8th Experts Live CTO Workshop 2016, September, 30th - October 1st, 2016 in Krakow, Poland

1. Retrograde CTO PCI in left
dominant coronary artery
Retrograde CTO PCI in left
dominant coronary artery
Nicolas Boudou, MD,
Cardiology department
Rangueil university hospital
Toulouse, France
Pôle Cardiovasculaire et Métabolique

2. Pôle Cardiovasculaire et Métabolique
Potential conflicts of interest
Speaker's name: Dr Nicolas Boudou
 I do not have any potential conflict of interest

4. LAD occlusion and collaterals

5. Conus artery

6. Guide catheter extension for ping pong
technique
Monorail, rapid exchange:
- Guidezilla®, Boston SC
5F dans 6F
- Guidion®, IMDS
…
Guideliner®, Vascular Solutions
5F dans 6F

7. • Coaxial, over the wire:
5F in 6F, 120 cm
Heartrail II®, Terumo
Guide catheter extension for ping pong
technique

8. Ping Pong technique:
2 guiding catheters in the same coronary artery
Brilakis ES, Grantham JA, Banerjee S. “Ping-pong” guide catheter technique for retrograde
intervention of a chronic total occlusion through an ipsilateral collateral.
Catheter Cardiovasc Interv 2011;78:3959.

9. • Retrograde approach through a septal colllateral
• Guide catheter extension in LCx to protect the left main
• Pure retrograde wire crossing and wiring in the Guide cath extension
Ping Pong technique:
2 guiding catheters in the Left coronary artery

11. CTO in ostial LAD
• Previous failure in another institution with dissection and haematoma of the proximal LAD
• Retrograde approach through septal from LCx

13. Retro CART with Guide extension

15. FU @ 3 months

16. Key points
• Retrograde in same coronary artery: left dominant
artery
• Septal or epicardial collateral
• Ping Pong technique
• Guide catheter extension
– To protect a branch not diseased
– To secure retrograde crossing