Comparison between traditional and guide-catheter extension reverse controlled antegrade dissection and retrograde tracking: Insights from the PROGRESS-CTO registry

Iosif Xenogiannis, Dimitri Karmpaliotis, Khaldoon Alaswad, Farouc A. Jaffer, Robert W. Yeh, Mitul Patel, Ehtisham Mahmud, James W. Choi, M. Nicholas Burke, Anthony H. Doing, Phil Dattilo, Catalin Toma, A. J. Conrad Smith, Barry Uretsky, Oleg Krestyaninov, Dmitrii Khelimskii, Elizabeth Holper, Srinivasa Potluri, R. Michael Wyman, David E. KandzariSantiago Garcia, Michalis Koutouzis, Ioannis Tsiafoutis, Wissam Jaber, Habib Samady, Jeffrey W. Moses, Nicholas J. Lembo, Manish Parikh, Ajay J. Kirtane, Ziad A. Ali, Darshan Doshi, Peter Tajti, Bavana Venkata Rangan, Shuaib Abdullah, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Objectives. The most common re-entry technique during retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is reverse controlled antegrade and retrograde tracking (rCART). The use of guide-catheter extensions can facilitate rCART, but has received limited study. Methods. We compared the clinical and procedural characteristics and outcomes of traditional rCART vs guide-catheter extension rCART vs cases in which both techniques were used (combined rCART) in patients with successful retrograde CTO crossing in a contemporary multicenter CTO-PCI registry. Results. Between 2012 and 2018, rCART was used in 467 of 1336 retrograde CTO-PCI cases. Guide-catheter extension rCART was used in 60/467 cases (13%; use increased from 0% in 2012 to 26% in 2017). The traditional rCART group, guide-catheter extension rCART group, and combined rCART group had similar target lesion J-CTO scores (3.3 ± 1.1 vs 3.2 ± 1.2 vs 3.6 ± 0.8, respectively; P=.28), technical success rates (99% vs 100% vs 96.4%, respectively; P=.36), procedural success rates (93.2% vs 93.8% vs 96.3%, respectively; P=.82), and major in-hospital adverse cardiac event (MACE) rates (6.4% vs 9.4% vs 3.6%, respectively; P=.66). Total procedural time was longer in the combined rCART group (196 min [IQR, 146-256 min] vs 200 min [IQR, 164-293 min] vs 255 min [IQR, 195-280 min], respectively; P<.01), with a trend for lower patient air kerma radiation dose in the guide-catheter extension groups (4.11 Gray [IQR, 2.49-5.77 Gray] vs 3.19 Gray [IQR, 1.29-4.74 Gray] vs 3.47 Gray [IQR, 2.89-5.56 Gray]; P=.07). Conclusions. Guide-catheter extension rCART is increasingly being used for retrograde CTO crossing and is associated with similar success and MACE rates as traditional rCART.

Original languageEnglish (US)
Pages (from-to)27-34
Number of pages8
JournalJournal of Invasive Cardiology
Issue number1
StatePublished - 2019


  • Chronic total occlusion
  • Guide-catheter extension Fo
  • Percutaneous coronary intervention
  • Retrograde approach
  • Reverse controlled antegrade and retrograde tracking

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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