This document summarizes Masahisa Yamane's presentation on the Japanese strategy for successful CTO PCI. It discusses techniques such as whip-jumping using rotational power retention, avoiding subintimal dissection through careful wire manipulation, and using IVUS to guide re-entry. It also provides data showing an increase in successful crossing from 2012 to 2013, with strategies transitioning from single wire to parallel wiring and IVUS guidance. The presentation emphasizes creating a safe and stable platform using single or dual wire strategies, while avoiding guide wire injuries through intentional deflection control and using IVUS to monitor vessel anatomy in real-time.

1. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
COMPLEX ANTEGRADE CASES
12: 25 -12:40
Japanese strategy for CTO PCI success
MasahisaYamane , MD, FACC
OLV Cardiovascular Center,
Aalst, Belgium
St Luke‘s International Hospital ,
Tokyo, Japan
SaitamaSekishinkai Hospital,
Saitama, Japan

2. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
I, (MasahisaYamane, 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. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
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Gaia1st over IVUSWire Deflection << Wire ControlGaia 2ndGaia 2 nd to 3 rd XT-R to Gaia 1 st over Crusade ( Dual Lumen)Deflection << ControlWire ∆ to Gaia 2XT-R over Crusade after IVUS

4. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
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Sion over CorsairGaia 1 to 2Gaia 3Confianza Pro 12CFZ Pro 12 to XT-R Gaia 1 over Corsair and “ Anchoring Balloon”Gaia 2 for further wiringStep down to Gaia 1IVUS from AC branchXT-R wire over the 2 nd OTW lumen of CrusadeDES deploymentAnother DES + KBT

5. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
Gaia 1 stGaia 1 in Diagonal over CorsairFloppy wire in Diagonal on Dual Lumen micro for LAD wiringXT-R for LAD 7F JR5.0SH2.5 mm ballooning3.5 mm DES deployment with side branch wire jailingGaia 1 over CorsairParallel over Dual Lumen MicroGaia 2 as a 2 nd WireAfter additional 2 DES+ Post

6. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
 Whip-Jumping by rotational power retention
Output
angle
Input
angle

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Madrid 2014
Subintimal dissection by Stiff CTO wire manipulation
Dense fibrous tissue
Injury can expand circumferentially and longitudinally

8. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
XT-R to Gaia 1Gaia 2 to 3Confianza Pro 12Confianza Pro 12 as a 2 nd WireMiracle Neo3g IVUS Guided LAD EntryRetrograde Gaia 1Ant 2.5 mm balloon

9. 83%
12%
3% 2%
82%
15%
2% 1%
0%
20%
40%
60%
80%
100%
Single wire Parallel
wire
IVUS
guided re-
entry
STAR NA
2012 2013
Corsair use: 78.1%
22%
43%
27%
8%
28%
39%
25%
8%
0%
20%
40%
Easy (0) Intermediate (1) Difficult (2) Very Difficult
(>3)
2012 2013
Successful CTO crossing strategy J-CTO score for “single wire” technique
Total (2201) 2012 (1063) 2013 (1138) P
Procedure success 91.6% (2016) 90.8% (965) 92.4%(1051) 0.1835
P<0.05P< 0.05
EURO CTO CLUB
Madrid 2014

10. CTO crossing Guide wire in 2012-13
Ante grade Approach
XT series,
31%
Con Pro,
10%
Gaia 1,
10%
Gaia 2,
6%
Wizard 3,
4%
ULTIM 3,
4%
SION, 4%
FFC, 4%
Other,
26%
2012
Total (2201) 2012 (1063) 2013 (1138) P
Guidewire cross 92.7% (2040) 91.8% (976) 93.5% (1064) 0.1300
XT series,
30%
Gaia 1,
23%
Gaia 2,
20%
Con Pro,
6%
Con Pro 12,
2%
Gaia 3, 2%
ULTIM3,
2%
SION, 2%
Other, 12%
2013
EURO CTO CLUB
Madrid 2014

11. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
10
0
5
10
15
20
25
30
35
Antegrade (N=59)
0
5
10
15
20
25
30
Retrograde (N=57)

12. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
 Safe and Stable platform on Single/ Dual wire strategy
 Guide wiring creates injury, dissection/hematoma
 IVUS provides ongoing anatomy of the vessel
 Precise and intentional control with deflection principle

13. 25/ 9/ 2014EURO CTO CLUB
Madrid 2014
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CCT 2014 , 10-30 to 11-1, in Kobe, Japan