The Efficacy of Bilateral Approach for the Lesions with Chronic Total Occlusion in Acute Results and Follow up. The CART Registry
Toyohashi Heart Center, Toyohashi, Japan
M. Kimura, O.K. Katoh, T. Suzuki, K. Nasu, Y. Kinoshita, M. Ehara, E. Tsuchikane, M. Terashima, T. Matsubara, Y. Asakura
Background: A successful percutaneous recanalization of chronic coronary occlusions (CTO) results in improved survival, as well as enhanced left ventricular function, reduction in angina, and improved exercise tolerance. Successful recanalization of chronic total occlusions in native coronary arteries is no doubt one of the most technically challenging of lesion subsets. The aim of this study was to evaluate safety and feasibility of a new concept for CTO recanalization using bilateral approach including a Controlled Antegrade and Retrograde subintimal Tracking technique (CART technique).
Methods: A total of 170 consecutive patients (mean age 65 กพ 13 years; 80.7 % males) who were enrolled in this prospective multicenter registry. This technique combines the simultaneous use of the antegrade and retrograde approaches. A subintimal dissection is created antegradely and retrogradely, which limit the extension of the subintimal dissection within the CTO portion.
Results: The consecutive 170 CTO lesions (>1 month) were attempted for CTO recanalization using CART technique. Of 170 cases, 121 cases (71%) had previous attempts of CTO recanalization. History of prior myocardial infarction was present in 78 % of the patients. The CTO lesions were most frequently located in RCA (69.7 %) followed by LAD (25.5 %), LCX (3.4 %) and SVG (1.4 %). The success rate of retrograde wire cross and balloon cross were 89% (152/170) and 82% (140/170), respectively. Successful recanalization was archived in 93% (158/170) of the patients and procedure success rate was 91% (155/170).
Conclusion: Bilateral approach for CTO lesions using CART technique is feasible, safe, and has a higher success rate than previous approach. These results indicate that this technique can solve a major prob.
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