD in order to gain access to the true coronary lumen. This technique may be feasible in cases in which conventional methods of PCI have failed. Methods and results: We performed a retrospective analysis of 11 patients with PCI complicated by IOCD. In all cases, IOCD was treated using the contrast-guided subintimal tracking and re-entry rescue (STAR-R) procedure. Angiographic success with TIMI 3 flow was achieved in all patients and stent implantation was performed in 81.8% (n=9). At clinical follow-up (mean 186 +/- 79 days), target lesion revascularisation was required in 9% (n=1), with target vessel revascularisation in 27.3% (n=3), and a major adverse cardiac event rate of 27.3% (n=3). Angiographic follow-up was obtained in 81.8% (n=9) with a restenosis rate of 11% (n=1). Conclusions: The STAR-R procedure is a feasible option for the treatment of IOCD following failure of conventional techniques of treatment.