LAUSR

Antegrade dissection and re ‐ entry (ADR) has significantly contributed to the rising success rates of chronic total occlusion (CTOs) percutaneous coronary intervention (PCI), especially in complex lesions. In the hybrid algorithm, ADR is recommended for >20 mm long lesions with a nonambiguous proximal cap and a suitable landing zone. ADR is also a key component of the global CTO crossing algorithm. 1 Antegrade fenestration and re ‐ entry (AFR) is a novel ADR technique that was first described in 2018 by Carlino et al. 2 AFR applies the key principles of reverse controlled antegrade and retrograde tracking (reverse CART) into the antegrade setting. AFR is a targeted ADR technique in which antegrade balloon inflations are performed in the extraplaque space at the level of the distal cap, creating fenestrations between the false and true lumen. These transient fenestrations are engaged by a polymer jacketed wire to achieve re ‐ entry into the distal true lumen. In a multicenter study of 41 patients, AFR was successful in achieving CTO recanalization in 27 (69.5%) patients. 3 the 4 describe their initial experience with use of a