Antegrade balloon transit of retrograde wire to bail out dissected left main during retrograde chronic total occlusion intervention--a variant of the reverse CART technique.

Left main dissection is usually caused by catheter manipulation during diagnostic angiography and occasionally during angioplasty. It is a dangerous complication due to the potential risk of left main territory ischemia. We report a novel iatrogenic cause of left main dissection from a retrograde wire during ostial left anterior descending artery chronic total occlusion retrograde angioplasty. We also report the use of the antegrade balloon as a transit chamber for the retrograde wire after a successful reverse CART technique in order to prevent further left main dissection. This technique is applicable to other retrograde approaches for chronic total occlusion cases where proximal artery dissection is undesirable.