Tips and tricks of the CART and reverse CART technique

Chronic total occlusion (CTO) remains one of the most challenging complexities in percutaneous coronary interventions. The controlled antegrade and retrograde subintimal tracking (CART) technique and its modified version "the reverse CART" technique, are two methods that utilize retrograde recanalization. The advent of the CART and reverse CART techniques has allowed operators to treat even these challenging CTOs. One adaptation of the CART technique involves the use of intravascular ultrasound (IVUS). IVUS is useful to estimate the precise size of antegrade balloon that can lead to medial disruption. Technical and procedural success rates of CTO PCI have risen tremendously over few years, because of operator experience, improved equipment, and refinements of retrograde approaches such as the CART and reverse CART techniques. Further technical improvements are necessary to simplify the techniques making them more widely used.