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12:10 CASE 10 - Meyer-Gessner
- 1. Long complex RCA CTO Antegrade and retrograde surprise Markus Meyer-Geßner Augusta Krankenhaus Düsseldorf
- 2. 1. Antegrade first 2. Retrograde first 3. Dissection/Reentry first 4. Only PCI of peripheral anastomosis Your initial approach?
- 3. 1. Retrograde first – bifurcation at distal cap problems: angulation, unstable lesion ?, max. 20 min 2. Antegrade second - problems: nontapered stump, long lesion length, 3 bifurcations 3. Diss./Reentry third – problems: bifurcations, landing zone 4. PCI anastomosis only or after losing PDA fourth My initial approach
- 4. 1. Continue retrograde by dedicated microcatheters (Venture, Crusade…) 2. Antegrade 3. Dissection/Reentry 4. Only PCI of peripheral anastomosis Failure of retrograde wiring. Your next step?
- 5. 1. Retrograde by dedicated microcatheters (Venture, Crusade…) 2. Continue antegrade (different guide…IVUS…) 3. Dissection/Reentry 4. Only PCI of peripheral anastomosis Failure of antegrade wiring. Your next step?
- 6. 1. Retrograde by dedicated microcatheters (Venture, Crusade…) 2. Continue antegrade (…IVUS…) 3. Dissection/Reentry 4. PCI of peripheral anastomosis Ischemia/threatening closure of anastomosis. Your next step?
- 7. 1. Retrograde by dedicated microcatheters (Venture, Crusade…) 2. Continue antegrade (…IVUS…) 3. Complete Dissection/Reentry Anastomosis repaired, antegrade dissection/flow. Your next step?
- 8. Key learning points AL guide: sometimes friend, sometimes enemy Arterial grafts: sometimes as fragile as the venous conduits Experience with new microcatheter technology
- 9. Key learning points “You never walk alone” with Euro CTO Club 25 years experience in PCI, 5 years of inspiration