14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
AGIK Parallel Session - Special Session:
Case of the month Competition
Best CTO Case of the Month
Felix Woitek, Dresden, Germany
Room:
West Foyer - Friday 12:45
Chairmen:
Pier Francesco Agostoni, Antwerp, Belgium;
Juan Luis Gutiérrez-Chico, Koblenz, Germany
1. Best CTO Case of the Month
Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Felix Woitek, Axel Linke, Norman Mangner
Department of Internal Medicine and Cardiology –
Heart Center Dresden at the
Technical University Dresden
Germany
2. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
82y/o gentleman presented with NSTEMI
LVEF 37%
Dyspnea NYHA II-III
previous PLA1 stenting
3. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
CTO of the proximal LAD J-Score 2-3
(bending, calcification, length)
Access: femoral 7F / radial 6F
5. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Setup:
1. One antegrade trial AWE: Turnpike, Fielder XT-A & Gaia 2nd
2. Epicardial retrograde approach, Turnpike LP Microcatheter/Sion Black
3. RWE/CART
4. Additional need for lesion preparation anticipated
6. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Unsuccessful antegrade crossing
due to low support at the LAD ostium
7. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Retrograde epicardial passage RIM distal LAD
8. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Retrograde recanalization (Turnpike LP, Fielder XT-A)
and Tipp-In
9. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Scooping of the retrograde Fielder XT-A
with the antegrade Turnpike within the guide cath
10. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Antegrade passage of the CTO with the turnpike
followed by wiring with a floppy rota wire
11. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Rota of the LAD with a 1.75mm RotaPro burr
14. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Clinical Course of the patient:
1. Small hematoma at the femoral puncture site
2. Fall at the ward during mobilization without any residual disability
3. Discharge one day after CTO recanalization
16. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Key Points:
1. Several crossing options should be prepared in heavy calcified CTO
2. Retrograde options may be considered at an early stage
3. Optimal lesion preparation especially in cases with successful recanalization
within the CTO (AWE/RWE) should be emphazized to secure optimal long term
results
17. Heart for CTO
Retrograde Wire Escalation & Rota in LAD CTO
Key Points:
1. Several crossing options should be prepared in heavy calcified CTO
2. Retrograde options may be considered at an early stage
3. Optimal lesion preparation especially in cases with successful recanalization
within the CTO (AWE/RWE) should be emphazized to secure optimal long term
results
