Author + information
- Received August 3, 2009
- Accepted October 26, 2009
- Published online February 1, 2010.
- Sudhir Rathore, MD⁎,⁎ (, )
- Osamu Katoh, MD⁎,
- Etsuo Tuschikane, MD, PhD⁎,
- Akitsugu Oida, MD†,
- Takahiko Suzuki, MD⁎ and
- Shimichi Takase, MD†
- ↵⁎Reprint requests and correspondence:
Dr. Sudhir Rathore, Department of Cardiology, Toyohashi Heart Center, 21-1, Gobudori, Oyama-cho, Toyohashi 441-8530, Japan
Objectives The study evaluates the feasibility and efficacy of the novel modification of the retrograde recanalization of the chronic total occlusion (CTO) of the coronary arteries by using intravascular ultrasound (IVUS)-guided reverse controlled antegrade and retrograde tracking (CART).
Background Despite improvement in the techniques and materials, CTO recanalization is still suboptimal. The CART procedure has improved success rates, but there are certain inherent technical uncertainties and risk with this procedure.
Methods This first series involves 31 patients, with 22 patients having previous failed attempts at CTO recanalization. All patients were treated with bilateral approach and using IVUS-guided reverse CART concept.
Results Successful recanalization of the CTO was achieved in all cases (100%). The access route was septal collateral in 20 (70%) cases and epicardial collateral in 11 (30%) cases. IVUS guidance was used successfully in 30 cases, and the channel dilator (microcatheter) was used in 27 cases. Guidewire injury and grade 1 perforation was seen in 3 (9%) cases, which were managed conservatively. There was no death, coronary artery bypass surgery, or pericardiocentesis in this group of patients. Mean fluoroscopy time was 65.84 ± 23.16 min, ranging from 31 to 106 min and total contrast volume used 321.32 ± 137.77 ml (range 115 to 650 ml).
Conclusions This first series describes a high success rate of CTO recanalization with IVUS-guided reverse CART in selected patients performed by an experienced operator.
- chronic total occlusion
- retrograde recanalization
- intravascular ultrasound
- controlled antegrade and retrograde tracking
- collateral channel
Dr. Katoh has contributed toward the invention of a channel dilator and has co-ownership of the company that receives royalties from ASAHI, Japan.
- Received August 3, 2009.
- Accepted October 26, 2009.
- American College of Cardiology Foundation