Case 254: Manual of CTO PCI - CART

A patient with prior CABG surgery was referred for PCI of a native RCA CTO due to recurrent failure of the SVG-PDA. Coronary CT angiography was done prior showing the proximal cap to be at the takeoff of an acute marginal branch, length of 34 mm, and calcification at the proximal cap and within the occlusion segment. A primary retrograde approach was used with a Pilot 200 wire advanced through a Corsair 200 microcatheter but the wire entered the extraplaque space at the proximal cap. Antegrade wiring was attempted using the retrograde wire as marker, but the antegrade wires kept on also entering into the extraplaque space. A 2.5 mm balloon was advanced retrogradely through the SVG to the proximal cap, followed by successful antegrade wiring (CART technique) with a nice result after stenting.