Dr. Prathap kumar.N Meditrina hospitals India Course ... · Dr. Prathap kumar.N Meditrina hospitals India Course director-IJCTO . Passive: higher size guide amplatz guide Active:

Dr. Prathap kumar.N Meditrina hospitals

IndiaCourse director-

IJCTO

Passive: higher size guide

amplatz guide

Active: deep engagement

Others:

1.Buddy wire

2.Guideliner

3.Guidewire

support cath

Case: 1

Double catheter

amplatz in the right

Failed antegrade intervention

from outside

Retrograde attempt first

Microcatheter with fielder XT R wire

Other micro catheters:

Corsair pro

Caravel

Other devices

• Dual lumen micro catheter

• crusade

• sazuke

• Rotablator

case : 2

Rotablator #1

CTO - LAD

Guidewire did not cross to LAD

both antegrade & retrograde

But the wire crossed to D1

No micro catheter crossed

Finally rotawire crossed to D1

case:3

case :4

Rotablator #2

Post CABG case

angiogram 18 mo back

95% ostial disease at CX

S.creatinine - 1.8mg%

Not done PTCA due to fear of CIN

Now refractory angina

Plan for PTCA

ANCHOR TECHNIQUES

RCA - CTO

Case: 5

Gaia 2nd wire

crossed distally

Second wire ..

Fielder FC with 1.25 x10 balloon

First wire with finecross

Balloon can not

cross the lesion

With anchor by micro catheter distally,

lesion could cross with 1.5x15 balloon

With guideliner only

stent could be pushed

CTO CX:

Gaia first not crossed ,

Tried with Gaia 2nd

Case: 6

redirecting the wire/

parallel wire technique

Gaia 2nd wire

out of track

Case:7

LAD- CTO

Lesion not crossed with filelder FC

Gaia 2nd tried

Gaia 3rd wire

parallel wire technique

LAD -CTO

Case : 8

Side branch opening

may help in opening CTO

Fielder FC , finecross not crossed

miracle 6 crossed

Finecross , fielder FCDilated with 1.5x15 balloon

Miracle 6, Fielder XT R

then Gaia second

Gaia 2nd

Case : 1CAD, TVD

PCI to RCA done

admitted for PCI to LAD

mid LAD occludedBranch at the site of occlusion

JCTO -score -1

Vessel has an

angulated entry.

No calcium seen

Nearly 20 mm length

Wire is in LAD after septal A

And went beyond diagonal A

Another 15 mm to reach

Distal segment seen from RCA

Distal wire is in

lumen

But junction with

LAD??

Sion black

Gaia 2nd,

fielder XT-R tried

Both wires in different planes

1.Both can be in sub-intima

Or

2.Ante-grade in sub-intima

and retrograde in intima

Miracle 6 with corsair retrograde

and guideliner antegrade

Gaia 3rd with corsair retrograde

not crossed

and guideliner antegrade

Both wires in one plane

Both wires in one planeRetrograde wire near guideliner

Retrograde wire near guideliner

Retrograde wire enter guideliner

Corsair pushed to guideliner

Guideliner removed

Corsair in antegrade

Catheter

Miracle wire

exchanged to RG3

Corsair taken back

to septal A

Removal of wire with corsair

Avoid deep seating of both

antegrade and retrograde

catheters

Final result

Check septal A by

retrograde injection

Final angiographic result

Conclusion..

• Impenetrable cap is a challenge in CTO

intervention

• Proper devices will make success better

• Skill and experience matters

Thank you for the kind attention

Next IJCTO meeting at New

Delhi

on 12,13 & 14 June 2020

www.ijcto.com

+917025222244

[email protected]

Thank you for the kind attention

Next IJCTO meeting at New

Delhi

on 12,13 & 14 June 2020

www.ijcto.com

+917025222244

[email protected]