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12:25 Yamane - Japanese strategy
- 1. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 COMPLEX ANTEGRADE CASES 12: 25 -12:40 Japanese strategy for CTO PCI success MasahisaYamane , MD, FACC OLV Cardiovascular Center, Aalst, Belgium St Luke‘s International Hospital , Tokyo, Japan SaitamaSekishinkai Hospital, Saitama, Japan
- 2. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 I, (MasahisaYamane, MD ) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
- 3. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 2 Gaia1st over IVUSWire Deflection << Wire ControlGaia 2ndGaia 2 nd to 3 rd XT-R to Gaia 1 st over Crusade ( Dual Lumen)Deflection << ControlWire ∆ to Gaia 2XT-R over Crusade after IVUS
- 4. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 3 Sion over CorsairGaia 1 to 2Gaia 3Confianza Pro 12CFZ Pro 12 to XT-R Gaia 1 over Corsair and “ Anchoring Balloon”Gaia 2 for further wiringStep down to Gaia 1IVUS from AC branchXT-R wire over the 2 nd OTW lumen of CrusadeDES deploymentAnother DES + KBT
- 5. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 Gaia 1 stGaia 1 in Diagonal over CorsairFloppy wire in Diagonal on Dual Lumen micro for LAD wiringXT-R for LAD 7F JR5.0SH2.5 mm ballooning3.5 mm DES deployment with side branch wire jailingGaia 1 over CorsairParallel over Dual Lumen MicroGaia 2 as a 2 nd WireAfter additional 2 DES+ Post
- 6. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 Whip-Jumping by rotational power retention Output angle Input angle
- 7. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 Subintimal dissection by Stiff CTO wire manipulation Dense fibrous tissue Injury can expand circumferentially and longitudinally
- 8. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 XT-R to Gaia 1Gaia 2 to 3Confianza Pro 12Confianza Pro 12 as a 2 nd WireMiracle Neo3g IVUS Guided LAD EntryRetrograde Gaia 1Ant 2.5 mm balloon
- 9. 83% 12% 3% 2% 82% 15% 2% 1% 0% 20% 40% 60% 80% 100% Single wire Parallel wire IVUS guided re- entry STAR NA 2012 2013 Corsair use: 78.1% 22% 43% 27% 8% 28% 39% 25% 8% 0% 20% 40% Easy (0) Intermediate (1) Difficult (2) Very Difficult (>3) 2012 2013 Successful CTO crossing strategy J-CTO score for “single wire” technique Total (2201) 2012 (1063) 2013 (1138) P Procedure success 91.6% (2016) 90.8% (965) 92.4%(1051) 0.1835 P<0.05P< 0.05 EURO CTO CLUB Madrid 2014
- 10. CTO crossing Guide wire in 2012-13 Ante grade Approach XT series, 31% Con Pro, 10% Gaia 1, 10% Gaia 2, 6% Wizard 3, 4% ULTIM 3, 4% SION, 4% FFC, 4% Other, 26% 2012 Total (2201) 2012 (1063) 2013 (1138) P Guidewire cross 92.7% (2040) 91.8% (976) 93.5% (1064) 0.1300 XT series, 30% Gaia 1, 23% Gaia 2, 20% Con Pro, 6% Con Pro 12, 2% Gaia 3, 2% ULTIM3, 2% SION, 2% Other, 12% 2013 EURO CTO CLUB Madrid 2014
- 11. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 10 0 5 10 15 20 25 30 35 Antegrade (N=59) 0 5 10 15 20 25 30 Retrograde (N=57)
- 12. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 Safe and Stable platform on Single/ Dual wire strategy Guide wiring creates injury, dissection/hematoma IVUS provides ongoing anatomy of the vessel Precise and intentional control with deflection principle
- 13. 25/ 9/ 2014EURO CTO CLUB Madrid 2014 12 CCT 2014 , 10-30 to 11-1, in Kobe, Japan