The use of a cutting balloon in contemporary reverse controlled antegrade and retrograde subintimal tracking (reverse CA
- PDF / 1,308,598 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 36 Downloads / 139 Views
CASE REPORT
The use of a cutting balloon in contemporary reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique Keisuke Nakabayashi1
•
Hisayuki Okada1 • Toshiaki Oka1
Received: 19 May 2016 / Accepted: 4 July 2016 Japanese Association of Cardiovascular Intervention and Therapeutics 2016
Abstract The key concept of reverse controlled antegrade and retrograde tracking (CART) technique is retrograde puncture with a tapered wire to an antegrade balloon (contemporary reverse CART) or new connections between the antegrade and retrograde subintimal space (classical reverse CART). In our case, a 75-year-old man with severe chronic total occlusion of the right coronary artery, reverse CART with conventional balloons could not be accomplished. Externalization wiring was completed by contemporary reverse CART using a cutting balloon as an antegrade balloon to improve the fenestration force of the retrograde guidewire. Thus, the use of a cutting balloon for contemporary reverse CART might be promising. Keywords Cutting balloon Reverse controlled antegrade and retrograde tracking technique (CART) Chronic total occlusion Percutaneous coronary intervention
Introduction The development of techniques [1, 2] and devices [3] for percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) has improved its success rate. The retrograde approach based on the reverse controlled antegrade and retrograde tracking (CART) technique is a milestone strategy for CTO-PCI [4]. The key concept is retrograde puncture with a tapered wire to an antegrade balloon
& Keisuke Nakabayashi [email protected] 1
Department of Cardiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan
(contemporary reverse CART) or a new connection between the antegrade and retrograde subintimal space (classical reverse CART). If either wire is not positioned in the subintimal space, retrograde puncture is favorable. We usually use a noncompliant balloon close to the vessel size as the antegrade balloon. Because 90 % of cases would be successful once wire crossing is achieved [5], reverse CART is the most important factor in PCI success. In the present report, we described the use of a cutting balloon (which has hard blades) as an antegrade balloon to improve the fenestration force of the retrograde guidewire for a tough right coronary artery (RCA) CTO case in which we could not accomplish a contemporary reverse CART with conventional balloons.
Case report A 75-year-old man with hypertension, chronic kidney disease, and current smoking history was diagnosed as having silent myocardial ischemia that was detected by transthoracic echocardiography and myocardial perfusion scintigraphy. He underwent coronary angiography and aortography in another hospital, which revealed severe stenosis of the left common iliac artery and three diseased vessels—the middle RCA had CTO, the proximal left anterior descending (LAD) artery had intermediate stenosis (fractional flow re
Data Loading...
