A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions

Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified...

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Main Authors: Tsuyoshi Isawa, Masahiko Ochiai, Masato Munehisa, Tatsushi Ootomo
Format: Article
Language:English
Published: Wiley 2017-01-01
Series:Case Reports in Cardiology
Online Access:http://dx.doi.org/10.1155/2017/3850646
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author Tsuyoshi Isawa
Masahiko Ochiai
Masato Munehisa
Tatsushi Ootomo
author_facet Tsuyoshi Isawa
Masahiko Ochiai
Masato Munehisa
Tatsushi Ootomo
author_sort Tsuyoshi Isawa
collection DOAJ
description Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible.
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spelling doaj-art-699f0b6ee30f41f9bf2de5d15eec91da2025-08-20T02:23:55ZengWileyCase Reports in Cardiology2090-64042090-64122017-01-01201710.1155/2017/38506463850646A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total OcclusionsTsuyoshi Isawa0Masahiko Ochiai1Masato Munehisa2Tatsushi Ootomo3Department of Cardiology, Sendai Kousei Hospital, Sendai, JapanDepartment of Cardiology and Cardiovascular Surgery, Showa University Northern Yokohama Hospital, Yokohama, JapanDepartment of Cardiology, Sendai Kousei Hospital, Sendai, JapanDepartment of Cardiology, Sendai Kousei Hospital, Sendai, JapanAntegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible.http://dx.doi.org/10.1155/2017/3850646
spellingShingle Tsuyoshi Isawa
Masahiko Ochiai
Masato Munehisa
Tatsushi Ootomo
A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
Case Reports in Cardiology
title A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
title_full A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
title_fullStr A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
title_full_unstemmed A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
title_short A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions
title_sort novel modified reverse controlled antegrade and retrograde subintimal tracking technique for bypassing the calcified proximal cap of coronary total occlusions
url http://dx.doi.org/10.1155/2017/3850646
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