14th Experts Live CTO
September 2nd - 3rd, 2022 - Mainz, Germany
AGIK Parallel Session - Session 3:
The 101 of antegrade approach
Keynote: My essential tips & tricks for success in antegrade approach
Jan Malte Sinning, Köln, Germany
Room:
West Foyer - Friday 16:10
Chairmen:
Michael Behnes, Mannheim, Germany;
Felix Woitek, Dresden, Germany
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Jan Malte Sinning: Keynote: My essential tips & tricks for success in antegrade approach
1. My essential tips & tricks
for success in antegrade approach
Jan-Malte Sinning, MD, FESC
St. Vincent Hospital Cologne
2. Potential Conflicts of Interest
Receipt of grants / research support:
Boston Scientific, Edwards Lifesciences, and Medtronic.
Proctor:
Medtronic and Boston Scientific.
Scientific Advisory Board:
Abbott, Abiomed, Boston Scientific, Boehringer Ingelheim, and Medtronic.
Receipt of speaker honoraria and/or travel expenses:
Abbott, Abiomed, Astra Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol
Myers Squibb, Edwards Lifesciences, Medtronic, Novartis, Novo Nordisk, Pfizer, Shockwave
Medical, and Zoll.
4. Rationales for CTO Recanalization
• Relief of angina/ischemia (typically exertional symptoms)
• Improvement of ventricular function
• Reduced incidence of late CABG
• Possible improvement in event-free survival
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5. Four options for crossing CTOs
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
AWE
ADR
RDR
RWE
6. Hybrid algorithm combining antegrade and retrograde skills
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
16. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
17. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
18. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
19. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
20. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
21. Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
22. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
23. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
24. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
25. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
26. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
27. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
28. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
29. Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
30. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
31. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Fielder XT
Gladius MG
Gaia II / III
Hornet 14
My Algorithm
32. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
33. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Stay intra-plaque (= true lumen) !
34. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
35. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
36. Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
63. Step 4: Assessment of implantation quality
Step 4: Assessment of implantation quality
No dissection
Circular stent expansion
Good strut apposition
Left main OK !
64. Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
65. Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
66. Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
67. My essential Tips & Tricks for success in antegrade CTO PCI
1. Safe vascular access (fluoroscopy or sonography guidance)
2. Guiding catheter strategy
3. Dedicated CTO wires
4. Microcatheter selection according to strategy
5. AWE (Fielder XT, Gaia II / III, Hornet 14), parallel wiring
6. Liberal use of IVUS
7. Know ADR techniques
8. Lesion preparation (rotational / orbital atherectomy, IVL, etc.)
9. Stenting optimized by intravascular imaging
10. Intraprocedural management (ACT, conscious sedation, echo etc.)
68. Thank you very much for your attention !
Jan-Malte.Sinning@cellitinnen.de
