08:05 Escaned - Final cto training for all

CTO training for allMore operators are required to treat

more patients better

Javier Escaned MD PhD

Hospital Clínico San Carlos

Madrid / Spain

Which is the main difference?

On average, PCI willbe attempted in 99.9% of cases

On average, PCI willbe attempted in

…. ? cases

PCI difficulty(skills required)

Overall PCI success rate

Technical improvement and PCI skills

Non-CTO revascularization

“The great equalizer”

• PCI has been hugely simplified by standardization and better tools.

• Success rate is today >95% after a short learning curve, even in off-label contexts.

• On the contrary, CTOs constitutes a challenging PCI subset, with little adoption of proposed standardization approaches over the years.

• Success rates have remained low (50%) over decades for the non-trained operator, being a cause of frustration. Success rate in trained operators is 80-90%.

• Despite of the frequency of CTOs with a clinical indications for revascularization, patients with CTOs are largely undertreated with PCI.

• There is growing evidence that non-treated CTOs translate into worse patient outcomes.

Low CTO PCI success rates

PCI difficulty(skills required)

Overall PCI success rate

(most PCI operators)


CTO revascularization

Success rateCTO operators

(minority)

• “Expert” clubs played a key role in standardization and consolidation of knowledge (J-CTO, EuroCTO, Hybrid Community)

• Success rate with these approaches is around 80-90% in overall CTO population



1994



1994 2014

• Established interventionalists less prone to adopt new approaches, follow logistic recommendations or accept that a colleague focuses in CTO PCI.

• Consolidated habits and cathlab workflow in non-CTO PCI act as obstacles.

• Perception of “CTO experts” as elite guys who speak a complex jargon among themselves may deter interventionalists to embark in CTO treatment.

• Interventionalists are less challenged by CTOs than by other PCI subsets (bifurcations) in clinical practice

Obstacles to adoption of consolidated knowledge

• Success rate increases when more patients with CTOs are attempted according to consolidated knowledge.

• As success rate increases, more patients benefit from complete revascularization.

• This is followed by an increase in case volume, treatment reclassification and patient referrals.

Success rate influences CTO PCI adoption

expertbeginner

CTO difficulty

50% 80%

% of success

Success rate influences adoption

95%

expertbeginner

CTO difficulty

70%

% of success

More CTO

patients

treated


95%85%

Thompson et al: JACC:CI vol 2., No. 9, 2009

0

10

20

30

40

50

60

70

80

90

100

early 05 late 05 early 06 late 06 early 07 late

07/early08

Experienced retrograde operators

Non retrograde operators

P<0.0001

Pro

ce

du

ral S

uc

ce

ss

(%

)

Year 1 Year 2 Year 3 Year 4 Year 5 Year 6


Learn, share, be proctored

• Understand CTO PCI developments and terminology

• Perform adequate procedural planning

• Incorporate new skills and get a proper tool kit

• Grade CTO difficulty to match cases to your level of expertise

• Build your experience in a gradual fashion

• Ensure patient and PCI team safety

• Contribute to create a CTO culture in your cathlab

• Offer your patients with CTOs better treatment options

The Expert´s Live 2014 aims to help you to:

EuroCTO Club6th Experts "Live" Workshop 2014Septemper, 25th – 26th , 2014Madrid, Spain

Thank you for your attention

08:05 Escaned - Final cto training for all

Health & Medicine

Transcript of 08:05 Escaned - Final cto training for all