Antegrade Wire Tracking of the Retrograde Tract (ATRT): A Novel Technique for Percutaneous Coronary Intervention for Chronic Total Occlusion

Background: Chronic total occlusion (CTO) lesions are the most challenging subset of coronary lesions. For lesions with a failed antegrade approach, the initial retrograde, followed by a combined retrograde and antegrade approach, remains the mainstay of therapy. Objective: The study evaluated a technique of initial retrograde followed by an antegrade approach to treat lesions with a failed antegrade approach. Methods: We have adopted this technique to treat 31 CTO lesions with a failed antegrade approach, where a floppy wire was advanced antegrade through the tract created by a retrograde balloon advanced over the retrograde wire (antegrade wire tracking of the retrograde tract (ATRT)), which was advanced into the aorta retrogradely. Result: In 31 patients with failed antegrade approaches, the ATRT technique was tried, which was successful in 25 patients (the success rate was 80.6%). There was a failure to cross the microchannel in four patients, although angiographically, it looked promising. In two patients, it was impossible to advance the microcatheter or the smallest profile balloon retrogradely until the entire length of the CTO body. So, a reverse controlled antegrade and retrograde subintimal tracking (CART) was performed on these two patients excluded from the study. Conclusion: ATRT is a useful technique for CTO percutaneous coronary intervention (PCI) for patients with failed antegrade approaches with acceptable success rates. The procedure is safe in terms of procedural complications.