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

1. Challenges and Opportunities in CTO
Recanalisation
Role of Mechanical Support in CTO Recanalisation
Jonathan Hill
EuroCTO and GISE CTO Florence 2023

2. DISCLOSURE
Grant support, Speaker fees and Honoraria ABBOTT VASCULAR
Grant support, Speaker fees and Honoraria ABIOMED
Grant support, Speaker fees and Honoraria BOSTON SCIENTIFIC
Equity, Speaker fees and Honoraria SHOCKWAVE MEDICAL

3. Protected PCI Algorithm… Evolving Concept
Courtesy of Jamie McCabe, MD,
University of Washington, Seattle, WA

4. Arrest
LMS Occlusion- PPCI
EF15%
Pulmonary oedema
Ventilated
CTO RCA
LMS/Cx/LAD
RCA CTO
Pulmonary oedema

5. High Risk CTO PCI PATHWAY
LAP Score Left Ventricular Support Algorithm
LV Function
CTO
Anatomy
Patient Factors
TOTAL SCORE
0-2
LMS Score
Collateral from graft Any 1 1
CTO +MVD
Previous HD failure 2 or more 2
2 or more CTOs
EF Score
>35% 0
20-35% 1
<20% 3
NO
LV SUPPORT
COPD Score
Pulmonary Oedema Any 1 1
Kidney Failure
Age>75 2 or more 2
PVD
STANDBY
LV SUPPORT
USE
LV SUPPORT
LAP Score 7
TOTAL SCORE
3-4
TOTAL SCORE
5-7

6. RDR RCA CTO and LMS PCI
Retro Knuckle Reverse CART

7. Left Main Stem PCI and Retrograde CTO with Impella
RCA Result
James Spratt/Jonathan Hill
LMS

8. Multiple CTOs Heart transplant turndown
45 year old male
Paraplegic following RTA
Multivessel Disease
Left Main Stem Disease
Poor LV function EF <30%
3 X CTO LAD, RCA and Cx
Turned down for heart transplant
LAD CTO attempted but
haemodynamically unstable
COMPLEX Long Lesion Multi Vessel and Bifurcations
MORE COMPLEX Left Main Stem
QUITE COMPLEX Rotablation
COMPLEX
LV support
CTO CTO
CTO

9. Impella Insertion
Harrington
Rods in spine
from spinal
injury

10. Multiple CTOs Previous haemodynamic failure
RCA occluded at
marginal.
RV Marginal
crossfills distal LAD
Distal LAD
crossfills distal
RCA via septal
collaterals

11. LAD CTO AWE
successful
RCA CTO
RCA CTO
RWE

12. CTO RCA Open and stented. LAD CTO Pre Stents
Long LAD diffuse disease. Vessel size
uncertain
Ostial LAD/LMS involvement
Imaging for Sizing and Optimisation

13. 45 year old male
Transplant turndown
Mulitvessel Disease
3 x CTO
Previous HD failure
LMS disease
Poor LV function on
LV support
Successful CTO PCI
to LAD and RCA with
LMS stent placement.

14. LV Function
CTO Anatomy
Patient
Factors
LMS occlusion
Retro/Collateral via graft
CTO +MVD
Previous HD failure
2 or more CTOs
<20%
Heart Transplant Turndown
Intubated
Pulmonary Oedema
Kidney Failure
USE
LV
SUPPORT
Role of Mechanical Support in CTO Recanalisation