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The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions

The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry

Masashi Kimura, MD^_*,_*, Osamu Katoh, MD^_*, Etsuo Tsuchikane, MD^_*, Kenya Nasu, MD^_*, Yoshihisa Kinoshita, MD^_*, Mariko Ehara, MD^_*, Mitsuyasu Terashima, MD^_*, Hitoshi Matsuo, MD^_*, Tetsuo Matsubara, MD^_*, Keiko Asakura, MD^_*, Yasushi Asakura, MD^_*, Shigeru Nakamura, MD, Akitsugu Oida, MD, Shinichi Takase, MD, Nicolaus Reifart, MD, Carlo Di Mario, MD^||, Takahiko Suzuki, MD^_*

^_* Toyohashi Heart Center, Aichi, Japan
Kyoto Katsura Hospital, Kyoto, Japan
Takase Clinic, Gunma, Japan
University of Frankfurt, Chief Department of Cardiology, Main Taunus Hospitals, Bad Soden, Germany
^|| Royal Brompton Hospital and Imperial College, London, United Kingdom

^_* Reprint requests and correspondence: Dr. Masashi Kimura, Toyohashi Heart Center 21-1, Gobudori, Oyama-cho, Toyohashi 4418530, Japan (Email: kimura.masashi{at}gmail.com).

Objectives: The aim of this study was to evaluate the safety and feasibility of a new concept for chronic total occlusion (CTO) recanalization—using a bilateral approach that utilizes a Controlled Antegrade and Retrograde subintimal Tracking (CART) technique.

Background: Successful percutaneous recanalization of coronary CTOs results in improved long-term outcomes. The recanalization of CTOs in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures.

Methods: A total of 224 consecutive patients (mean age 61 ± 9 years; 86.2% men) were enrolled in this prospective multicenter registry. This technique combines the simultaneous use of antegrade and retrograde approaches. A subintimal dissection is created in both antegrade and retrograde fashion, thereby limiting the extension of the subintimal dissection within the CTO portion.

Results: Of 224 CTO lesions (>3 months in duration) undergoing attempted recanalization using the CART technique, 145 cases (64.7%) had undergone previous CTO recanalization attempts. The success rates of crossing in a retrograde fashion with a wire and a balloon were 87.9% and 79.9%, respectively. The overall technical and procedural success rates achieved in this registry were 92.4% and 90.6%, respectively.

Conclusions: A bilateral approach for CTO lesions using the CART technique is feasible, safe, and has a higher success rate than previous approaches. These results indicate that a bilateral technique can solve a major dilemma that commonly affects CTO procedures.

Key Words: chronic total occlusions • bilateral approach • CART technique • revascularization

Abbreviations and Acronyms   CTO = chronic total occlusion   MACE = major adverse cardiac events   MI = myocardial infarction   PCI = percutaneous coronary intervention