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Guide Extension Catheter
This document discusses guide catheter extensions used in interventional cardiology. It describes four types of guide catheter extensions currently available: Guideliner V2, Guidezilla, Telescope, and Guidion. It provides details on the sizes, lengths, and features of Guideliner V2 and Guidezilla. Applications of guide catheter extensions include increasing backup support, bypassing calcification/tortuosity, limiting contrast use, and facilitating procedures like CTO PCI and thrombus aspiration. Potential complications are discussed, along with tips to minimize risks like dissection or ischemia.
CTO
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
Design is not Art
This talk is not about design or art; it’s about designers. It’s about the things that we create and the ways in which we create them. It’s about the processes that we use and how those processes define us. It’s about the qualities that set us apart (and why they matter). What are the differences between design and art? What is the most important quality that a designer can possess? And how are the two so closely related? In this talk, we’ll examine the ways in which design and art are fundamentally different, and how through those differences, we can extract the qualities that comprise great designers and leaders. Learn about the contrasting purposes, data sources, and creative processes that design and art hold. Gain a new perspective on what it means to be a designer, and how designers that possess one particular quality are prone to better feedback, accountability, innovation, collaboration, and outcomes. Finally, hear personal accounts from designers at companies like Google and Apple, sharing their approaches to design and the qualities that they value. You may or may not leave this talk convinced that design is not art, but no matter what, you will leave with a better understanding for what it means to be a designer.
Parallel sheath technique
This document describes a novel "parallel sheath technique" for overcoming severe iliac artery tortuosity during catheterization procedures. It presents 5 case examples where the technique was used successfully. The technique involves inserting a second sheath parallel to the first, with an extra-stiff guidewire to straighten the artery. This significantly improves catheter maneuverability through the first sheath. The technique provides an alternative to workarounds like larger sheaths or switching access sites when standard techniques cannot overcome extreme kinking.
Teleflex Guidewires performance in microcatheters
1. The document discusses the interaction between microcatheters and guidewires in complex percutaneous coronary interventions (PCI). It describes key components and properties of guidewires and microcatheters that influence their performance as a combination.
2. Effective tip load range is introduced as a measure of how the tip load of a guidewire varies depending on the distance between the microcatheter tip and guidewire tip. Bench test data is presented comparing effective tip load ranges for different guidewire-microcatheter combinations.
3. The combination of a Warrior guidewire with the Turnpike microcatheter is shown to have an effective tip load range of 11.8g to 33.16g,
Meerkin D
This document discusses techniques for optimizing guide catheter support during percutaneous coronary interventions (PCIs), especially for surgically bypass graft (SVG) procedures which pose additional challenges. It describes how inadequate guide catheter support can lead to procedural failure. Several options are presented to improve support, including use of buddy wires, lesion preparation, distal anchor balloons, guide catheter extensions, and coaxial "mother-and-child" guide systems like the GuideLiner which allows deep intubation and staged procedures. The GuideLiner is highlighted as a versatile option that can be customized to different scenarios to maximize support and guidewire backup.
Arch final harkit2015 __
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Recommended
Guide Extension Catheter
This document discusses guide catheter extensions used in interventional cardiology. It describes four types of guide catheter extensions currently available: Guideliner V2, Guidezilla, Telescope, and Guidion. It provides details on the sizes, lengths, and features of Guideliner V2 and Guidezilla. Applications of guide catheter extensions include increasing backup support, bypassing calcification/tortuosity, limiting contrast use, and facilitating procedures like CTO PCI and thrombus aspiration. Potential complications are discussed, along with tips to minimize risks like dissection or ischemia.
CTO
This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.
Design is not Art
This talk is not about design or art; it’s about designers. It’s about the things that we create and the ways in which we create them. It’s about the processes that we use and how those processes define us. It’s about the qualities that set us apart (and why they matter). What are the differences between design and art? What is the most important quality that a designer can possess? And how are the two so closely related? In this talk, we’ll examine the ways in which design and art are fundamentally different, and how through those differences, we can extract the qualities that comprise great designers and leaders. Learn about the contrasting purposes, data sources, and creative processes that design and art hold. Gain a new perspective on what it means to be a designer, and how designers that possess one particular quality are prone to better feedback, accountability, innovation, collaboration, and outcomes. Finally, hear personal accounts from designers at companies like Google and Apple, sharing their approaches to design and the qualities that they value. You may or may not leave this talk convinced that design is not art, but no matter what, you will leave with a better understanding for what it means to be a designer.
Parallel sheath technique
This document describes a novel "parallel sheath technique" for overcoming severe iliac artery tortuosity during catheterization procedures. It presents 5 case examples where the technique was used successfully. The technique involves inserting a second sheath parallel to the first, with an extra-stiff guidewire to straighten the artery. This significantly improves catheter maneuverability through the first sheath. The technique provides an alternative to workarounds like larger sheaths or switching access sites when standard techniques cannot overcome extreme kinking.
Teleflex Guidewires performance in microcatheters
1. The document discusses the interaction between microcatheters and guidewires in complex percutaneous coronary interventions (PCI). It describes key components and properties of guidewires and microcatheters that influence their performance as a combination.
2. Effective tip load range is introduced as a measure of how the tip load of a guidewire varies depending on the distance between the microcatheter tip and guidewire tip. Bench test data is presented comparing effective tip load ranges for different guidewire-microcatheter combinations.
3. The combination of a Warrior guidewire with the Turnpike microcatheter is shown to have an effective tip load range of 11.8g to 33.16g,
Meerkin D
This document discusses techniques for optimizing guide catheter support during percutaneous coronary interventions (PCIs), especially for surgically bypass graft (SVG) procedures which pose additional challenges. It describes how inadequate guide catheter support can lead to procedural failure. Several options are presented to improve support, including use of buddy wires, lesion preparation, distal anchor balloons, guide catheter extensions, and coaxial "mother-and-child" guide systems like the GuideLiner which allows deep intubation and staged procedures. The GuideLiner is highlighted as a versatile option that can be customized to different scenarios to maximize support and guidewire backup.
Arch final harkit2015 __
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Blood supply to cardiac conduction system
The cardiac conduction system receives its blood supply from branches of the left anterior descending coronary artery and right coronary artery. A critical portion of the interventricular conduction system is supplied by the first septal branch of the left anterior descending artery. The bundle of His receives blood supply from both the left anterior descending artery and right coronary artery, with approximately 50% of the blood coming from the septal branch of the left anterior descending artery and atrioventricular nodal branch of the right coronary artery.
Components and classification of coronary guide wire dr md toufiqur rahman ca...
Components and classification of coronary guide wire dr md toufiqur rahman ca...PROFESSOR DR. MD. TOUFIQUR RAHMAN
This document provides information about coronary guidewires. It discusses the history of angioplasty and development of over-the-wire balloon systems. It describes the key components and characteristics of guidewires, including the core, tip, coils, covers, and coatings. It explains properties like torque control, trackability, steerability, and flexibility. It also covers classifications of guidewires based on tip flexibility, device support, coating, and clinical scenario. Examples of commonly used guidewires are provided.Chronic total occlusion (CTO)
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
What do we need to indicate CTO PCI?
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
CTO
This document discusses techniques for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention. It describes the distal cap penetration technique using a reverse controlled antegrade and retrograde subintimal tracking (CART) approach. Key aspects of CTO wiring are discussed, including wire features needed for penetration, pushability, steerability, and shaping memory. Retrograde strategies and hardware options are presented, including parallel wiring, the star technique, and snaring. The document shares experience from over 300 CTO cases with a high success rate and low complications.
Frequent Flyers in the ED
This document discusses frequent flyers (FF), defined as patients who make 3-12 emergency department visits per year. FF account for 20-30% of annual ED visits despite constituting only 4% of patients. While FF contribute to overcrowding, overcrowding has many causes and low-complexity FF impact it little. FF often have complex medical and social issues like chronic diseases and substance abuse. They rely on the ED as a primary source of care. Targeted interventions like care management programs and on-site clinics have shown success in reducing FF visits and associated costs. Comprehensive approaches are needed to address the needs of this vulnerable population.
Surgery for aortic root pathologies
The aortic root consists of the aortic annulus, leaflets, sinuses, and sinotubular junction. It extends from the left ventricle outflow tract to the ascending aorta. Conditions requiring aortic root replacement include aneurysm, dissection, and connective tissue disorders. The Bentall procedure involves replacing the root with a composite graft. The Ross procedure uses the patient's pulmonary valve as an autograft. The reimplantation and remodeling techniques aim to spare the native valve. Long-term outcomes of root replacement are generally good with low rates of reoperation and structural valve deterioration.
Optimize guide catheter support
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Microcatheters for antegrade and retrograde approach
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
1800 syntax lm
The document summarizes the 3-year outcomes of the SYNTAX clinical trial for patients with left main coronary artery disease. The SYNTAX trial randomized patients with complex coronary artery disease to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention with paclitaxel-eluting stents (PCI). For the 705 patients in the left main subgroup, the rates of all-cause death at 3 years were similar between CABG (8.4%) and PCI (7.3%). However, the rate of stroke was significantly higher in the CABG group (4.0%) compared to the PCI group (1.2%).
Chronic Total Occlusions: The Road Less Traveled
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Chronic total occlusion pci
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.
Chronic total occlusion
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
Valeri Gelev - Ostial CTO Lesions
Ostial lesions involve areas near the origin of coronary arteries. They represent around 3% of all CTO lesions and are more complex to treat than non-ostial lesions. Aorto-ostial lesions involving the origins of the RCA, LMS, and bypass grafts have higher J-CTO scores and require longer stents than other lesions. Retrograde wiring requires extra care to avoid incorrect vessel selection or subintimal wiring. Case examples demonstrate the technical challenges of ostial CTOs, with meticulous planning and imaging needed due to ambiguity of the proximal cap and vessel course.
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Blood supply to cardiac conduction system
The cardiac conduction system receives its blood supply from branches of the left anterior descending coronary artery and right coronary artery. A critical portion of the interventricular conduction system is supplied by the first septal branch of the left anterior descending artery. The bundle of His receives blood supply from both the left anterior descending artery and right coronary artery, with approximately 50% of the blood coming from the septal branch of the left anterior descending artery and atrioventricular nodal branch of the right coronary artery.
Components and classification of coronary guide wire dr md toufiqur rahman ca...
Components and classification of coronary guide wire dr md toufiqur rahman ca...PROFESSOR DR. MD. TOUFIQUR RAHMAN
This document provides information about coronary guidewires. It discusses the history of angioplasty and development of over-the-wire balloon systems. It describes the key components and characteristics of guidewires, including the core, tip, coils, covers, and coatings. It explains properties like torque control, trackability, steerability, and flexibility. It also covers classifications of guidewires based on tip flexibility, device support, coating, and clinical scenario. Examples of commonly used guidewires are provided.Chronic total occlusion (CTO)
This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.
What do we need to indicate CTO PCI?
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
CTO
This document discusses techniques for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention. It describes the distal cap penetration technique using a reverse controlled antegrade and retrograde subintimal tracking (CART) approach. Key aspects of CTO wiring are discussed, including wire features needed for penetration, pushability, steerability, and shaping memory. Retrograde strategies and hardware options are presented, including parallel wiring, the star technique, and snaring. The document shares experience from over 300 CTO cases with a high success rate and low complications.
Frequent Flyers in the ED
This document discusses frequent flyers (FF), defined as patients who make 3-12 emergency department visits per year. FF account for 20-30% of annual ED visits despite constituting only 4% of patients. While FF contribute to overcrowding, overcrowding has many causes and low-complexity FF impact it little. FF often have complex medical and social issues like chronic diseases and substance abuse. They rely on the ED as a primary source of care. Targeted interventions like care management programs and on-site clinics have shown success in reducing FF visits and associated costs. Comprehensive approaches are needed to address the needs of this vulnerable population.
Surgery for aortic root pathologies
The aortic root consists of the aortic annulus, leaflets, sinuses, and sinotubular junction. It extends from the left ventricle outflow tract to the ascending aorta. Conditions requiring aortic root replacement include aneurysm, dissection, and connective tissue disorders. The Bentall procedure involves replacing the root with a composite graft. The Ross procedure uses the patient's pulmonary valve as an autograft. The reimplantation and remodeling techniques aim to spare the native valve. Long-term outcomes of root replacement are generally good with low rates of reoperation and structural valve deterioration.
Optimize guide catheter support
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Microcatheters for antegrade and retrograde approach
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
1800 syntax lm
The document summarizes the 3-year outcomes of the SYNTAX clinical trial for patients with left main coronary artery disease. The SYNTAX trial randomized patients with complex coronary artery disease to either coronary artery bypass grafting (CABG) or percutaneous coronary intervention with paclitaxel-eluting stents (PCI). For the 705 patients in the left main subgroup, the rates of all-cause death at 3 years were similar between CABG (8.4%) and PCI (7.3%). However, the rate of stroke was significantly higher in the CABG group (4.0%) compared to the PCI group (1.2%).
Chronic Total Occlusions: The Road Less Traveled
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Chronic total occlusion pci
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.
Chronic total occlusion
This document discusses chronic total occlusion (CTO) of coronary arteries. It defines CTO and differentiates it from functional occlusions and pseudo-occlusions. The prevalence of CTO is estimated to be around 15% based on registry data. CTOs present technical challenges for percutaneous coronary intervention (PCI) due to factors like lesion length, calcification, and tortuosity. Proper preparation is important for CTO PCI, including adequate guide support and anticoagulation. Scoring systems can help predict the difficulty of crossing a CTO. Special guidewires and techniques may be needed depending on the lesion characteristics and collateral pathways.
Valeri Gelev - Ostial CTO Lesions
Ostial lesions involve areas near the origin of coronary arteries. They represent around 3% of all CTO lesions and are more complex to treat than non-ostial lesions. Aorto-ostial lesions involving the origins of the RCA, LMS, and bypass grafts have higher J-CTO scores and require longer stents than other lesions. Retrograde wiring requires extra care to avoid incorrect vessel selection or subintimal wiring. Case examples demonstrate the technical challenges of ostial CTOs, with meticulous planning and imaging needed due to ambiguity of the proximal cap and vessel course.
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Microcatheters for antegrade and retrograde approach
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Formy interwencjonizmu państwowego
- 2. Interwencjonizm – stosunki gospodarczo-polityczne, polegające na bezpośrednich interwencjach państwa w rynek.
- 3. 1. Ograniczenie bezrobocia 2. Pobudzenie popytu globalnego 3. Podniesienie tempa wzrostu gospodarczego
- 4. 1) podejmowanie przedsięwzięć inwestycyjnych 2) dotacje do nierentownych przedsiębiorstw lub ich nacjonalizacja 3) protekcjonizm w zakresie handlu zagranicznego 4) polityka monetarna 5) polityka fiskalna
- 5. Instrumenty polityki pieniężnej: 1. stopa procentowa kredytu refinansowego 2. stopa rezerw obowiązkowych 3. stopa rezerw specjalnych
- 6. 1) redystrybucja dochodów 2) stabilizacja gospodarki