A case of stent-facilitated reverse-controlled anterograde and retrograde subintimal tracking technique for chronic occlusion

Abstract

An elderly patient with previous drug eluting stent (DES) to distal right coronary artery, presented with non-ST elevation myocardial infarction. Angiography showed no flow limitation within the left coronary system, but calcified chronic total occlusion (CTO) of the dominant right coronary artery with retrograde collateralization. He failed medical management and decision was taken for PCI to CTO with primary retrograde reverse-controlled antegrade and retrograde subintimal tracking (CART) approach. The case demonstrates a novel approach using stent to facilitate exteriorizing the retrograde wire from false to true lumen. Reverse CART is an established option for CTO PCI, albeit it is not unusual to fail in transition of the retrograde wire from false into true lumen. Approaches to facilitate this crucial phase have been described including that above but to our knowledge this is the first publication detailing this complex technique.