Author + information
- Received June 15, 2009
- Revision received September 8, 2009
- Accepted September 18, 2009
- Published online November 1, 2009.
- 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∥ and
- Takahiko Suzuki, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Masashi Kimura, Toyohashi Heart Center 21-1, Gobudori, Oyama-cho, Toyohashi 4418530, Japan
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.
- Received June 15, 2009.
- Revision received September 8, 2009.
- Accepted September 18, 2009.
- American College of Cardiology Foundation