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Controlled antegrade and retrograde subintimal tracking (CART) is rarely performed in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We aim to analyze the indications, procedural characteristics, and outcomes of CART at a high-volume CTO program. We included all patients undergoing a retrograde CTO PCI in which CART was performed at our institution between January 2019 and November 2023. The primary endpoint was technical success. Of 1,582 CTO PCIs, the retrograde approach was performed in 603 procedures (38.1%), and CART was used in 45 cases (7.5%). Mean age was 69.1±10.3 years, 93.3% were men, prior coronary bypass graft surgery was present in 68.9%. The most common target CTO vessel was the right coronary artery (48.9%). Anatomic complexity was high (J-CTO score of 3.8±0.9). The most common collateral used for CART was a saphenous vein graft (62.2%). Advanced calcium modification was required in 15.6% of cases. CART was successful in 73.3%. Technical and procedural success was 82.2%. Coronary perforation was diagnosed in 4 subjects (8.9%), but only one patient (2.2%) suffered tamponade and required pericardiocentesis. No other in-hospital major adverse events were diagnosed. CART is a useful technique in selected very complex CTOs tackled with the retrograde approach. Success rates were high, while complications rates were low, considered the high anatomic complexity and baseline patient risk.
Moscardelli et al. (Wed,) studied this question.