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Bail-out reverse controlled antegrade and retrograde subintimal tracking accompanied by multiple complications in

Jon Suh1, Yoon Haeng Cho, Nae Hee Lee

  • 1Division of Cardiology, SoonChunHyang University Bucheon Hospital, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, Korea.

The Journal of Invasive Cardiology
|December 6, 2008
PubMed

Insights

The reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique successfully treated complex coronary chronic total occlusion (CTO) after conventional methods failed. Careful technique and experienced operators are crucial due to potential collateral vessel complications.

Area of Science:

  • Interventional Cardiology
  • Vascular Surgery

Background:

  • Percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) can be challenging.
  • Retrograde approaches using collateral channels improve PCI success rates.
  • The reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique is rarely used due to complexity and risk of dissection.

Observation:

  • A case of failed conventional antegrade PCI for CTO is presented.
  • The reverse CART technique was successfully employed in a setting of severe dissection.
  • Unexpected collateral-donor vessel complications occurred during the procedure.

Findings:

  • The reverse CART technique demonstrated potential usefulness in complex CTO cases where antegrade approaches fail.
  • Successful application of reverse CART in a severely dissected vessel was achieved.
  • The procedure highlighted the risk of significant collateral-donor vessel complications.

Implications:

  • Highly experienced operators and a systematic approach are essential for successful and safe reverse CART procedures.
  • This technique may offer a viable option for complex CTOs, but requires careful risk management.
  • Further research into optimizing reverse CART and managing its complications is warranted.

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