Debate: Is there a difference between RDR and reverse CART? – Yes
- 1. P A U L H S I E N - L I K A O , M D P R O F E S S O R O F M E D I C I N E N A T I O N A L T A I W A N U N I V E R S I T Y H O S P I T A L Reverse CART is not RDR HLK2109
- 2. Disclosure I have nothing to disclose relevant to the following presentation HLK2109
- 3. Goal of CTO PCI – no argument Re-open the occluded segment, maintaining patency of pertinent side branches and outflow vessels, and re-perfuse the ischemic bed, with safety and efficiency Success should provide anginal relief, improve exercise tolerance and LV function, reduce need for CABG, and even long-term survival Not just TIMI3 flow with <20% residual diameter stenosis!! HLK2109
- 4. Terminology RDR: retrograde dissection re-entry r-CART: reverse controlled antegrade and retrograde tracking HLK2109
- 5. My argument 1 r-CART is not RDR HLK2109
- 6. Are they the same ideas? Very frequently used interchangeably in the “HTBRID universe” Riley RF, et al. Cathet Cardiovasc Interv 2019 Brilakis ES, et al. JACC Intv 2012 HLK2109
- 7. But RWE and RDR are mutually exclusive Brilakis ES, et al. J Am Coll Cardiol Intv 2012 Sianos G, et al. EuroIntervention 2018 HLK2109
- 8. RDR the violent way: intentional knuckling DeMartini TJ, et al. Intervent Cardiol Clin 2012 HLK2109
- 9. And r-CART is based on RWE Aim to preserve distal cap, and space creation within plaque Theoretically less side branch loss, especially in- segment and distal ones Joyal D, et al. J Am Coll Cardiol Intv 2012 HLK2109
- 10. APCTO and EuroCTO only knuckle conditionally Wu EB, et al. AsiaIntervention 2018 Galassi A, et al. Eurointervention 2019 HLK2109
- 11. We want r-CART even less traumatic when plausable Matsuno S, et al. Eurointervention 2018 HLK2109
- 12. r-CART Should be wire-based and started with RWE, different from RDR Minimal space (intentionally only within the plaque) creation for wire connection “The most commonly used method to connect the proximal and distal true lumen … if retrograde true lumen crossing attempts are unsuccessful.” We should try to stay within the plaque from cap to cap, and knuckle should only be done within the occluded segment when necessary HLK2109 Brilakis ES, et al. JACC Intv 2012
- 13. My argument 2 r-CART (especially wire-based) is better than RDR Because by staying within the plaque and in between the caps, we can have better outcome And that’s why we should differentiate r-CART from RDR HLK2109
- 14. SI tracking related to bad outcome Florence CTO Registry data Valenti R, et al. J Am Coll Cardiol 2013 HLK2109
- 15. And procedural complications Sabbah M, et al. Cathet Cardiovasc Interv 2019 Kurashiki data HLK2109
- 16. Up to 40% retrograde will result in SI tracking Tsujita K, et al. J Am Coll Cardiol Intv 2012 NYPH/CUMC data J-PROCTOR data Muramatsu T, et al. EuroIntervention 2014 HLK2109
- 17. RDR: more SI tracking and longer stents Song L, et al. J Am Coll Cardiol Intv 2017 NYPH/CUMC data HLK2109
- 18. And SI tracking means trouble Song L, et al. J Am Coll Cardiol Intv 2017 NYPH/CUMC data HLK2109
- 19. SI in retrograde means more stent and TVR Hasekawa K, et al. EuroIntervention 2017 J-PROCTOR 2 data HLK2109 25/81 =31%
- 20. Conclusions RDR and r-CART are different Staying intraplaque gives you the best procedural and long term outcomes Don’t win the battle (TIMI 3, <20% RS) while losing the whole war (TVR, ischemic relief)! Remember the non-CTO community is asking seriously for evidence for clinical benefits over OMT! HLK2109
- 21. But r-CART not necessarily means knuckle Brilakis ES, et al. Catheter Cardiovasc Interv 2012
- 22. But r-CART not necessarily means knuckle Brilakis ES, et al. Catheter Cardiovasc Interv 2012