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Plan the approach based on the angiogram
- 1. Plan the approach based on the angiogram Markus Meyer-Geßner Augusta-Krankenhaus Düsseldorf
- 2. 2 Alexander von Humboldt, Born in Berlin 250 years ago 14th of september A Pioneer of scientific expeditions through terra incognita Roadmap of several expeditions
- 3. 3 The roadmap with terra incognita: Bilateral angiogram Complete overview (limited collimation) No panning Adequate angulations Start with retrograde injection
- 4. 4 Retrograd septal via ACVB und RIVP
- 5. 5 Barriers inside terra incognita 4 C of complexity: Cap, Calcium, Curve, Channel length
- 6. „RECALL“ = 4C + Redo J Am Coll Cardiol Intv. 2011;4(2):213-221. doi:10.1016/j.jcin.2010.09.024 J-CTO Score 0-5
- 7. J Am Coll Cardiol Intv. 2011;4(2):213-221. doi:10.1016/j.jcin.2010.09.024 J-CTO Score: Antegrade wiring success rate and time
- 8. 8 EURO CTO (CASTLE) score= 4C + age + prior CABG
- 9. 9 EURO CTO (CASTLE) Score JACC CVI 2019 JACC CVI 2019
- 10. 10 From roadmap to expedition plan J-CTO score 3, CASTLE score 3 – success rate antegrade <80% Interventional collaterals -> retrograde septal access Cap: not tapered Channel length: >20mm Calcification: moderate Collaterals: septals and epicardials, septal approach feasible
- 12. 12 Easy case for beginners – J CTO score 0 Basics: contralateral injection, microcatheter
- 13. 13 Challenging case for experts - CASTLE score 6 CTO RCA 2007 before CABG
- 14. 14 Multilevel CTO RCA 2017 10 y post CABG, CASTLE Score 6 Part 1: proximal opening, retrograde via ACVB
- 15. 15 Part 2: distal opening retrograde via epicardial channel LCX to PLB
- 16. 16 CTO RCA 2007 - result 2017
- 17. 17 A challenge for men and material: RG3
- 18. Consensus Paper from Euro CTO Club Eurointervention 2019
- 19. Conclusion A carefully performed and analyzed roadmap is the key for planning the expedition through terra incognita