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Published on: July 21, 2013
Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions
Silvia Moscardelli1,2, Kathleen E Kearney1, William L Lombardi1
1Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.
Insights
Controlled antegrade and retrograde subintimal tracking (CART) is a valuable technique for complex chronic total occlusion (CTO) percutaneous coronary intervention (PCI). This study shows CART has high success and low complication rates in challenging retrograde CTO cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Controlled antegrade and retrograde subintimal tracking (CART) is infrequently utilized in modern chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
- There is a need to evaluate the utility of CART in complex CTO cases.
Purpose of the Study:
- To analyze the indications, procedural characteristics, and outcomes of CART within a high-volume CTO program.
- To assess the efficacy and safety of CART in challenging retrograde CTO PCI procedures.
Main Methods:
- Retrospective analysis of patients undergoing retrograde CTO PCI with CART from January 2019 to November 2023.
- Primary endpoint was technical success; secondary endpoints included procedural success and complications.
- Patient demographics, CTO characteristics (e.g., J-CTO score), collateral selection, and procedural details were recorded.
Main Results:
- CART was performed in 7.5% of 1,582 CTO PCI cases (45 patients).
- Patients were older males with high anatomical complexity (J-CTO score 3.6±0.9) and prior bypass surgery (68.9%).
- Technical and procedural success rates were 82.2%, with a CART success rate of 73.3%. Coronary perforation occurred in 8.9%, with tamponade in 2.2%.
Conclusions:
- CART is an effective technique for selected, highly complex CTOs addressed via a retrograde approach.
- The procedure demonstrates high success rates and low complication rates, even in high-risk patients with complex anatomy.
- CART expands the interventional toolkit for challenging CTO cases.
Background:
Controlled antegrade and retrograde subintimal tracking (CART) is rarely performed in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Aims:
We aimed to analyse the indications, procedural characteristics, and outcomes of CART at a high-volume CTO programme.
Methods:
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.
Results:
Of 1,582 CTO PCI, the retrograde approach was performed in 603 procedures (38.1%), and CART was used in 45 cases (7.5%). The mean age was 69.1±10.3 years, 93.3% were male, and prior coronary artery bypass graft surgery was present in 68.9%. The most common target CTO vessel was the right coronary artery (48.9%). Anatomical complexity was high (Multicentre CTO Registry of Japan [J-CTO] score of 3.6±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 1 patient (2.2%) suffered tamponade and required pericardiocentesis. No other in-hospital major adverse cardiac events were diagnosed.
Conclusions:
CART is a useful technique in selected, very complex CTOs tackled with the retrograde approach. Success rates were high, while complication rates were low, considering the high anatomical complexity and baseline patient risk.
