The efficacy of a bilateral approach for treating lesions with chronic total occlusions the CART (controlled antegrade and retrograde subintimal tracking) registry

JACC Cardiovasc Interv. 2009 Nov;2(11):1135-41. doi: 10.1016/j.jcin.2009.09.008.


Objectives: 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.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / methods*
  • Angioplasty, Balloon, Coronary / mortality
  • Chronic Disease
  • Coronary Angiography
  • Coronary Occlusion / diagnostic imaging
  • Coronary Occlusion / mortality
  • Coronary Occlusion / therapy*
  • Feasibility Studies
  • Female
  • Germany
  • Hospital Mortality
  • Humans
  • Japan
  • Male
  • Middle Aged
  • Myocardial Infarction / etiology
  • Prospective Studies
  • Registries
  • Time Factors
  • Treatment Outcome
  • United Kingdom