The Application of the CART Technique for Chronic Total Occlusion of the External Iliac Artery

Abstract

Even though endovascular treatment for chronic total occlusion (CTO) of peripheral arterial disease is challenging, subintimal angioplasty (SIA) has proven to be an effective procedure. However, SIA cannot cross CTO lesions because of the inability to reinsert the guidewire into the distal true lumen in some cases. We herein describe the case of a 67-year-old male patient who was admitted to our hospital with intermittent claudication due to the CTO of the left external iliac artery. We attempted to cross the CTO using a SIA technique, but the guidewire could not reenter the true lumen. Therefore, by using a controlled antegrade and retrograde subintimal tracking (CART) technique, we treated the CTO of the left external iliac artery with stenting. When using the CART technique, there is no need for extension of the subintimal dissection beyond the occluded lesion, which might be useful technique for the CTO lesions.