title: New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique.
abstract: OBJECTIVE
  To demonstrate the safety and feasibility of a new concept for CTO recanalization using a controlled antegrade and retrograde subintimal tracking technique (CART technique).
  
  
  BACKGROUND
  A successful percutaneous recanalization of chronic coronary occlusions results in improved survival, as well as enhanced left ventricular function, reduction in angina, and improved exercise tolerance. However, successful recanalization of CTOs is still not optimal, and needs further improvements.
  
  
  METHODS
  Ten patients with a CTO underwent the CART procedure. This technique combines the simultaneous use of the antegrade and retrograde approaches. A subintimal dissection is created antegradely and retrogradely, which allows the operator to limit the extension of the subintimal dissection in the CTO portion. A retrograde approach means that the occlusion site is approached in a retrograde fashion through the best collateral channel from any other patent coronary artery.
  
  
  RESULTS
  The occlusion site was located in the RCA in 9 patients, and in the LAD in 1 patient. CTO duration varied from 7 to 84 months. Vessel recanalization was achieved in all patients. In all cases, the subintimal dissection was limited to the CTO region. No complications occurred in the collateral channel used for the retrograde approach. There were no in-hospital major adverse cardiac events.
  
  
  CONCLUSIONS
  The CART technique is feasible, safe, and has a high success rate.
authors.affiliation: Toyohashi Heart Center, Toyohashi, Japan.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Surmely
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Nishida
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Nakayama
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakamura
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Oida
authors.forename: Eijiro
authors.initials: E
authors.lastname: Hattori
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods*; D016896:Treatment Outcome; D017539:Tunica Intima / Q000503:physiopathology / Q000601:surgery*; D018084:Ultrasonography, Interventional / Q000379:methods*; D016277:Ventricular Function, Left / Q000502:physiology