CTO PCI – How it all started in Europe Nicolaus Reifart, Wuppertal, Germany 11th Experts Live CTO The annual Euro CTO meeting September 13th –14th, 2019 - Berlin, Germany

1. CTO-PCI
How it all started in Europe
Nicolaus Reifart

2. Andreas
Roland
Grüntzig
Born June 25,
1939 Dresden
Died October 27,
1985 Atlanta

3. The First Case – September 77

4. • 1977 the first PCI interventions
were performed
alternating between
Zürich and Frankfurt
1978 followed by San Francisko
and New York

5. Interventionelle Kardiologie bei MK 1979 - 1985
Martin Kaltenbach
NR

6. Diagnostic Angiogram
Four weeks before PCI
80 % RCA LV normal
Angio before PCI 5 w later
RCA occlusion
Inferior wall akinesia
After reopening RCA
LV contraction normalized
Three months follow up
Recurrence RCA stenosis
LV still normal
Frankfurt 1978

7. • Kaltenbach, inventor of the Rotacs ® for CTO in
1984
• Rotacs (slow rotational
angioplasty) to overcome
friction of and resistance
even in very tortuous vessels.
The technique inspired the evolution of Magnum
wire, CrossBoss etc….

8. Bernie Meier
Andreas
The Magnum
wire 1989

9. My first experience 1986-90
in 509 patients
• Success 284/509 patients 55.8 %
• Occl length < 10 mm 75.8%
• Kinked occlusion: 28.5 %
• Occlusion age < 4 weeks 68.5 %
• Occlusion age > 6 mos 9.5 %
DMW 1994 Dec 23;119(51-52):1766-70
Wires: ACS Intermediate, Standard, Magnum

10. History of Japanese CTO Club
1991 complex PTCA live course
1992-’94
the Mid-Japan Interventional Cardiology
Conference
1994-’99
the Complex Coronary Intervention Conference
(CCIC)
1999-present the annual Japanese CTO club meeting
2000-present the Complex Catheter Therapeutics (CCT)
NR invited speaker

11. New aproach and new
dedicated wires
Trap threshhold, torqueability

12. 1995/96 Osamu Katoh in Frankfurt teaching the japanese way

13. My most important experience:
1991-96
• Invited to 1991 Toyohashi live
demonstration course where I first met Drs
Katoh, Tamai and Suzuki
• „ CTO is not just a difficult PTCA-
procedure, but totally different“ requiring
different skills, preparation and persistance

14. EuroCto Club
Founding Meeting
Paris 14.12.2006
Joachim Büttner
Carlo Di Mario
Gerald Werner
Dariusz Dudek
George Sianos
Nicolaus Reifart
Alfredo Galassi
Jaques Koolen
Hans Bonnier
Success 70-80%

15. Hamburg 2007 analysing the cases
H.Tamai
A.Büttner C.DiMario
O.Katoh
Y.Asakura
2nd attempt:Succeeded in 9/10
CTO cases of €CTO
Breakthrough for the Club

16. Eurointervention
2007; 30

17. Euro CTO members
0
10
20
30
40
50
60
2006 2007 2008 2009 2010 2011 2012
13
21
29
33
38
43
52
Requirements: experience of 300 CTO and 50 / year

18. EuroCTO Club 2010

19. 11481 CTO Procedures
3591
3090
1215
1608
1977
0
500
1000
1500
2000
2500
3000
3500
4000
2006 2007 2008 2009 2010
Online
Registry

20. 2009
Live in
the box

21. ERCTO-Monitoring since 2016
• Randomly selects 10% of cases
• Non biased controll of data entry
• To indentify: errors of data entry,
interpretation or coding and errors of
intention
• To increase credibility and scientific value

22. 2008 vs 2018 : lessons effective
62
58
41
49
80
11
65
59
75
86
89
33
0
10
20
30
40
50
60
70
80
90
100
Age Proc. Time Contral Inj OTW Success retrograde

23. 2008 vs 2018 : lessons effective
62
58
41
49
80
11
65
59
75
86
89
33
0
10
20
30
40
50
60
70
80
90
100
Age Proc. Time Contral Inj OTW Success retrograde
Inspired by a group of dedicated japanese CTO-
operators the €CTO club was established in 2006
Continuous teaching within the club and
international /intercontinental exchange increased
succssrate from 75% to 90%
We must continue our activities and not lose
momentum and visability