Key result
Modified reverse CART facilitates CTO retrograde crossing by avoiding the proximal hard cap.
Why the study?
Antegrade crossing of CTOs is often difficult due to the inability to penetrate the proximal hard cap, especially in anomalous coronary arteries lacking support.
A modified reverse CART technique creating dissection reentry in the proximal segment may provide a viable option for CTOs with calcified proximal caps when conventional reverse CART is not possible.
Answers are grounded in this paper and cite their sources.
May facilitate proximal cap penetration in anomalous coronary CTOs; hypothesis-generating and requires prospective validation before wider adoption.
Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible.
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Isawa et al. (2017) studied Chronic total occlusions (CTOs). Modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique was evaluated. A modified reverse controlled antegrade and retrograde subintimal tracking technique facilitated retrograde crossing of chronic total occlusions by avoiding the proximal hard cap.
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