title: The efficacy of a bilateral approach for treating lesions with chronic total occlusions the CART (controlled antegrade and retrograde subintimal tracking) registry.
abstract: OBJECTIVE
  The aim of this study was to evaluate the safety and feasibility of a new concept for chronic total occlusion (CTO) recanalization-using a bilateral approach that utilizes a Controlled Antegrade and Retrograde subintimal Tracking (CART) technique.
  
  
  BACKGROUND
  Successful percutaneous recanalization of coronary CTOs results in improved long-term outcomes. The recanalization of CTOs in native coronary arteries no doubt represents one of the most technically challenging of interventional procedures.
  
  
  METHODS
  A total of 224 consecutive patients (mean age 61 +/- 9 years; 86.2% men) were enrolled in this prospective multicenter registry. This technique combines the simultaneous use of antegrade and retrograde approaches. A subintimal dissection is created in both antegrade and retrograde fashion, thereby limiting the extension of the subintimal dissection within the CTO portion.
  
  
  RESULTS
  Of 224 CTO lesions (>3 months in duration) undergoing attempted recanalization using the CART technique, 145 cases (64.7%) had undergone previous CTO recanalization attempts. The success rates of crossing in a retrograde fashion with a wire and a balloon were 87.9% and 79.9%, respectively. The overall technical and procedural success rates achieved in this registry were 92.4% and 90.6%, respectively.
  
  
  CONCLUSIONS
  A bilateral approach for CTO lesions using the CART technique is feasible, safe, and has a higher success rate than previous approaches. These results indicate that a bilateral technique can solve a major dilemma that commonly affects CTO procedures.
authors.affiliation: Toyohashi Heart Center, Aichi, Japan. kimura.masashi@gmail.com
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Mariko
authors.initials: M
authors.lastname: Ehara
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Matsubara
authors.forename: Keiko
authors.initials: K
authors.lastname: Asakura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asakura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Nakamura
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Oida
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takase
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Reifart
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002908:Chronic Disease; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom