This document provides information about the 6th European Live Summit on Retrograde CTO Revascularization that was held on April 28-29, 2017 in Zurich, Switzerland. It summarizes data from the Euro CTO Club registry on techniques and outcomes of retrograde CTO revascularization between 2008-2016. Key findings include an increase in retrograde approach use over time, higher success rates with retrograde vs antegrade approach, and improved outcomes with increasing experience as measured by operator case volume and decreasing J-CTO scores of treated lesions.

1. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
CTO in Europe
Alfredo R. Galassi MD, FESC, FACC, FSCAI
Department of Clinical and Experimental Medicine,
University of Catania, Italy and
University Heart Center, University Hospital Zurich, Switzerland

2. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
0
50
100
150
200
13
21
29 33 38 43 52 55 61
124
143
182
Club Membership
Full
0
10
20
30
40
50
60
70
80
90
100
63
92
3
13
Associate
Non-European
Associate
Non-European
Affiliate

3. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC

4. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
0 10 20 30 40 50 60 70
from 0 to 9
from 10 to
49
50+
2016 2015
Case #
Members #
Associate Members

5. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
Online Registry 2008 – 2016
Full Members
Associate Members

6. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
Antegrade/Retrograde Operators
Full Members
Associate Members
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015 2016
50
31 28.6
20.5 18.8 14.6 16.6
5.5 7.2
50
69 71.4
79.5 81.2 85.4 83.4
94.5 92.8
Antegrade only Retrograde + Antegrade
0%
20%
40%
60%
80%
100%
2015 2016
19.5 20
81.5 80

7. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
Antegrade/Retrograde Procedures
Full Members
Associate Members
0%
20%
40%
60%
80%
100%
2008 2009 2010 2011 2012 2013 2014 2015 2016
90 88.5 89.5 86
77 71 72.4
64.9 67.2
10 11.5 10.5 14
23 29 27.6
35.1 32.8
Antegrade Retrograde± Antegrade
0%
20%
40%
60%
80%
100%
2015 2016
76.3 76.7
23.7 23.3

8. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
Angiographic Success
Full Members
Associate Members
0
20
40
60
80
100
2008 2009 2010 2011 2012 2013 2014 2015 2016
85.5 86.5 88.1 87.6 87.8 90.3
87 89 89
73.6
64.2
77.1 76.5 77.8
79.5 82.2 83.3
81.2
Antegrade Retrograde
0
20
40
60
80
100
2015 2016
8.8
91.3
78.1
81.2

9. Industry Assembly
6th European Live Summit on
Retrograde CTO Revascularization
April 28-29, 2017 - Zurich, Switzerland
Course Directors Course Vice Director & Coordinator
Alfredo R. Galassi , MD, FACC, FESC Oliver Gaemperli, MD, FESC
Thomas F. Luscher, MD, FACC, FESC
George Sianos, MD, PhD, FESC
0
0.5
1
1.5
2
2.5
3
3.5
2008 2009 2010 2011 2012 2013 2014 2015 2016
0
0.5
1
1.5
2
2.5
3
3.5
4
2015 2016
Full members
Associate members
Death Cardiac tamponade
Myocardial infarction Vascular complication
Coronary perforation Donor vessel dissection

10. 0
10
20
30
40
50
60
2011
2012
2013
2014
2015
2016
Wires to start
%

11. 0
5
10
15
20
25
30
35
2011
2012
2013
2014
2015
2016
Final wires to cross
%

12. Guiding Catheter Selection in the ERCTO
No trend differences were observed between antegrade
and retrograde approach during years
0
10
20
30
40
50
60
70
2008 2009 2010 2011 2012 2013 2014 2015 2016
6 Fr 7 Fr 8 Fr

13. Procedural Details
0
10
20
30
40
50
60
70
80
2008 2009 2010 2011 2012 2013 2014 2015 2016
Contralateral injection Radial approach

14. 40.3
38.3
2.3 0.9
0
10
20
30
40
50
2015 2016
Corsair Tornus
Corsair / Tornus
%

15. Cross Boss / Stingray
3.7
2.2
2.7
2.4
0
2
4
6
8
10
2015 2016
Cross Boss Stingray
%

16. 2.3
3.2
0
2
4
6
8
10
2015 2016
Rotablator
%
Rotational Atherectomy

17. Guiding Extension
%
11.7 12.1
0
5
10
15
20
2015 2016

18. Dual Lumen Microcatheter
%
7.7
9.7
0
5
10
15
20
2015 2016

19. 0
5
10
15
20
25
30
2009 2010 2011 2012 2013 2014 2015 2016
3
2
5
7.9 7.3 6.7
12 12.6
1 1
6
17.6
22.8 22.7
27.2
23.6
2.4 2.1
5
10.3
11.8 11.1
17.3
14.6
Antegrade Retrograde Overall
IVUS
%

20. Revascularization strategies
according to J-CTO score 2016
98.2 94
85
75.5 70.2 69.4
1.8 6
15
24.5 29.8 31.6
0
20
40
60
80
100
0 1 2 3 4 5
Conventional wire escalation Dissection re-entry
P<0.05
%

21. 94.2
94.9
83.7 85.5
74.4
70.2
79.9
93.9
90.5 86.6
81.6
73.2
82.5
94.7
91.7
87.7
79.1
68.4
0
20
40
60
80
100
0 1 2 3 4 5
2014 2015 2016
Success according to J-CTO score
2014 p<0.05
2015 p=NS
2016 p=NS
%

22. Case Selection Guided by the J-CTO Score
Harding SA, Tsuchikane E et al. JACC Intv in press

23. 13.1 11.8 9.1
26
19.8 19.6
26.7
27.1 30
22.3
24.9 24.8
9.5 13.4 13.9
2.4 3 2.7
0%
20%
40%
60%
80%
100%
2014 2015 2016
0 1 2 3 4 5
J-CTO score during years

24. Angiographic Success Vs J-CTO score

25. EURO CTO CLUB
Krakow 2016
Zurich
2017
THANK YOU
FOR YOUR PARTICIPATION
Berlin
2017