Improvement of regional ischemia after successful percutaneous intervention of bypassed native coronary chronic total occlusion: an application of the CART technique.
Myocardial ischemia has been associated with patent saphenous vein grafts (SVG) for reasons that may be attributable to graft-related endothelial dysfunction. Recanalization of the bypassed native coronary arteries may relieve the regional ischemia. In this clinical scenario, percutaneous coronary intervention (PCI) of the challenging chronic total occlusions (CTO) can be facilitated by a retrograde approach utilizing the SVGs as access conduits. Controlled antegrade and retrograde subintimal tracking (CART) is a technique developed to facilitate the recanalization of CTOs by aggressive wire manipulation from both ends of the lesions. Success rates of CART are high in experienced hands with few complications. We discuss 2 patients who presented with anginal symptoms, ischemia on stress nuclear scintigraphy and patent SVGs on angiography. After the corresponding native CTOs in the bypassed coronary arteries were successfully recanalized using the CART technique, both patients' symptoms and reversible scintigraphic defects resolved. The CART technique is highlighted utilizing SVGs as access conduits for the retrograde approach.
Chief, Division of Cardiology, Hawaii Region Kaiser Permanente, 3288 Moanalua Road, Honolulu, HI 96819, USA. paul.c.ho@kp.org
Paul C
PC
Ho
Etsuo
E
Tsuchikane
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000503:physiopathology / Q000628:therapy*; D004730:Endothelium, Vascular / Q000503:physiopathology; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization; D010865:Pilot Projects; D012501:Saphenous Vein; D016896:Treatment Outcome