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Pedal-origin controlled antegrade and retrograde subintimal tracking (CART) procedure. (A) After unsuccessful proximal re-entry into the true lumen, a retrograde approach via pedal access was selected. (B) A 4.0-mm balloon was advanced over the retrograde guidewire from the pedal artery and inflated at the popliteal artery to create a controlled subintimal connection (CART maneuver). (C) After balloon inflation, the antegrade guidewire was successfully advanced into the true lumen of the distal target vessel. (D) <t>A</t> <t>drug-coated</t> balloon was subsequently inflated along the previously occluded segment of the superficial femoral artery (SFA). (E) Final digital subtraction angiography demonstrates restored antegrade flow with satisfactory distal runoff through the revascularized SFA.
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Pedal-origin controlled antegrade and retrograde subintimal tracking (CART) procedure. (A) After unsuccessful proximal re-entry into the true lumen, a retrograde approach via pedal access was selected. (B) A 4.0-mm balloon was advanced over the retrograde guidewire from the pedal artery and inflated at the popliteal artery to create a controlled subintimal connection (CART maneuver). (C) After balloon inflation, the antegrade guidewire was successfully advanced into the true lumen of the distal target vessel. (D) <t>A</t> <t>drug-coated</t> balloon was subsequently inflated along the previously occluded segment of the superficial femoral artery (SFA). (E) Final digital subtraction angiography demonstrates restored antegrade flow with satisfactory distal runoff through the revascularized SFA.
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Pedal-origin controlled antegrade and retrograde subintimal tracking (CART) procedure. (A) After unsuccessful proximal re-entry into the true lumen, a retrograde approach via pedal access was selected. (B) A 4.0-mm balloon was advanced over the retrograde guidewire from the pedal artery and inflated at the popliteal artery to create a controlled subintimal connection (CART maneuver). (C) After balloon inflation, the antegrade guidewire was successfully advanced into the true lumen of the distal target vessel. (D) <t>A</t> <t>drug-coated</t> balloon was subsequently inflated along the previously occluded segment of the superficial femoral artery (SFA). (E) Final digital subtraction angiography demonstrates restored antegrade flow with satisfactory distal runoff through the revascularized SFA.
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Pedal-origin controlled antegrade and retrograde subintimal tracking (CART) procedure. (A) After unsuccessful proximal re-entry into the true lumen, a retrograde approach via pedal access was selected. (B) A 4.0-mm balloon was advanced over the retrograde guidewire from the pedal artery and inflated at the popliteal artery to create a controlled subintimal connection (CART maneuver). (C) After balloon inflation, the antegrade guidewire was successfully advanced into the true lumen of the distal target vessel. (D) A drug-coated balloon was subsequently inflated along the previously occluded segment of the superficial femoral artery (SFA). (E) Final digital subtraction angiography demonstrates restored antegrade flow with satisfactory distal runoff through the revascularized SFA.

Journal: Journal of Vascular Surgery Cases, Innovations and Techniques

Article Title: Intentional subintimal loop technique for orientation recovery in superficial femoral artery chronic total occlusion with pedal-origin controlled antegrade and retrograde subintimal tracking

doi: 10.1016/j.jvscit.2026.102251

Figure Lengend Snippet: Pedal-origin controlled antegrade and retrograde subintimal tracking (CART) procedure. (A) After unsuccessful proximal re-entry into the true lumen, a retrograde approach via pedal access was selected. (B) A 4.0-mm balloon was advanced over the retrograde guidewire from the pedal artery and inflated at the popliteal artery to create a controlled subintimal connection (CART maneuver). (C) After balloon inflation, the antegrade guidewire was successfully advanced into the true lumen of the distal target vessel. (D) A drug-coated balloon was subsequently inflated along the previously occluded segment of the superficial femoral artery (SFA). (E) Final digital subtraction angiography demonstrates restored antegrade flow with satisfactory distal runoff through the revascularized SFA.

Article Snippet: The occluded SFA segment was subsequently treated with a drug-coated balloon (5 mm × 200 mm Ranger DCB balloon; Boston Scientific) ( , D ), which achieved satisfactory final angiographic results with good distal runoff ( , E ).

Techniques: