A novel modification of the retrograde approach for the recanalization of chronic total occlusion of the coronary arteries intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking

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). Despite improvement i...

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Bibliographic Details
Published in:JACC. Cardiovascular interventions 2010-02, Vol.3 (2), p.155-164
Main Authors: Rathore, Sudhir, Katoh, Osamu, Tuschikane, Etsuo, Oida, Akitsugu, Suzuki, Takahiko, Takase, Shimichi
Format: Article
Language:English
Subjects:
Adult
Aged
Coronary Angiography
Coronary Artery Disease - diagnostic imaging
Coronary Artery Disease - pathology
Coronary Artery Disease - therapy
Coronary Circulation
Coronary Occlusion - diagnostic imaging
Coronary Occlusion - pathology
Coronary Occlusion - therapy
Coronary Vessels - pathology
Feasibility Studies
Female
Fluoroscopy
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Ultrasonography, Interventional - instrumentation
Ultrasonography, Interventional - methods
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Summary: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). 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. 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. 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). This first series describes a high success rate of CTO recanalization with IVUS-guided reverse CART in selected patients performed by an experienced operator.
ISSN:1876-7605
DOI:10.1016/j.jcin.2009.10.030