Retrograde algorithm for chronic total occlusion from the Asia Pacific Chronic Total Occlusion club.

Retrograde CTO PCI is an effective method to improve the success rate of CTO PCI. Despite several comprehensive and detailed descriptive papers on the retrograde techniques, retrograde CTO PCI remains difficult for many interventionists. We, the Asia Pacific CTO club, propose a new retrograde CTO PCI algorithm, which focuses on three specific problems in the retrograde approach. First, how to overcome the tough proximal cap. Then, how to cross the collateral channels safely and efficiently. Finally, how to cross the CTO and, in particular, the problems of reverse CART. We explain our new philosophy of contemporary reverse CART. We hope that this algorithm will provide the tools for operators to overcome the difficulties of retrograde CTO PCI and that it will become a platform for discussion, training, and proctoring for the retrograde approach.