Reverse CART facilitated by a novel perfusion balloon in chronic total occlusion percutaneous coronary intervention

A 36-year-old man underwent percutaneous coronary intervention (PCI) of his right coronary artery (RCA) chronic total occlusion (CTO) due to refractory angina.

Dual angiography was performed using a 7 Fr Extra backup (EBU) 3.75 guide catheter in the left main and an 8 Fr Amplatz left (AL) 1 guide in the RCA (Figure 1A-Figure 1B, Moving image 1). The distal cap was accessed through septal collaterals using retrograde techniques (Figure 1C). The knuckle wire technique was employed to enter the extraplaque space of the CTO body using a polymer-jacketed wire.

The proximal CTO cap was engaged antegradely using a penetrative wire and microcatheter. This wire was exchanged for a polymer-jacketed wire, which was knuckled into the extraplaque space.

Reverse controlled antegrade and retrograde tracking (rCART) was then performed. The antegrade extraplaque space was predilated using a 3.0x15 mm balloon. An attempt to connect the retrograde Gladius Mongo (Asahi Intecc) wire with an antegrade 6 Fr LiquID guide extension (Seigla Medical) was unsuccessful. Subsequently, a 3.0x20 mm Ringer perfusion balloon catheter (RPBC; Teleflex), selected based on...