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Antegrade Wire Tracking of the Retrograde Tract (ATRT): A Novel Technique for Percutaneous Coronary Intervention for
Asit Das1, Gaurav Lakhani1, Tusharkanti Patra1
1Department of Cardiology, Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, IND.
Insights
The Antegrade Wire Tracking of the Retrograde Tract (ATRT) technique offers an 80.6% success rate for treating complex coronary total occlusions (CTO) when the standard antegrade approach fails. This safe interventional method provides a viable option for challenging CTO cases.
Area of Science:
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary total occlusions (CTO) represent the most complex coronary lesions.
- For CTOs where the antegrade approach fails, retrograde techniques, often combined with antegrade methods, are standard treatment.
- The antegrade wire tracking of the retrograde tract (ATRT) technique is a specific approach for these challenging cases.
Purpose of the Study:
- To evaluate the efficacy and safety of the ATRT technique.
- To assess ATRT as an initial retrograde followed by an antegrade approach for CTO lesions with a failed antegrade attempt.
Main Methods:
- The ATRT technique was applied to 31 CTO lesions after a failed antegrade approach.
- A floppy wire was advanced antegrade through the tract created by a retrograde balloon advanced over a retrograde wire.
- The retrograde balloon was advanced into the aorta retrogradely.
Main Results:
- The ATRT technique achieved a success rate of 80.6% in 25 out of 31 patients.
- Failure to cross the microchannel occurred in four patients.
- Two patients required a reverse controlled antegrade and retrograde subintimal tracking (CART) procedure due to inability to advance retrograde microcatheters or balloons.
Conclusions:
- ATRT is an effective and safe technique for percutaneous coronary intervention (PCI) in CTO lesions with failed antegrade approaches.
- The procedure demonstrates acceptable success rates and a favorable safety profile regarding complications.
Background:
Chronic total occlusion (CTO) lesions are the most challenging subset of coronary lesions. For lesions with a failed antegrade approach, the initial retrograde, followed by a combined retrograde and antegrade approach, remains the mainstay of therapy.
Objective:
The study evaluated a technique of initial retrograde followed by an antegrade approach to treat lesions with a failed antegrade approach.
Methods:
We have adopted this technique to treat 31 CTO lesions with a failed antegrade approach, where a floppy wire was advanced antegrade through the tract created by a retrograde balloon advanced over the retrograde wire (antegrade wire tracking of the retrograde tract (ATRT)), which was advanced into the aorta retrogradely.
Result:
In 31 patients with failed antegrade approaches, the ATRT technique was tried, which was successful in 25 patients (the success rate was 80.6%). There was a failure to cross the microchannel in four patients, although angiographically, it looked promising. In two patients, it was impossible to advance the microcatheter or the smallest profile balloon retrogradely until the entire length of the CTO body. So, a reverse controlled antegrade and retrograde subintimal tracking (CART) was performed on these two patients excluded from the study.
Conclusion:
ATRT is a useful technique for CTO percutaneous coronary intervention (PCI) for patients with failed antegrade approaches with acceptable success rates. The procedure is safe in terms of procedural complications.
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