SlideShare a Scribd company logo
My essential tips & tricks
for success in antegrade approach
Jan-Malte Sinning, MD, FESC
St. Vincent Hospital Cologne
Potential Conflicts of Interest
Receipt of grants / research support:
Boston Scientific, Edwards Lifesciences, and Medtronic.
Proctor:
Medtronic and Boston Scientific.
Scientific Advisory Board:
Abbott, Abiomed, Boston Scientific, Boehringer Ingelheim, and Medtronic.
Receipt of speaker honoraria and/or travel expenses:
Abbott, Abiomed, Astra Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol
Myers Squibb, Edwards Lifesciences, Medtronic, Novartis, Novo Nordisk, Pfizer, Shockwave
Medical, and Zoll.
76 years old patient with dyspnea NYHA III
Rationales for CTO Recanalization
• Relief of angina/ischemia (typically exertional symptoms)
• Improvement of ventricular function
• Reduced incidence of late CABG
• Possible improvement in event-free survival
✅
✅
✅
Four options for crossing CTOs
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
AWE
ADR
RDR
RWE
Hybrid algorithm combining antegrade and retrograde skills
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Global CTO Crossing Algorithm
Wu EB et al., JACC 2021;78:840-853
J-CTO Score predicts lesion complexity and success rate
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
My Essential Tips & Tricks for
Success in Antegrade CTO PCI
Tips & Tricks 1 – Vascular Access
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 1 – Vascular Access
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 1 – Vascular Access
Tips & Tricks 2 – Guiding catheters
LCA RCA
Tips & Tricks 2 – Guiding catheters
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 2 – Guiding catheters & extensions
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 3 – Guidewire selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 4 – Microcatheter selection
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Fielder XT
Gladius MG
Gaia II / III
Hornet 14
My Algorithm
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Stay intra-plaque (= true lumen) !
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 5 – Antegrade Wire Escalation (AWE)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
76 years old patient with dyspnea NYHA III
Bifemoral (5F, 7F), AWE via Caravel 135: Fielder XT, Gaia 2nd
Dual injections are essential
Antegrade crossing with Gaia 2nd
- Wire position in distal LAD ?
- True to true crossing ?
- Diagonal branches ?
- Lesion preparation necessary?
Tips & Tricks 6 – Intravascular Imaging
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
IVUS interpretation: 4 steps to success
Step 1: Evaluation of lesion significance / wire position
Step 1: Evaluation of lesion significance / wire position
Step 2: Characterization of lesion
Step 2: Characterization of lesion
Step 3: Evaluation of vessel diameter & lesion length
Step 3: Evaluation of vessel diameter & lesion length
Step 4: Assessment of implantation quality
Step 4: Assessment of implantation quality
Step 1: Evaluation of lesion significance
Step 1: Evaluation of lesion significance Step 2: Characterization of lesion
Step 2: Characterization of lesion
True lumen
Severe calcification 270°
False lumen
True
False
True lumen
LAD
D1
Circular calcification
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 7 – Antegrade Dissection Reentry (ADR)
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 8 - Lesion Preparation & plaque modification
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
RotaPRO® Rotational Atherectomy System
1.25 mm
1.5mm 1.75mm
2.0mm
Sharma SK et al., Circ Cardiovasc Interv. 2019;12:e007448
Rotational atherectomy with RotaPro 1.50 burr
High pressure PTCA (24atm) with NC-Balloon 3.0/15.0, 3.5/15.0 mm
Step 3: Evaluation of vessel diameter & lesion length
Step 3: Evaluation of vessel diameter & lesion length
3.0mm
4.0mm
51.0mm
Tips & Tricks 9 - Stenting
PCI with Promus 3.5/38.0mm, 3.0/16.0mm plus POT 4.0/15.0mm
Step 4: Assessment of implantation quality
Step 4: Assessment of implantation quality
No dissection
Circular stent expansion
Good strut apposition
Left main OK !
Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
Tips & Tricks 10 – Intraprocedural Management
James Spratt et al. eBook „A guide
to mastering antegrade CTO PCI“
My essential Tips & Tricks for success in antegrade CTO PCI
1. Safe vascular access (fluoroscopy or sonography guidance)
2. Guiding catheter strategy
3. Dedicated CTO wires
4. Microcatheter selection according to strategy
5. AWE (Fielder XT, Gaia II / III, Hornet 14), parallel wiring
6. Liberal use of IVUS
7. Know ADR techniques
8. Lesion preparation (rotational / orbital atherectomy, IVL, etc.)
9. Stenting optimized by intravascular imaging
10. Intraprocedural management (ACT, conscious sedation, echo etc.)
Thank you very much for your attention !
Jan-Malte.Sinning@cellitinnen.de

More Related Content

What's hot

Microcatheters for antegrade and retrograde approach
Microcatheters for antegrade and retrograde approachMicrocatheters for antegrade and retrograde approach
Microcatheters for antegrade and retrograde approach
Euro CTO Club
 
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
Euro CTO Club
 
Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021
Chronic total ocllusion(cto)   dr hafeesh fazulu - pushpagiri - may 14th 2021Chronic total ocllusion(cto)   dr hafeesh fazulu - pushpagiri - may 14th 2021
Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021
Hafeesh Fazulu
 
Parallel wire Technique in CTO PCI
Parallel wire Technique in CTO PCIParallel wire Technique in CTO PCI
Parallel wire Technique in CTO PCI
wasimcardio21
 
PCI guidewires
PCI guidewires PCI guidewires
PCI guidewires
Mohamed Ashraf
 
IVUS
IVUSIVUS
Components and classification of coronary guide wire dr md toufiqur rahman ca...
Components and classification of coronary guide wire dr md toufiqur rahman ca...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
 
Gerald Werner - AntegradeApproach Step by Step
Gerald Werner - AntegradeApproach Step by StepGerald Werner - AntegradeApproach Step by Step
Gerald Werner - AntegradeApproach Step by Step
Euro CTO Club
 
Session 3 - Microcatheters, new developments
Session  3 - Microcatheters, new developmentsSession  3 - Microcatheters, new developments
Session 3 - Microcatheters, new developments
Euro CTO Club
 
Optimize guide catheter support
Optimize guide catheter supportOptimize guide catheter support
Optimize guide catheter support
Euro CTO Club
 
Coronary bifurcations
Coronary bifurcationsCoronary bifurcations
Coronary bifurcations
AhmedElBorae1
 
Coronary guidewires
Coronary guidewiresCoronary guidewires
Coronary guidewires
rajijustin
 
wires,balloons,stents.pptx
wires,balloons,stents.pptxwires,balloons,stents.pptx
wires,balloons,stents.pptx
PaulTopol1
 
Coronary anomalies 11-18-04
Coronary anomalies 11-18-04Coronary anomalies 11-18-04
Coronary anomalies 11-18-04muhammed Yasar
 
Dedicated CTO kit: microcatheters, balloons, adjunctive devices
Dedicated CTO kit: microcatheters, balloons, adjunctive devicesDedicated CTO kit: microcatheters, balloons, adjunctive devices
Dedicated CTO kit: microcatheters, balloons, adjunctive devices
Euro CTO Club
 
Chronic total occlusion
Chronic total occlusionChronic total occlusion
Chronic total occlusion
Dr Virbhan Balai
 
Meerkin D
Meerkin DMeerkin D
Guiding catheter in coronary intervention
Guiding catheter in coronary interventionGuiding catheter in coronary intervention
Guiding catheter in coronary intervention
kefelegn Tadesse
 
Retrograde approach Step by Step
Retrograde approach Step by StepRetrograde approach Step by Step
Retrograde approach Step by Step
Euro CTO Club
 
Saturday 1630 – brilakis balloon uncrossable
Saturday 1630 – brilakis   balloon uncrossableSaturday 1630 – brilakis   balloon uncrossable
Saturday 1630 – brilakis balloon uncrossable
Euro CTO Club
 

What's hot (20)

Microcatheters for antegrade and retrograde approach
Microcatheters for antegrade and retrograde approachMicrocatheters for antegrade and retrograde approach
Microcatheters for antegrade and retrograde approach
 
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
Kambis Mashayekhi: Keynote: My essential tipps & tricks for success in compli...
 
Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021
Chronic total ocllusion(cto)   dr hafeesh fazulu - pushpagiri - may 14th 2021Chronic total ocllusion(cto)   dr hafeesh fazulu - pushpagiri - may 14th 2021
Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021
 
Parallel wire Technique in CTO PCI
Parallel wire Technique in CTO PCIParallel wire Technique in CTO PCI
Parallel wire Technique in CTO PCI
 
PCI guidewires
PCI guidewires PCI guidewires
PCI guidewires
 
IVUS
IVUSIVUS
IVUS
 
Components and classification of coronary guide wire dr md toufiqur rahman ca...
Components and classification of coronary guide wire dr md toufiqur rahman ca...Components and classification of coronary guide wire dr md toufiqur rahman ca...
Components and classification of coronary guide wire dr md toufiqur rahman ca...
 
Gerald Werner - AntegradeApproach Step by Step
Gerald Werner - AntegradeApproach Step by StepGerald Werner - AntegradeApproach Step by Step
Gerald Werner - AntegradeApproach Step by Step
 
Session 3 - Microcatheters, new developments
Session  3 - Microcatheters, new developmentsSession  3 - Microcatheters, new developments
Session 3 - Microcatheters, new developments
 
Optimize guide catheter support
Optimize guide catheter supportOptimize guide catheter support
Optimize guide catheter support
 
Coronary bifurcations
Coronary bifurcationsCoronary bifurcations
Coronary bifurcations
 
Coronary guidewires
Coronary guidewiresCoronary guidewires
Coronary guidewires
 
wires,balloons,stents.pptx
wires,balloons,stents.pptxwires,balloons,stents.pptx
wires,balloons,stents.pptx
 
Coronary anomalies 11-18-04
Coronary anomalies 11-18-04Coronary anomalies 11-18-04
Coronary anomalies 11-18-04
 
Dedicated CTO kit: microcatheters, balloons, adjunctive devices
Dedicated CTO kit: microcatheters, balloons, adjunctive devicesDedicated CTO kit: microcatheters, balloons, adjunctive devices
Dedicated CTO kit: microcatheters, balloons, adjunctive devices
 
Chronic total occlusion
Chronic total occlusionChronic total occlusion
Chronic total occlusion
 
Meerkin D
Meerkin DMeerkin D
Meerkin D
 
Guiding catheter in coronary intervention
Guiding catheter in coronary interventionGuiding catheter in coronary intervention
Guiding catheter in coronary intervention
 
Retrograde approach Step by Step
Retrograde approach Step by StepRetrograde approach Step by Step
Retrograde approach Step by Step
 
Saturday 1630 – brilakis balloon uncrossable
Saturday 1630 – brilakis   balloon uncrossableSaturday 1630 – brilakis   balloon uncrossable
Saturday 1630 – brilakis balloon uncrossable
 

Similar to Jan Malte Sinning: Keynote: My essential tips & tricks for success in antegrade approach

Where is the role for Antegrade dissection reentry?
Where is the role for Antegrade dissection reentry?Where is the role for Antegrade dissection reentry?
Where is the role for Antegrade dissection reentry?
Euro CTO Club
 
Gregor Leibundgut: When the “uncrossable” becomes crossable
Gregor Leibundgut: When the “uncrossable” becomes crossableGregor Leibundgut: When the “uncrossable” becomes crossable
Gregor Leibundgut: When the “uncrossable” becomes crossable
Euro CTO Club
 
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
Euro CTO Club
 
Saito S
Saito SSaito S
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
Euro CTO Club
 
Erik Rafflenbeul: Guidewires – which one in which situation?
Erik Rafflenbeul: Guidewires – which one in which situation?Erik Rafflenbeul: Guidewires – which one in which situation?
Erik Rafflenbeul: Guidewires – which one in which situation?
Euro CTO Club
 
CTO PCI failure – When to try again?
 CTO PCI failure – When to try again? CTO PCI failure – When to try again?
CTO PCI failure – When to try again?
Euro CTO Club
 
Chapter 5 - Making Sense of the 12 Lead
Chapter 5 - Making Sense of the 12 LeadChapter 5 - Making Sense of the 12 Lead
Chapter 5 - Making Sense of the 12 Lead
ryanhall911
 
Evaluation and management of Pacemaker malfunction
Evaluation and management of Pacemaker malfunctionEvaluation and management of Pacemaker malfunction
Evaluation and management of Pacemaker malfunction
PRAVEEN GUPTA
 
When am I prepared enough for my first retrograde approach?
When am I prepared enough for my first retrograde approach?When am I prepared enough for my first retrograde approach?
When am I prepared enough for my first retrograde approach?
Euro CTO Club
 
Defero Test 2
Defero Test 2Defero Test 2
Defero Test 2
marriaga1
 
Defero Test 3
Defero Test 3Defero Test 3
Defero Test 3
marriaga1
 
Defero Test
Defero TestDefero Test
Defero Test
marriaga1
 
Detection and Classification of ECG Arrhythmia using LSTM Autoencoder
Detection and Classification of ECG Arrhythmia using LSTM AutoencoderDetection and Classification of ECG Arrhythmia using LSTM Autoencoder
Detection and Classification of ECG Arrhythmia using LSTM Autoencoder
IRJET Journal
 
Kandzari DE 201305
Kandzari DE 201305Kandzari DE 201305
CTO in India
CTO in IndiaCTO in India
CTO in India
Euro CTO Club
 
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
SriSruthiChilukuri
 

Similar to Jan Malte Sinning: Keynote: My essential tips & tricks for success in antegrade approach (20)

Where is the role for Antegrade dissection reentry?
Where is the role for Antegrade dissection reentry?Where is the role for Antegrade dissection reentry?
Where is the role for Antegrade dissection reentry?
 
CARDIAC_CT_PRESENTATION
CARDIAC_CT_PRESENTATIONCARDIAC_CT_PRESENTATION
CARDIAC_CT_PRESENTATION
 
Gregor Leibundgut: When the “uncrossable” becomes crossable
Gregor Leibundgut: When the “uncrossable” becomes crossableGregor Leibundgut: When the “uncrossable” becomes crossable
Gregor Leibundgut: When the “uncrossable” becomes crossable
 
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
15th Experts Live CTO: Mohamed Ayoub: Aorto-ostial CTO
 
Saito S
Saito SSaito S
Saito S
 
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...
 
Erik Rafflenbeul: Guidewires – which one in which situation?
Erik Rafflenbeul: Guidewires – which one in which situation?Erik Rafflenbeul: Guidewires – which one in which situation?
Erik Rafflenbeul: Guidewires – which one in which situation?
 
CTO PCI failure – When to try again?
 CTO PCI failure – When to try again? CTO PCI failure – When to try again?
CTO PCI failure – When to try again?
 
Bslabmanual
BslabmanualBslabmanual
Bslabmanual
 
Chapter 5 - Making Sense of the 12 Lead
Chapter 5 - Making Sense of the 12 LeadChapter 5 - Making Sense of the 12 Lead
Chapter 5 - Making Sense of the 12 Lead
 
Evaluation and management of Pacemaker malfunction
Evaluation and management of Pacemaker malfunctionEvaluation and management of Pacemaker malfunction
Evaluation and management of Pacemaker malfunction
 
Kaul P - AIMRADIAL 2014 Technical - Guide catheter
Kaul P - AIMRADIAL 2014 Technical - Guide catheterKaul P - AIMRADIAL 2014 Technical - Guide catheter
Kaul P - AIMRADIAL 2014 Technical - Guide catheter
 
When am I prepared enough for my first retrograde approach?
When am I prepared enough for my first retrograde approach?When am I prepared enough for my first retrograde approach?
When am I prepared enough for my first retrograde approach?
 
Defero Test 2
Defero Test 2Defero Test 2
Defero Test 2
 
Defero Test 3
Defero Test 3Defero Test 3
Defero Test 3
 
Defero Test
Defero TestDefero Test
Defero Test
 
Detection and Classification of ECG Arrhythmia using LSTM Autoencoder
Detection and Classification of ECG Arrhythmia using LSTM AutoencoderDetection and Classification of ECG Arrhythmia using LSTM Autoencoder
Detection and Classification of ECG Arrhythmia using LSTM Autoencoder
 
Kandzari DE 201305
Kandzari DE 201305Kandzari DE 201305
Kandzari DE 201305
 
CTO in India
CTO in IndiaCTO in India
CTO in India
 
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
Synthesizing electrocardiogram (ecg) from photoplethysmogram(ppg)
 

More from Euro CTO Club

15th Experts Live CTO - Carlo Di Mario: Conclusions
15th Experts Live CTO - Carlo Di Mario: Conclusions15th Experts Live CTO - Carlo Di Mario: Conclusions
15th Experts Live CTO - Carlo Di Mario: Conclusions
Euro CTO Club
 
Francesco Burzotta: Wrap up Gemelli Cases
Francesco Burzotta: Wrap up Gemelli CasesFrancesco Burzotta: Wrap up Gemelli Cases
Francesco Burzotta: Wrap up Gemelli Cases
Euro CTO Club
 
Shunsuke Matsuno: Progress in dedicated novel CTO material
Shunsuke Matsuno: Progress in dedicated novel CTO materialShunsuke Matsuno: Progress in dedicated novel CTO material
Shunsuke Matsuno: Progress in dedicated novel CTO material
Euro CTO Club
 
Jonathan Hill: Role of mechanica support in CTO recanalization
Jonathan Hill: Role of mechanica support in CTO recanalizationJonathan Hill: Role of mechanica support in CTO recanalization
Jonathan Hill: Role of mechanica support in CTO recanalization
Euro CTO Club
 
Gregor Leibundgut: Role of DEB in CTO-PCI
Gregor Leibundgut: Role of DEB in CTO-PCIGregor Leibundgut: Role of DEB in CTO-PCI
Gregor Leibundgut: Role of DEB in CTO-PCI
Euro CTO Club
 
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experienceLeszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
Euro CTO Club
 
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practice
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practiceSunsuke Matsuno: Intracoronary imaging guidance in CTO practice
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practice
Euro CTO Club
 
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
Euro CTO Club
 
Gregor Leibundgut Update on microcatheter options and selection
Gregor Leibundgut Update on microcatheter options and selectionGregor Leibundgut Update on microcatheter options and selection
Gregor Leibundgut Update on microcatheter options and selection
Euro CTO Club
 
Francesco Burzotta: Tips & tricks on radial CTO-PCI
Francesco Burzotta: Tips & tricks on radial CTO-PCIFrancesco Burzotta: Tips & tricks on radial CTO-PCI
Francesco Burzotta: Tips & tricks on radial CTO-PCI
Euro CTO Club
 
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
Euro CTO Club
 
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
Euro CTO Club
 
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
Euro CTO Club
 
Javier Escaned: 3 Low contrast complex and CTO PCI
Javier Escaned: 3 Low contrast complex and CTO PCIJavier Escaned: 3 Low contrast complex and CTO PCI
Javier Escaned: 3 Low contrast complex and CTO PCI
Euro CTO Club
 
Giuseppe Tarantini: Protect IV and PROTECT-Europe trial
Giuseppe Tarantini: Protect IV and PROTECT-Europe trialGiuseppe Tarantini: Protect IV and PROTECT-Europe trial
Giuseppe Tarantini: Protect IV and PROTECT-Europe trial
Euro CTO Club
 
Paul Knaapen: The PROCTOR randomized trial
Paul Knaapen: The PROCTOR randomized trialPaul Knaapen: The PROCTOR randomized trial
Paul Knaapen: The PROCTOR randomized trial
Euro CTO Club
 
John Davies: Update on the ORBITA - CTO trial
John Davies: Update on the ORBITA - CTO trialJohn Davies: Update on the ORBITA - CTO trial
John Davies: Update on the ORBITA - CTO trial
Euro CTO Club
 
Masahisa Yamane: The Complex CTO Japanese Registry
Masahisa Yamane: The Complex CTO Japanese RegistryMasahisa Yamane: The Complex CTO Japanese Registry
Masahisa Yamane: The Complex CTO Japanese Registry
Euro CTO Club
 
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO RegistryKambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
Euro CTO Club
 
Emmanouil Brilakis: Update on the PROGRESS Registry
Emmanouil Brilakis: Update on the PROGRESS RegistryEmmanouil Brilakis: Update on the PROGRESS Registry
Emmanouil Brilakis: Update on the PROGRESS Registry
Euro CTO Club
 

More from Euro CTO Club (20)

15th Experts Live CTO - Carlo Di Mario: Conclusions
15th Experts Live CTO - Carlo Di Mario: Conclusions15th Experts Live CTO - Carlo Di Mario: Conclusions
15th Experts Live CTO - Carlo Di Mario: Conclusions
 
Francesco Burzotta: Wrap up Gemelli Cases
Francesco Burzotta: Wrap up Gemelli CasesFrancesco Burzotta: Wrap up Gemelli Cases
Francesco Burzotta: Wrap up Gemelli Cases
 
Shunsuke Matsuno: Progress in dedicated novel CTO material
Shunsuke Matsuno: Progress in dedicated novel CTO materialShunsuke Matsuno: Progress in dedicated novel CTO material
Shunsuke Matsuno: Progress in dedicated novel CTO material
 
Jonathan Hill: Role of mechanica support in CTO recanalization
Jonathan Hill: Role of mechanica support in CTO recanalizationJonathan Hill: Role of mechanica support in CTO recanalization
Jonathan Hill: Role of mechanica support in CTO recanalization
 
Gregor Leibundgut: Role of DEB in CTO-PCI
Gregor Leibundgut: Role of DEB in CTO-PCIGregor Leibundgut: Role of DEB in CTO-PCI
Gregor Leibundgut: Role of DEB in CTO-PCI
 
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experienceLeszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
Leszek Bryniarski: Mechanical protection in CTO PCI: the Krakow experience
 
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practice
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practiceSunsuke Matsuno: Intracoronary imaging guidance in CTO practice
Sunsuke Matsuno: Intracoronary imaging guidance in CTO practice
 
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
15th Experts Live CTO - Claudia Cosgrove: Calcium and CTO
 
Gregor Leibundgut Update on microcatheter options and selection
Gregor Leibundgut Update on microcatheter options and selectionGregor Leibundgut Update on microcatheter options and selection
Gregor Leibundgut Update on microcatheter options and selection
 
Francesco Burzotta: Tips & tricks on radial CTO-PCI
Francesco Burzotta: Tips & tricks on radial CTO-PCIFrancesco Burzotta: Tips & tricks on radial CTO-PCI
Francesco Burzotta: Tips & tricks on radial CTO-PCI
 
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
 
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...
 
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...
 
Javier Escaned: 3 Low contrast complex and CTO PCI
Javier Escaned: 3 Low contrast complex and CTO PCIJavier Escaned: 3 Low contrast complex and CTO PCI
Javier Escaned: 3 Low contrast complex and CTO PCI
 
Giuseppe Tarantini: Protect IV and PROTECT-Europe trial
Giuseppe Tarantini: Protect IV and PROTECT-Europe trialGiuseppe Tarantini: Protect IV and PROTECT-Europe trial
Giuseppe Tarantini: Protect IV and PROTECT-Europe trial
 
Paul Knaapen: The PROCTOR randomized trial
Paul Knaapen: The PROCTOR randomized trialPaul Knaapen: The PROCTOR randomized trial
Paul Knaapen: The PROCTOR randomized trial
 
John Davies: Update on the ORBITA - CTO trial
John Davies: Update on the ORBITA - CTO trialJohn Davies: Update on the ORBITA - CTO trial
John Davies: Update on the ORBITA - CTO trial
 
Masahisa Yamane: The Complex CTO Japanese Registry
Masahisa Yamane: The Complex CTO Japanese RegistryMasahisa Yamane: The Complex CTO Japanese Registry
Masahisa Yamane: The Complex CTO Japanese Registry
 
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO RegistryKambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
Kambis Mashayekhi: Trends and spin-offs from the EuroCTO Registry
 
Emmanouil Brilakis: Update on the PROGRESS Registry
Emmanouil Brilakis: Update on the PROGRESS RegistryEmmanouil Brilakis: Update on the PROGRESS Registry
Emmanouil Brilakis: Update on the PROGRESS Registry
 

Recently uploaded

Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
MedicoseAcademics
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
DrSathishMS1
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
Little Cross Family Clinic
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Dr Jeenal Mistry
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
Dr. Vinay Pareek
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
greendigital
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Dr. Rabia Inam Gandapore
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
touseefaziz1
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
Levi Shapiro
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Oleg Kshivets
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
Sapna Thakur
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
د.محمود نجيب
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
i3 Health
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
bkling
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
addon Scans
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
Dr. Rabia Inam Gandapore
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
FFragrant
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
LanceCatedral
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
vimalpl1234
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
SumeraAhmad5
 

Recently uploaded (20)

Non-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdfNon-respiratory Functions of the Lungs.pdf
Non-respiratory Functions of the Lungs.pdf
 
24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all24 Upakrama.pptx class ppt useful in all
24 Upakrama.pptx class ppt useful in all
 
Are There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdfAre There Any Natural Remedies To Treat Syphilis.pdf
Are There Any Natural Remedies To Treat Syphilis.pdf
 
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdfAlcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
Alcohol_Dr. Jeenal Mistry MD Pharmacology.pdf
 
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTSARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
ARTHROLOGY PPT NCISM SYLLABUS AYURVEDA STUDENTS
 
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness JourneyTom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
 
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptxTriangles of Neck and Clinical Correlation by Dr. RIG.pptx
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
 
POST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its managementPOST OPERATIVE OLIGURIA and its management
POST OPERATIVE OLIGURIA and its management
 
Prix Galien International 2024 Forum Program
Prix Galien International 2024 Forum ProgramPrix Galien International 2024 Forum Program
Prix Galien International 2024 Forum Program
 
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
 
NVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control programNVBDCP.pptx Nation vector borne disease control program
NVBDCP.pptx Nation vector borne disease control program
 
KDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologistsKDIGO 2024 guidelines for diabetologists
KDIGO 2024 guidelines for diabetologists
 
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
 
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
 
Flu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore KarnatakaFlu Vaccine Alert in Bangalore Karnataka
Flu Vaccine Alert in Bangalore Karnataka
 
Superficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptxSuperficial & Deep Fascia of the NECK.pptx
Superficial & Deep Fascia of the NECK.pptx
 
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptxHow STIs Influence the Development of Pelvic Inflammatory Disease.pptx
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
 
How to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for DoctorsHow to Give Better Lectures: Some Tips for Doctors
How to Give Better Lectures: Some Tips for Doctors
 
Knee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdfKnee anatomy and clinical tests 2024.pdf
Knee anatomy and clinical tests 2024.pdf
 
heat stroke and heat exhaustion in children
heat stroke and heat exhaustion in childrenheat stroke and heat exhaustion in children
heat stroke and heat exhaustion in children
 

Jan Malte Sinning: Keynote: My essential tips & tricks for success in antegrade approach

  • 1. My essential tips & tricks for success in antegrade approach Jan-Malte Sinning, MD, FESC St. Vincent Hospital Cologne
  • 2. Potential Conflicts of Interest Receipt of grants / research support: Boston Scientific, Edwards Lifesciences, and Medtronic. Proctor: Medtronic and Boston Scientific. Scientific Advisory Board: Abbott, Abiomed, Boston Scientific, Boehringer Ingelheim, and Medtronic. Receipt of speaker honoraria and/or travel expenses: Abbott, Abiomed, Astra Zeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Edwards Lifesciences, Medtronic, Novartis, Novo Nordisk, Pfizer, Shockwave Medical, and Zoll.
  • 3. 76 years old patient with dyspnea NYHA III
  • 4. Rationales for CTO Recanalization • Relief of angina/ischemia (typically exertional symptoms) • Improvement of ventricular function • Reduced incidence of late CABG • Possible improvement in event-free survival ✅ ✅ ✅
  • 5. Four options for crossing CTOs James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“ AWE ADR RDR RWE
  • 6. Hybrid algorithm combining antegrade and retrograde skills James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 7. Global CTO Crossing Algorithm Wu EB et al., JACC 2021;78:840-853
  • 8. J-CTO Score predicts lesion complexity and success rate James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 9. My Essential Tips & Tricks for Success in Antegrade CTO PCI
  • 10. Tips & Tricks 1 – Vascular Access James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 11. Tips & Tricks 1 – Vascular Access James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 12. Tips & Tricks 1 – Vascular Access
  • 13. Tips & Tricks 2 – Guiding catheters LCA RCA
  • 14. Tips & Tricks 2 – Guiding catheters James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 15. Tips & Tricks 2 – Guiding catheters & extensions
  • 16. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 17. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 18. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 19. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 20. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 21. Tips & Tricks 3 – Guidewire selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 22. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 23. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 24. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 25. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 26. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 27. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 28. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 29. Tips & Tricks 4 – Microcatheter selection James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 30. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 31. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“ Fielder XT Gladius MG Gaia II / III Hornet 14 My Algorithm
  • 32. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 33. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“ Stay intra-plaque (= true lumen) !
  • 34. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 35. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 36. Tips & Tricks 5 – Antegrade Wire Escalation (AWE) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 37. 76 years old patient with dyspnea NYHA III
  • 38. Bifemoral (5F, 7F), AWE via Caravel 135: Fielder XT, Gaia 2nd
  • 39. Dual injections are essential
  • 40. Antegrade crossing with Gaia 2nd - Wire position in distal LAD ? - True to true crossing ? - Diagonal branches ? - Lesion preparation necessary?
  • 41. Tips & Tricks 6 – Intravascular Imaging James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 42. IVUS interpretation: 4 steps to success Step 1: Evaluation of lesion significance / wire position Step 1: Evaluation of lesion significance / wire position Step 2: Characterization of lesion Step 2: Characterization of lesion Step 3: Evaluation of vessel diameter & lesion length Step 3: Evaluation of vessel diameter & lesion length Step 4: Assessment of implantation quality Step 4: Assessment of implantation quality
  • 43. Step 1: Evaluation of lesion significance Step 1: Evaluation of lesion significance Step 2: Characterization of lesion Step 2: Characterization of lesion True lumen Severe calcification 270° False lumen True False True lumen LAD D1 Circular calcification
  • 44. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 45. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 46. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 47. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 48. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 49. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 50. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 51. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 52. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 53. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 54. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 55. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 56. Tips & Tricks 7 – Antegrade Dissection Reentry (ADR) James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 57. Tips & Tricks 8 - Lesion Preparation & plaque modification James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 58. RotaPRO® Rotational Atherectomy System 1.25 mm 1.5mm 1.75mm 2.0mm Sharma SK et al., Circ Cardiovasc Interv. 2019;12:e007448
  • 59. Rotational atherectomy with RotaPro 1.50 burr
  • 60. High pressure PTCA (24atm) with NC-Balloon 3.0/15.0, 3.5/15.0 mm
  • 61. Step 3: Evaluation of vessel diameter & lesion length Step 3: Evaluation of vessel diameter & lesion length 3.0mm 4.0mm 51.0mm Tips & Tricks 9 - Stenting
  • 62. PCI with Promus 3.5/38.0mm, 3.0/16.0mm plus POT 4.0/15.0mm
  • 63. Step 4: Assessment of implantation quality Step 4: Assessment of implantation quality No dissection Circular stent expansion Good strut apposition Left main OK !
  • 64. Tips & Tricks 10 – Intraprocedural Management James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 65. Tips & Tricks 10 – Intraprocedural Management James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 66. Tips & Tricks 10 – Intraprocedural Management James Spratt et al. eBook „A guide to mastering antegrade CTO PCI“
  • 67. My essential Tips & Tricks for success in antegrade CTO PCI 1. Safe vascular access (fluoroscopy or sonography guidance) 2. Guiding catheter strategy 3. Dedicated CTO wires 4. Microcatheter selection according to strategy 5. AWE (Fielder XT, Gaia II / III, Hornet 14), parallel wiring 6. Liberal use of IVUS 7. Know ADR techniques 8. Lesion preparation (rotational / orbital atherectomy, IVL, etc.) 9. Stenting optimized by intravascular imaging 10. Intraprocedural management (ACT, conscious sedation, echo etc.)
  • 68. Thank you very much for your attention ! Jan-Malte.Sinning@cellitinnen.de