RetrogradeApproach2013
How to Succeedin Reverse-CART TechniqueKasai Shoikai Hospital
Yasushi Asakura M.D.
2. Retrograde Wiring1. Channel CrossingPrevious Standardized
Retrograde TechniqueKasai Shoikai Hospital
CaseRCA
Kasai Shoikai Hospital
IVUSGuidedWiringRetrogradeWireCrossing
Kasai Shoikai Hospital
Final
Kasai Shoikai Hospital
Driving Pressure
Kasai Shoikai Hospital
attempted techniquenumber (%)retrograde wire crossing38
(32%)kissing wire6 (5%)R-CART66 (55%)CART3 (3%)antegrade approach2
(2%)
96%4%
success recanalization
failed
Acute Results in RegistryKasai Shoikai Hospital
2. Retrograde Wiring3. Kissing Wire Technique1. Channel
CrossingPrevious Standardized Retrograde TechniqueKasai Shoikai
Hospital
Kissing Wire Technique
Kasai Shoikai Hospital
Major Limitation ofKissing Wire Technique
If antegrade and retrograde wires are in different layers, it is
difficult to align both wires.Kasai Shoikai Hospital
attempted techniquenumber (%)retrograde wire crossing38
(32%)kissing wire6 (5%)R-CART66 (55%)CART3 (3%)antegrade approach2
(2%)
96%4%
success recanalization
failed
Acute Results in Registry
Kasai Shoikai Hospital
2. Retrograde Wiring3. Kissing Wire Technique4. Subintimal
Tracking1. Channel CrossingPrevious Standardized Retrograde
TechniqueKasai Shoikai Hospital
Problem in Retrograde Wiring
Kasai Shoikai Hospital
Kasai Shoikai Hospital
Concept ofContemporary Reverse CART
Kasai Shoikai Hospital
Concept ofContemporary Reverse CART
Kasai Shoikai HospitalCase
Kasai Shoikai HospitalAntegradeApproach
Kasai Shoikai HospitalFailedWiring
Kasai Shoikai Hospital
RetrogradeApproach
Kasai Shoikai Hospital
AntegradeBallooning
ContemporaryReverseCART!!
Kasai Shoikai Hospital
SuccessfulWiring
Kasai Shoikai HospitalTrappingTechnique
Kasai Shoikai Hospital
Balloon
Kasai Shoikai HospitalStent
Kasai Shoikai Hospital
Final
Kasai Shoikai HospitalFinal
2. Retrograde Wiring3. Kissing Wire TechniqueSubintimal
Tracking5. IVUS Guidance1. Channel CrossingStandardized Retrograde
TechniqueKasai Shoikai Hospital2. Antegrade Ballooning Contemporary
X-CART3. IVUS Guidance Recent Standardized Retrograde Technique
2. W/O Kissing Wire Technique3. Preferred Antegrade
BallooningSmaller Balloon5. Wire with Good Torque Ability1. W/O
Retrograde WiringPoints of ContemporaryReverse CARTKasai Shoikai
Hospital
2. Retrograde Wiring3. Kissing Wire Technique1. Channel
CrossingStandardized Retrograde TechniqueKasai Shoikai Hospital2.
Antegrade Ballooning Contemporary X-CART3. IVUS GuidanceRecent
Standardized Retrograde Technique
IVUS FindingsKasai Shoikai Hospital
CaseRAOKasai Shoikai Hospital
RetrogradeApproachKasai Shoikai Hospital
IVUSKasai Shoikai Hospital
4.0mmBalloonKasai Shoikai Hospital
IVUSGuidedWiringKasai Shoikai Hospital
IVUSKasai Shoikai Hospital
RetrogradeWiringKasai Shoikai Hospital
Case
Kasai Shoikai Hospital
Reverse CART
Kasai Shoikai Hospital
Penetration Using Confienza Pro 12
Kasai Shoikai Hospital
Final
Kasai Shoikai Hospital
Summary1. The retrograde approach is absolutely indispensable in
CTO PCI.2. This technique has been established and standardized.3.
Retrograde wiring and kissing wire technique are not recommended.4.
Contemporary reverse CART is common procedure.Kasai Shoikai
Hospital
Thank You for Attention!
