4th European Live Summit on Retrograde CTO Revascularization - May 8–9, 2015, in Zurich, Switzerland

1. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
16:00 – 16:15
Trouble shooting in complex reverse
CART Technique
Masahisa Yamane , MD, FACC
St Luke‘s International Hospital ,Tokyo, Japan
Saitama Sekishinkai Hospital, Saitama, Japan

2. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Disclosure Statement of Financial Interest
I, Masahisa Yamane MD,DO NOT have a financial
interest/arrangement or affiliation with one or
more organizations that could be perceived as a
real or apparent conflict of interest in the context
of the subject of this presentation.

3. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties encountered in XCART
1) Antegrade Gear Advancement
Wires
Balloon
Vessel (course) ambiguity
2) Retrograde Gear Advancement
Microcatheter resistance
Collateral entry Retro system stack or dislodgement
3) Difficulties in Re-entry
Size/Ant balloon
Vessel Ambiguity
Re-entry
4) Inability to XCART

4. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Antegrade Gear Advancement(1)
Antegrade : Gaia 2 Retrograde :SionBlackGaia 2 Knuckle wiringDouble KnuckleXCART by 2.5 mm balloon

5. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties encountered in XCART
1) Antegrade Gear Advancement
Wires Knuckle wiring
Balloon Anchor, Guide Extension, Tornus

6. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Retrograde Gear Trouble 1)
Micro catheter resistanceCaravel 150 cm >> Finecross 150 cm >>Corsair 135 cm + Wire AnchorCorsair 150 cm2.0 mm LAD balloon anchoringAnchoring (FF) better than Push (FR)

7. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Retrograde Gear Trouble 2)
Retrograde XT-RSion BlackGaia1Gaia2Balloon 2.0 for XCARTRetro wire into proximal True lumen

8. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Retrograde Gear Trouble 3)
Retro Sion BlackWire and Micro stack togatherNew XTR over Finecross deeper alongside as possibleAfter system removal

9. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties encountered in XCART
2) Retrograde Gear Advancement
Microcatheter resistance
Collateral exit closer to the distal cap
Softer wire – Micro – Gaia for control
Collateral entry Retro system stack or
dislodgement
Rescue XT-R/ Finecross

10. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (1)
Sion BlackSion BlackMicro as deeper as possibleAnt Gaia1Retro Gaia2 to3 over 2.0 mm balloonRetro Gaia 1

11. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (2)
CASE 6
Ant: 2.5 mm Ba/ Retro: Gaia 1Ant: 3.0 mm Ba/Retro: Gaia 1Reverse CART

12. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (3)a
Wires in Sub-intima ( False Lumen) and in Intima

13. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (3)a
IntimaSubintima
Ant: 3.0 mm Ba/ Retro: XT-RAnt: Intimal/ Retro: SubintimalAnt: 2.5mm Ba/Retro: FCAnt: 2.5 mm Ba/ Retro: Gaia 1After Wire Externalization via XCART, Distal wire
placed over Dual Lumen catheter, and then IVUS

14. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (3)b
Retro Wire in Intima/ IVUS in Subintima

15. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties in Re-Entry (3)b
Gaia 2 over IVUSRetrograde Gaia 1Ante Subintima/ Retro Intima
IntimaSubintima
3.0 mm balloon over Retro Gaia 1After retrograde wire re-entering

16. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties encountered in XCART
3) Difficulties in Re-entry
Vessel Course Ambiguity Alternate inching
Size/Ant balloon undersize
Re-entry V IVUS for wire location

17. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Inability to perform XCART
Retro Access through IMDAnt CQ 12 over TornusNo balloon could crossSwitch strategyNew CQ12g Ret 2.5 mmClassic CARTRetro balloon anchoringAnchoring balloon over IMDTornus 88FLEX
Calcified, Bending, <20mm, Poor target vessel, Prior failed Attempt

18. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Difficulties encountered in XCART
4) Inability to XCART
>>> Classic CART

19. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
Trouble shooting in XCART
1) Antegrade Gear Advancement
Wires Knuckle wiring
Balloon Anchor, Guide Extension, Tornus
2) Retrograde Gear Advancement
Microcatheter resistance
Collateral exit closer to the distal cap
Softer wire – Micro – Gaia for control
Collateral entry Retro system stack or dislodgement
Rescue XT-R/ Finecross
3) Difficulties in Re-entry
Vessel Course Ambiguity Alternate inching
Size/Ant balloon undersize
Re-entry V IVUS for wire location
4) Inability to XCART
>>> Classic CART

20. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss
CTO Club 2015,
June 19-20, Nagoya, Japan

21. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich Heart House, University Hospital Zurich, Swiss