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Gsw physician teleflex
- 1. Advanced tools and techniques to address challenging coronary interventions Gerald S. Werner MD PhD Medizinische Klinik I Klinikum Darmstadt GmbH Darmstadt, Germany
- 2. Disclosures Speaker is a paid consultant of Teleflex Speaker honorarium from Abbott Vascular ASAHI Boston Scientific IMDS Terumo
- 3. The basic rules for CTO approach • Bilateral access to visualize the wire position and wire progress • Maximum back-up by guide catheter for wire and balloon advancement (options for anchoring) • Microcatheter over the wire approach essential • Know your wires
- 4. What you need to treat a CTO • Guiding catheters • Microcatheters • Guide wires • Dedicated devices (BridgePoint) • Balloon catheters • Guide Extension • Rotablator (Laser) • Stents • IVUS
- 5. Common Clinical Challenges • Guide catheter support and device delivery • Guidewire support and deliverability • Navigating complex anatomy • Exchanging over-the-wire catheters
- 6. Common Clinical Challenges • Guide catheter support and device delivery • Guidewire support and deliverability • Navigating complex anatomy • Exchanging over-the-wire catheters
- 7. What is Guide Extension? Potential Indicators for Guide Extension: • Lack of guide support or guide catheter back-out • RCA • Radial access • Tortuosity • Calcium • Ostial lesions Rapid-exchange, coaxial “mother-and-child” guide catheter support
- 8. Guideliner® V3 Catheter Product Features Proximal Tab • GL French size – indicates compatible guide catheter • GL inner diameter (inches) • Five sizes – 5F, 5.5F, 6F, 7F, & 8F Stainless Steel Push Rod • Strength & kink resistance, optimal push • 0.056” lumen through 6F guide catheter Half-Pipe Design • Aligns device for seamless delivery • 17 cm length Coil Reinforced Guide Extension • Flexibility & kink resistance for deep- seating in tortuous vessels • 25 cm rapid exchange section • Extend up to 10 cm out of 5-7F guide catheter (10cm for 8F)
- 9. Added Back-up Support Testing completed by Vascular Solutions, Inc. Bench testing data may not be indicative of clinical performance. Testing has shown that extending a GuideLiner® V3 Catheter just 5mm beyond a 6F guiding catheter greatly increases back-up support
- 10. Added Back-up Support Without With Guide catheter tip GuideLiner® V3 Catheter tip GuideLiner® V3 Catheter puts the guide into a more supportive position against both the aortic valve cusp & the opposite wall of the aorta But, when you can anchor, I would prefer anchoring specifically in the RCA
- 11. Coaxial Alignment GuideLiner® V3 Catheter creates coaxial alignment for devices to track smoothly into the coronary artery Without With
- 12. Guide Extension Deployment Techniques • Avoid advancing the Guideliner without a leading balloon • Balloon inflation out of the Guideliner and advancing it while deflating the balloon makes it possible to conquer even most tortuous segments
- 13. RCA CTO in 70 year old male post CABG Ante: 7Fr AL1.0 SH 90cm via Rt FA
- 14. 6Fr Guide Extension with Emerge 2.5x30mm RCA CTO
- 16. My personal sizing approach • I prefer to use the appropriate size as it provides the maximum working lumen • In exceptional cases I use a smaller diameter in case of difficult delivery or extrem bends
- 17. It is important to know the dimensions of the device GuideLiner® V3 Catheter Product Specifications Model Size Required Guide Catheter I .D. GuideLiner I.D. Tip O.D. RX Length Working Length 5569 5F 5F I.D. ≥0.056” (1.42 mm) 0.046" (1.17 mm) 0.053” (1.35mm) 25 cm 150 cm 5570 5.5F 6F I.D. ≥0.066” (1.68 mm) 0.051" (1.30 mm) 0.063” (1.60mm) 25 cm 150 cm 5571 6F (5-in-6) 6F I.D. ≥ 0.070” (1.78 mm) 0.056” (1.42 mm) 0.067” (1.70mm) 25 cm 150 cm 5572 7F (6-in-7) 7F I.D. ≥ 0.078” (1.98 mm) 0.062” (1.57 mm) 0.075” (1.90mm) 25 cm 150 cm 5573 8F (7-in-8) 8F I.D. ≥ 0.088” (2.24 mm) 0.071” (1.80 mm) 0.085” (2.16mm) 25 cm 150 cm Factors to consider when choosing guide extension: • Vessel size • Lesion location • Lesion complexity • Adjunctive tools and therapies
- 18. Guide Extension Case Example LAD CTO with extreme tortuosity and calcification
- 19. 7Fr EBU3.75SH via Rt radial LAD CTO in 65 year old male
- 22. Guideliner with Tazuna 1.25mm
- 23. Stenting
- 24. Final
- 25. Guide Extension Case Example RCA CTO: Guide Extension assisted reverse CART
- 26. Ante: 7Fr AL1.0 SH 100cm via Rt femoral Retro: 7Fr EBU4.0 SH 100cm via Rt radial RCA CTO in a 65 year old male
- 27. Antegrade approach Sasuke with Hornet14
- 28. Retrograde approach Tip injection with Caravel
- 29. Retrograde approach Caravel with SION
- 30. Caravel with Gaia3rd Retrograde approach Tip injection
- 31. Ante: Hornet14 with 2.0mm TAZUNA Retro: Caravel with Gaia3rd R-CART with 7Fr Guideliner
- 32. Externalization and wiring to PL Sasuke with XT-R
- 33. Final (after 7 DES)
- 34. Guide Extension Case Example RCA CTO: Guideliner assisted retrograde procedure with tip-in exchange within the Guideliner
- 35. RCA – CTO in a 74 year old male Antegrade; 7Fr AL1.0 SH via Rt TFA Retrograde; 7Fr EBU3.75 SH via Rt TRA
- 37. Retrograde approach Caravel with SION
- 38. Retrograde approach Caravel with Ultimate
- 39. R-CART Ante: XT with 3.0x15mm Retro: Caravel with Gaia3rd
- 40. Rendezvous Technique inside GuideLiner Trunpike Spiral in the Anteguide
- 42. Final
- 43. What you need to treat a CTO • Guiding catheters • Microcatheters • Guide wires • Dedicated devices (BridgePoint) • Balloon catheters • Guide Extension • Rotablator (Laser) • Stents • IVUS
- 44. What you need to treat a CTO • Guiding catheters • Microcatheters • Guide wires • Dedicated devices (BridgePoint) • Balloon catheters • Guide Extension • Rotablator (Laser) • Stents • IVUS