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      From reverse CART to antegrade wire access: a guide to externalisation, tip-in, rendezvous, and snaring from the APCTO club: Reverse CART to antegrade access.

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          Abstract

          We at the Asia Pacific Chronic Total Occlusion (APCTO) club, provide this review to address the gap between reverse controlled antegrade and retrograde subintimal tracking (CART) and antegrade wire access. We describe the usual method for wire externalisation. We then address how to deal with failure to wire the proximal part of the chronic total occlusion (CTO) vessel or the guiding catheter. After successful antegrade guiding catheter wiring, we address the problem of failing to cross the CTO body with the retrograde microcatheter and we recommend the use of a retrograde small balloon, reversion to traditional CART, retrograde knuckle wiring into the subintimal space and antegrade scratch and go, and external cap crush. We also propose rendezvous type tip-in and describe the way to do this to overcome problems. In conclusion, we review and make recommendations for methods to gain antegrade wire access after successful reverse CART. We have addressed each failure mode in detail covering the different options, balancing risks and success rates. Our recommendations focus upon safety first and ease of use. We hope this work will help all retrograde operators to further improve the safety, efficacy, and success rates of their retrograde procedures.

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          Author and article information

          Journal
          AsiaIntervention
          AsiaIntervention
          Europa Digital & Publishing
          2491-0929
          2426-3958
          Jul 2020
          : 6
          : 1
          Affiliations
          [1 ] Prince of Wales Hospital, Hong Kong.
          [2 ] National Taiwan University Hospital, Taipei, Taiwan.
          [3 ] Liverpool Hospital, Sydney, Australia.
          [4 ] National Heart Centre, Singapore.
          [5 ] Shanghai Zhongshan Hospital, Shanghai, China.
          [6 ] Guangdong General Hospital, Guangdong, China.
          [7 ] Beijing Fuwai Hospital, Beijing, China.
          [8 ] Asan Medical Centre, Seoul, Republic of Korea.
          [9 ] Wellington Hospital, Wellington, New Zealand.
          [10 ] Toyohashi Heart Centre, Toyohashi, Aichi, Japan.
          Article
          10.4244/AIJ-D-19-00031
          8525603
          34912979
          5ab396ee-8a0e-481a-886d-5dfa2e578bdc
          History

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