Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to 5 most important things you can do wrong in the antegrade approach
Similar to 5 most important things you can do wrong in the antegrade approach (20)
More from Euro CTO Club
More from Euro CTO Club (20)
Recently uploaded
Recently uploaded (20)
5 most important things you can do wrong in the antegrade approach
- 1. 5 most important things you can do wrong in the antegrade approach Pôle Cardiovasculaire et Métabolique Nicolas Boudou, MD, Cardiology department Rangueil university hospital Toulouse, France
- 2. Pôle Cardiovasculaire et Métabolique Potential conflicts of interest Speaker's name: Dr Nicolas Boudou Consulting, proctoring Boston SC, Terumo, Biotronik, Abbott
- 3. 1- Coronary angiogram analysis understand the anatomy
- 4. Coronary angiogram analysis understand the anatomy – The artery and the lesion (MSCT if necessary)
- 5. RCA Pôle Cardiovasculaire et Métabolique LAD LCx CTO and collaterals
- 7. Coronary angiogram analysis Bilateral approach - To understand the anatomy - To assess the distal landing zone Plan the intervention No ad hoc CTO PCI!
- 8. CTO in LAD: distal landing zone?
- 10. Ostium of the conus artery separated with RCA CTO in proximal LAD & collaterals
- 11. Bilateral approach with selective injection in the conus artery J-CTO score: 0
- 12. 2- Guiding catheters • Sheath (long) : 6F, 7F, 8F • Good support – RCA: AL 0.75, AL 1, SAL, AR… – LCx: EBU, XB, AL2… – IVA: EBU, XB… • Guide catheter extension Good passive and active support to help to cross the lesion
- 13. 3- Microcatheters and guidewires • Guidewires – To approach the lesion – To cross the CTO – To finalize the PCI (balloon inflation and stenting) • Microcatheters to exchange wire
- 14. COURTESY . . Stiffwire: only to cross the CTO No balloon inflation if you are not sure that your wire is in distal landing zone! « Flying wire »
- 15. 4- No injection through a microcatheter • Don’t inject contrast in the microcatheter to check if your in the distal true lumen
- 16. 4- No injection through a microcatheter • Don’t inject contrast in the microcatheter to check if your in the distal true lumen dissection treated by retrograde approach
- 17. 4- No injection through a microcatheter • Don’t inject contrast in the microcatheter to check if your in the distal true lumen dissection treated by retrograde approach
- 18. 5- Be able to treat complications Patel et al. J Am Coll Cardiol Intv 2013;6:128-36
- 19. Main vessel perforation Ping Pong technique to implant a covered stent (2 guiding catheters in the same coronary artery for perforation)
- 20. Use microcatheter to remove a stif wire and exchange with a soft one Distal perforation treated by coïls embolization Distal vessel perforation
- 21. conclusion • No ad hoc PCI. Strategy planned, aware of the complexity. • Guiding catheters with good support • CTO guidewires and workhorse guidewires • Microcatheters and dedicated devices • Be ready to treat complications (perforations,…)
Editor's Notes
- MSCT can help to understand the anatomy
- Blood return in the microcatheter ( from small sides branches) doesn’t mean that the microcatheter is in the distal true lumen
- Blood return in the microcatheter ( from small sides branches) doesn’t mean that the microcatheter is in the distal true lumen
- Blood return in the microcatheter ( from small sides branches) doesn’t mean that the microcatheter is in the distal true lumen
- Distal vessel perforation or collateral perforation