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

JA Rossington & A Alahmar

An elderly patient with previous drug eluting stent (DES) to distal right coronary artery, presented with non-ST elevation myocardial infarction. Angiography showed no l w limitation within the left coronary system, but calcified chronic total occlusi n (CTO) the dominant right coronary artery with retrograde collateralization. He failed medical management and decision was taken for PCI to CTO with primary retr grade reverse controlled antegrade and retrograde subintimal tracking (CART) app ach. The case demonstrates a novel approach using stent to facilitate exte io izing the etr grade wire from false to true lumen. Reverse CART is an established option f CTO PCI, albeit it is not unusual to fail in transition of the retrograde wire from false into t ue 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.