Isawa Tsuyoshi, Ochiai Masahiko, Munehisa Masato, Ootomo Tatsushi
Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan.
Department of Cardiology and Cardiovascular Surgery, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Case Rep Cardiol. 2017;2017:3850646. doi: 10.1155/2017/3850646. Epub 2017 Apr 26.
Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible.
顺行穿过是处理慢性完全闭塞病变（CTO）最常用的方法。然而，有时很难用导丝穿透近端硬帽，特别是在异常冠状动脉CTO的情况下，因为缺乏支撑。在此，我们描述一种新颖的、改良的逆向控制顺行和逆行内膜下寻径（CART）技术，其中使用逆行导丝并借助顺行球囊，有意在血管近端节段而非闭塞节段内制造夹层再入。该技术通过避开近端硬帽促进了CTO的逆行穿过，并且对于无法进行传统逆向CART的患者可能提供了一种可行的选择。
