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IVUS-guided reverse CART effective in CTO interventions
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IVUS-guided reverse controlled antegrade and retrograde subintimal tracking yielded a procedural success rate of more than 90% in a cohort of patients requiring percutaneous revascularization of complex coronary chronic total occlusion.
The study researchers said challenges and risk are still present in controlled antegrade and retrograde subintimal tracking (CART) or reverse CART techniques in this patient population. They aimed to evaluate the efficacy and safety of the most recent developments in IVUS-guided reverse CART in a cohort of 49 patients.
Eligibility criteria included failed antegrade and/or retrograde percutaneous revascularization of CTO from true lumen to true lumen. Enrollment occurred from November 2006 to November 2012.
Results indicated a mean J-CTO score of 2.5 in the study cohort. The rate of successful IVUS guidance implementation was 95.9%. The ratio of retrograde wires located at intimal space was 61.7% compared with 59.5% antegrade wires located at subintimal space, according to IVUS identification.
Clinicians used a Corsair channel dilator in 77.6% of cases.
The technique was successful in 95.9% of cases. The success rate of the procedure was 93.9%.
The rate of technical minor complications in the procedure was 10.2%, which did not significantly affect clinical outcomes, according to the researchers.
Non-STEMI MACE occurred in 2% of cases. There was no target vessel revascularization or mortality.
The researchers observed a mean stent length in a single CTO vessel of 51.3 mm. Radiation dermatitis or contrast-induced rise in creatinine were reported at patient presentation.
The researchers concluded that IVUS-guided reverse CART may be a feasible approach for percutaneous revascularization of complex CTO. They added, however, that suitable case selection and handling by experienced operators is necessary for success.
Disclosure: The researchers report no relevant financial disclosures.
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