Antegrade approach – how to start? Views of a minimalist and a maximalist poi...Euro CTO Club
Room: Salon Schinkel
Antegrade approach – how to start? Views of a minimalist and a maximalist point of view combattants
David M. Leistner, Germany vs. Alexander Ghanem, Germany
The Experts “Live” Workshop 2017
Saturday, September 16th, 2017
Antegrade approach – how to start? Views of a minimalist and a maximalist poi...Euro CTO Club
Room: Salon Schinkel
Antegrade approach – how to start? Views of a minimalist and a maximalist point of view combattants
David M. Leistner, Germany vs. Alexander Ghanem, Germany
The Experts “Live” Workshop 2017
Saturday, September 16th, 2017
Chronic Total Occlusions: The Road Less TraveledAllina Health
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Despite the advances in wire technology and development of algorithm-driven methodology for chronic
total occlusion (CTO) intervention, there is a void in the literature about the technical aspects of CTO wiring.
The Asia Pacific CTO Club, a group of 10 experienced operators in the Asia Pacific region, has tried to fill this
void with this state-of-the-art review on CTO wiring
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
Application of retrograde dual lumen microcatheter for a chronic total occlus...Euro CTO Club
Application of retrograde dual lumen microcatheter for a chronic total occlusion percutaneous coronary intervention in a bypassed right coronary artery
Peter Tajti, Rami Abu Fanne , Imre Ungi
University of Szeged, Hungary
Case Competition - 11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Microcatheters for antegrade and retrograde approachEuro CTO Club
Microcatheters for antegrade and retrograde approach
George Sianos, Thessaloniki, Greece
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
15th Experts Live CTO - Carlo Di Mario: ConclusionsEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Francesco Burzotta: Wrap up Gemelli CasesEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Jonathan Hill: Role of mechanica support in CTO recanalizationEuro CTO Club
10:42
Role of mechanica support in CTO recanalization
Jonathan Hill (London - UK)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Gregor Leibundgut: Role of DEB in CTO-PCIEuro CTO Club
10:35 Role of DEB in CTO-PCI
Gregor Leibundgut (Basel - CH)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Euro CTO Club
AUDITORIUM ZUBIN MEHTA
08/09/2023 04:30 - 05:20
PLENARY SESSION - INTERVENTIONAL CTO & CHIP RESEARCH Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Euro CTO Club
16:33
EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions
Mario Iannaccone (Turin)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. Optimizing Collateral Crossing
The Experts „Live“ Workshop 2014
Session 3
AN INITIATION TO RETROGRADE TECHNIQUES
25 Sept 2014, 15:05 - 15:20
Prof Georgios Sianos, MD, PhD, FESC
Department of Interventional Cardiology, AHEPA University Hospital,
Thessaloniki , Greece
2. Collaterals in RCA occlusion
Pathways and Functional Significance of the Coronary Collateral Circulation
David C Levin, Circ 1974;50:831-837
Collaterals in LAD occlusion
Pathways and Functional Significance of the Coronary Collateral Circulation
David C Levin, Circ 1974;50:831-837
3. Collateral Connections
RAO Caudal Projection
Septal
Septal-Septal
Epicardial- Dg
Epicardial-Apical
Conus-Septal
Epi (OM to Dg or Dg to Dg)
Yamane TCT 2014
4. Collateral Connection Grades in Septal Channels
CC 0 : no visible connection
CC 1: thread-like, but visible connection, mild torturosity and
mild cork-screw morphology
CC 2: clearly defined visible channel, mild torturosity and mild
cork-screw morphology
(Werner G. Circ 2003)
5. ”Collateral Connection Size“ (CC)
Septal pathways in 44%, epicardial in 32%
CC0 14% CC1 51% CC2 35%
B
D E
A C
F
AB C
Werner et al. Circulation 2003;107:1972-7
6. Corkscrew-like
Inextensible/
Stenosis
Length Applicability Distensibility
Epicardial Significant Potential Long Modest(>35%) Undilatable
Atrial Moderate Occasional Long Low(<10%)
Undilatable
Septal Moderate∽Mild Rare Short High(>60%) Dilatable
Modified from O. Katoh: CCT 2008: Retrograde for CTO Course
Characteristics of specific channels-not
all the same
7. Predictors of Retrograde failure
Rathore S, Katoh O, et al, Circ Cardiovasc Intervent. 2009;2:124-132
8. View angle in Septal Channels
RAO cranial view: good for checking the origin of the septal
channel
Pitfalls continuing channel crossing with this view
Notice non-orthogonal view for the junction point
RA0 caudal view: mandatory to check the anatomy of the body
and the junction point
Single view is inadequate to check the anatomy
Rotational angiography
9. View Angle and Issues in Other Channels
optimal view angles issues
epicardial
(RV channel)
•RAO (cranial)
•APcranial for connection to LAD
•most tortuous channel
•many side branches
•invisibility of channel during wiring
•shape-changeable channel by heart
beating
•step by step approach
PL channel
• RAO/ AP cranial (LCx-RCA, Dx-DX/LCx)
• LAO(cranial/ caudal) for PL channels
located in anterolateral wall
tortuous feeding artery
atrial
•LAD (cranial)
•RAO cranial
•RAO/AP caudal for checking origin of
feeding artery
•difficult to access feeding artery
•most fragile channel
16. Septal Surfing
• Septal surfing is useful for saving time
• Try to slide the wire through gently, avoid buckling, avoid loops,
follow with the micro-catheter
• Do not persist on a specific pathway
• The wire must move quickly with changing directions towards the
orientation of the target vessel
• The wire tip shaping is less acute bending compared to the targeted
collateral crossing after tip injection
• Tapered wires should not be used for SS
• Invisible channels are sometimes crossed with septal surfing.
17. Tip Injection
Tip injection (with rotational angiogram) is useful to
maximize chance of channel crossing.
isolating channel
revealing channel anatomy
estimating possibility of crossing
Check of blood back-flow is mandatory to avoid channel
injury and confirm connection with recipient artery prior to
tip injection.
As long as channel anatomy is revealed with tip injection,
double/triple wire technique is helpful.
18. Epicardial vs Septal Crossing
Epicardial
Directed
Higher need for
MC support to
negotiate
tortuosity
Higher need for
“tip injections”
Septal
Often more
random (septal
surfing)
Tortuosity
responds less well
to MC support
Tip injection if
failure of septal
surfing
19. Collateral Connection size and continuity (CC class)
Tortuosity/branching of the channel
Angle of take-off from the donor artery
Collateral take-on from the distal cup
Donor artery proximal from the take-off of the CC
Diseased/Tortous
Relation of the CC insertion site to the distal cup
Parameters to be considered for CC selection
20. Collateral Connection size and continuity (CC class)
Tortuosity/branching of the channel
Angle of take-off from the donor artery
Collateral take-on from the distal cup
Donor artery proximal from the take-off of the CC
Diseased/Tortous
Relation of the CC insertion site to the distal cup
Parameters to be considered for CC selection
25. Collateral Connection size and continuity (CC class)
Tortuosity/branching of the channel
Angle of take-off from the donor artery
Collateral take-on from the distal cup
Donor artery proximal from the take-off of the CC
Diseased/Tortous
Relation of the CC insertion site to the distal cup
Parameters to be considered for CC selection
27. Acute angle at origin/destination
Acute angle (>90°) at A or B is a negative
factor for channel crossing.
Dissection/ rupture is rarely caused by
wire/ catheter.
For negotiating acute curve at origin (A/B),
double lumen microcatheres (Twinpass,
Crusade are useful.
A
B
28. Collateral Connection size and continuity (CC class)
Tortuosity/branching of the channel
Angle of take-off from the donor artery
Collateral take-on from the distal cup
Donor artery proximal from the take-off of the CC
Diseased/Tortous
Relation of the CC insertion site to the distal cup
Parameters to be considered for CC selection
31. Collateral Connection size and continuity (CC class)
Tortuosity/branching of the channel
Angle of take-off from the donor artery
Collateral take-on from the distal cup
Donor artery proximal from the take-off of the CC
Diseased/Tortous
Relation of the CC insertion site to the distal cup
Parameters to be considered for CC selection
33. Relation of the CC insertion site to
the distal cup
Wire entrapment
34. Channel crossing wire selection
Polymer wires (Fielder FC / Whisper) were the first to be used
for channel crossing but were related with high incidence of
collateral injuries.
Metal ball tip hydrophilic wires are more effective and safer.
Sion is first choice wire for channel crossing instead of polymer jacket
wire (Fielder FC, Whisper, etc).
Tapered polymer jacket wires (XTR) became the choice for
very thin and very tourtous collaterals during targeted channel
crossing
37. Potential Sequence for Collateral Crossing
SION
SION Black / FFC
XRT
Hydrophilic ball tip
Polymeric
Tapered
38. Bend used for septal access Bend used to facilitate septal crossing
Tip shaping for Collateral Crossing
In targeted crossing of very tortuous and thing channels a very sharp and short tip
bending might be necessary
39. Retrograde: Collateral approach
48.6%
18.6%
9.9%
9.9%
13.0% SION
XT-R
Fielder FC
SION blue
other
Attempt
94.2%
9.6% 1.5%
0%
50%
100%
Corsair OTW
Catheter
Other
microcatheter
Catheter used for GW support
(multiple selection)
92.2%
7.2% 0.6%
0%
50%
100%
Successfully crossed catheter
Corsair OTW
Catheter
Other
microcatheter
No. of GW: 1.8
60.1%25.1%
7.1%
3.3% 4.4%
Succesful collateral route
Septal
Epicardial
AC
Ipsilateral
Bypass graft
Collateral cross by GW, 77.1% (370/480)
Multicenter Japanese Registry (2012)
40. Japanese Multicenter Registry Evaluating the Retrograde
Approach for Chronic Coronary Total Occlusion
(801 patients treated in 28 Japanese centers between January 2009 and December 2010,
Corsair use increased from 36% to 95.3% from 2009 to 2010)
Tsuchikane et al, Catheterization and Cardiovascular Interventions 82:E654–E661 (2013)
Procedural success rate 84.8 % (retrograde success 71.2%)
Clinical success rate 83.8% (retrograde success70.3%)
All (n:801) 2009 (n:378) 2010 (n:423)
Collateral channel cross by guidewire 82.3% (659) 80.4% (304) 83.9% (355)
Successfully crossed collateral channel
Septal 63.0% (415/659) 68.4% (208/304) 58.3% (207/355)
Epicardial 32.6% (215/659) 27.6% (84/304) 36.9% (131/355)
Bypass graft 4.4% (29/659) 3.9% (12/304) 4.8% (17/355)
Procedure time (min) 195.1±84.5 203.3±84.4 187.9±84.1 (p:0.024)
Multivariate analysis identified age 65 years or more and lesion calcification as unfavorable factors and the use of a
channel dilator as a favorable factor for retrograde procedural success.
41. MALE, 63 Y, SA CLASS III
Radial AL 1.5 6Fr
Femoral EBU 3.5 7 Fr
Gaia First
50. Solving MC crossing problems
Choose Guiding catheters with good backup support
Change the failing MC (Corsair/Finecross)
Ballooning by small balloon with low pressure
Balloon anchoring
Others (another retro channel, ante approach)
51. Summary
Good guiding catheter support
Careful evaluation of the angiogram in multiple projections or rotational
angiography
Donor artery
CC for angle of take-off, size, tortouosity, branching, angle of insertion at the
distal vessel, its relation with the distal cup
In septal channels try surfing first
Slide the wire through gently, avoid buckling, avoid loops, follow with the
microcatheter
In case of failure continue with tip injections
In epicardial channels tip injection is mandatory
Use composite core SION wire as first choice followed by polymeric/tapered wires
according to the anatomy of the channel
Reshape the wire tip once you are in the channel if necessary
Optimize parameters for micro-cather crossing
Most injuries are un-harmful but be prepared for coil embolization if nessecary
Remember what is visible is not necessary crossable and visa versa