Bail-out reverse controlled antegrade and retrograde subintimal tracking accompanied by multiple complications in coronary chronic total occlusion.
Recently, a retrograde approach through collateral channels was introduced to improve the success rate of percutaneous coronary intervention (PCI) for a coronary chronic total occlusion (CTO). Among the various wire-crossing techniques via the retrograde approach, the reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique is the most rarely used due to technical difficulties and the probability of causing an iatrogenic dissection. We describe a case in which the conventional antegrade approach failed and the reverse CART technique was performed successfully in the setting of severe dissection, suggesting the usefulness of this novel technique. However, we encountered unexpected collateral-donor vessel complications that could have resulted in life-threatening ischemia, suggesting that a systemized approach by a highly-experienced operator is essential in ensuring the success of this complex procedure.
Suh
Jon
J
Division of Cardiology, SoonChunHyang University Bucheon Hospital, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, Korea.
Cho
Yoon Haeng
YH
Lee
Nae Hee
NH
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D003097:Collateral Circulation; D003324:Coronary Artery Disease / Q000628:therapy*; D003326:Coronary Circulation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents