Cutting balloon in reverse CART technique for recanalization of chronic coronary total occlusion

Chronic coronary total occlusion (CTO) is still one of the last frontiers for myocardial revascularization by percutaneous coronary interventions (PCI). New devices (microcatheters, dedicated tools, guidewires), new techniques, and retrograde approach increase success rate of CTOPCI. The reverse controlled anterograde and retrograde subintimal tracking (CART) technique can be an option to succeed. Sometimes the retrograde guidewire fails to cross the calcified proximal cap into the antegrade space, despite several standard balloon inflations. In our case, we describe the first case of CTO-PCI by the reverse CART technique using a cutting balloon to facilitate the retrograde connection with the antegrade space in case of failure with conventional balloon.