Experts "Live" CTO Workshop 2014 25th Septemper 2014 in Madrid, Spain

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