CTO PCI - JCR · CTO PCI What’s New in 2011 Toyohashi Heart Center Yasushi Asakura M.D. Toyohashi...
Transcript of CTO PCI - JCR · CTO PCI What’s New in 2011 Toyohashi Heart Center Yasushi Asakura M.D. Toyohashi...
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CTO PCI What’s New in 2011
Toyohashi Heart Center Yasushi Asakura M.D.
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Toyohashi Heart Center
Antegrade Approach with Single Wire
↓ Parallel Wire Technique
↓
Retrograde Approach ↓
IVUS Guided Wiring
Step by Step Approach
Antegrade Approach with Single Wire
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Toyohashi Heart Center
Wire Selection
1. Miracle 3, 6, 12g
2. Confienza Family
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0%
20%
40%
60%
80%
100%
2004 2009
Spring coil floppy wire
Plastic jacket wire
Spring coil CTO wire67.5%
15.0%
17.5%
52.0%
47.3%
7.0%
Crossing Guide Wire in THC
(n=120) (n=114)
Toyohashi Heart Center
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Crossing Guide Wire in THC
Miracle33%
Confienza11%
Pilot4%
Wizard4%
FielderFC15%
X-treme27%
Others3%
Failure3%
Toyohashi Heart Center
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Toyohashi Heart Center
Microchannels in CTO
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Toyohashi Heart Center
Structure of Fielder-XT
0.009 Tapered Tip Hydrophilic Coating & Polymer Sleeve Tip Load: 0.8g
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Toyohashi Heart Center
Soldering Length at Wire Tip
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Toyohashi Heart Center
Case
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Toyohashi Heart Center
Fielder XT
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Toyohashi Heart Center
CTO Wire Manipulation
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Toyohashi Heart Center
Tapered Wire Manipulation
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Toyohashi Heart Center
Fielder XT
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Toyohashi Heart Center
Final
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Toyohashi Heart Center
Microchannels and Wire Tip
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0.010”
32mm O.D: 0.014” / 12.5cm
0.6g O.D: 0.010” / 4cm O.D: 0.014” / 12.5cm
0.0078”
8mm
Wizard78 Structural Image
Toyohashi Heart Center
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Toyohashi Heart Center
Tapered Wires 2011
Fielder-XT (ASAHI)
Fielder-XTA, XTR (ASAHI)
Abbyss (NIPRO)
Wizard (Life Line)
Progress (Abbott)
Equation (JJ)
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Toyohashi Heart Center
Antegrade Approach with Single Wire
↓ Parallel Wire Technique
↓
Retrograde Approach ↓
IVUS Guided Wiring
Step by Step Approach
Retrograde Approach
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ASAHI Corsair was originally developed as a septal channel dilator,
to ease retrograde approaches for CTO-PCI. This is a unique device
that can be used both as a microcatheter and as a support catheter.
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Toyohashi Heart Center
2. Retrograde Wiring
3. Kissing Wire Technique
4. IVUS Guided Wiring
5. Subintimal Tracking
1. Channel Crossing
Standardized Retrograde Technique
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Toyohashi Heart Center
What’s New?
1. Wire Selection
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Toyohashi Heart Center
Wire Selection 2011
Fielder FC Fielder XT
SION
SION BLUE Fielder XTR
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Toyohashi Heart Center
Case
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Toyohashi Heart Center
Retrograde Approach
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Toyohashi Heart Center
SION
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Toyohashi Heart Center
SION
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Toyohashi Heart Center
Case Fielder XTR
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Toyohashi Heart Center
Channel Selection (Septal / Epicardial )
Trends in a Retrograde Technique
Wire Selection (SION, Fielder XTR)
Subintimal Tracking (R-CART >>CART)
Corsair Support Procedure
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Toyohashi Heart Center
What’s New?
1. Wire Selection
2. IVUS Guided R-CART
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Toyohashi Heart Center
IVUS Tells Us
1. Vessel Size
2. Position of Wires
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Toyohashi Heart Center
IVUS Findings
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Toyohashi Heart Center
Both Wires in Intima
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Toyohashi Heart Center
Both Wires in Sub-Intima
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Toyohashi Heart Center
Antegrade Wire in Intima Retrograde Wire in Sub-Intima
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Toyohashi Heart Center
IVUS
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Toyohashi Heart Center
Antegrade Wire in Intima Retrograde Wire in Sub-Intima
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Toyohashi Heart Center
IVUS
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Toyohashi Heart Center
Antegrade Wire in Sub-Intima Retrograde Wire in Intima
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Toyohashi Heart Center
Case RAO
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Toyohashi Heart Center
Retrograde Approach
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Toyohashi Heart Center
IVUS
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Toyohashi Heart Center
4.0mm Balloon
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Toyohashi Heart Center
IVUS Guided Wiring
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Toyohashi Heart Center
IVUS
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Toyohashi Heart Center
Retrograde Wiring
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Toyohashi Heart Center
How to Make Connection?
1. R-CART
2. CART
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Antegrade Wire in Sub-Intima Retrograde Wire in Intima
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Toyohashi Heart Center
How to Make Connection?
1. R-CART
2. CART
3. Knuckle Wire
4. Wire Penetration
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Toyohashi Heart Center
Case
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Toyohashi Heart Center
Reverse CART
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Toyohashi Heart Center
Penetration Using Conquest Pro 12
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Toyohashi Heart Center
Final
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Toyohashi Heart Center
Summary
1. In an antegrade approach, we often start with tapered soft wire in order to do micro-channel tracking.
3. In a retrograde approach, we more often use epicardial channel owing to Corsair and new wires.
4. R-CART is common procedure and IVUS guidance is sometimes helpful.
2. Retrograde technique has been established and standardized.
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Toyohashi Heart Center
TOPIC 2012 July 26-28, 2012
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Toyohashi Heart Center
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Toyohashi Heart Center
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Toyohashi Heart Center
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Toyohashi Heart Center
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Toyohashi Heart Center
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Toyohashi Heart Center