Complications of fenestrated endovascular aneurysm repair- a case study of Na...Mohammad Moynul Islam
This document summarizes a case study of complications from a fenestrated endovascular aortic aneurysm repair (EVAR) procedure in Bangladesh. The procedure involved deployment of a fenestrated endograft with covered stents in the renal arteries. Complications included migration of the left renal covered stent, failure to reposition it, and accidental deployment of the contralateral iliac extension through the right iliac limb, requiring a femoro-femoral bypass. Follow-up showed the endograft and bypass graft in place with no endoleak and the aneurysm sac thrombosed. The experience highlights the need for multidisciplinary approaches with newer endovascular technologies.
This document discusses various procedures for addressing aortic valve disease. It describes the aortic annulus and sinotubular junction. When the aortic annulus is too small, options include enlarging the annulus through procedures like the Ross-Konno operation or replacing the valve with techniques such as the Bentall procedure. The document outlines factors considered in determining whether to enlarge the aortic root or replace the valve. These include patient age, comorbidities, anatomy and surgeon experience. Specific procedures are described for enlarging the annulus in children versus adults.
Orientated foam sclerotherapy (OFS) is a new method for treating great saphenous vein (GSV) varicose veins that is safe, effective, and inexpensive. It involves inserting a catheter into the GSV under ultrasound guidance, then injecting and orienting sclerosing foam to fully fill the GSV and tributary veins. This is done under fluoroscopy to monitor foam distribution. OFS provides complete GSV occlusion in most cases with minimal complications. It can treat complex GSV anatomy more effectively than other options like surgery or thermal ablation. OFS allows immediate ambulation, has a high patient satisfaction rate, and may become the ideal treatment for GSV reflux.
Patologia de las arterias pulmonares en cardiopatias congenitas ,por Jose Lui...Fundacion EPIC
Presentación de "Patologia de las arterias pulmonares en cardiopatias congenitas" por Jose Luis Zunzunegui del Hospital Gregorio Marañon, en el I Curso IVP, Intervencionismo Vascular Pulmonar, organizado por EpicLearning (Fundación EPIC) el 23 de marzo de 2021.
This document contains brief summaries of several patients' medical histories and conditions related to thoracic or abdominal aortic aneurysms. It describes patients ranging from ages 38 to 77 with histories of Marfan's syndrome, aortic dissections, previous open or endovascular surgeries, and expanding aneurysms. The patients underwent treatments including custom stent grafts, total endovascular aneurysm repair, robotic cannulation, and hybrid graft procedures.
"How I Do It" Thoracoabdominal Aneurysm Repairuams
This document outlines the surgical plan and procedure for replacing the descending thoracic aorta with a graft. Key steps include: preoperative localization of an important artery; preparing the patient with blood products, lines, and antibiotics; making an incision and removing a rib for exposure; dividing surrounding tissues to access the aorta; clamping and replacing the aorta with a graft from the subclavian artery down; reattaching arteries along the new graft; and closing the chest and monitoring the patient in recovery.
Complications of fenestrated endovascular aneurysm repair- a case study of Na...Mohammad Moynul Islam
This document summarizes a case study of complications from a fenestrated endovascular aortic aneurysm repair (EVAR) procedure in Bangladesh. The procedure involved deployment of a fenestrated endograft with covered stents in the renal arteries. Complications included migration of the left renal covered stent, failure to reposition it, and accidental deployment of the contralateral iliac extension through the right iliac limb, requiring a femoro-femoral bypass. Follow-up showed the endograft and bypass graft in place with no endoleak and the aneurysm sac thrombosed. The experience highlights the need for multidisciplinary approaches with newer endovascular technologies.
This document discusses various procedures for addressing aortic valve disease. It describes the aortic annulus and sinotubular junction. When the aortic annulus is too small, options include enlarging the annulus through procedures like the Ross-Konno operation or replacing the valve with techniques such as the Bentall procedure. The document outlines factors considered in determining whether to enlarge the aortic root or replace the valve. These include patient age, comorbidities, anatomy and surgeon experience. Specific procedures are described for enlarging the annulus in children versus adults.
Orientated foam sclerotherapy (OFS) is a new method for treating great saphenous vein (GSV) varicose veins that is safe, effective, and inexpensive. It involves inserting a catheter into the GSV under ultrasound guidance, then injecting and orienting sclerosing foam to fully fill the GSV and tributary veins. This is done under fluoroscopy to monitor foam distribution. OFS provides complete GSV occlusion in most cases with minimal complications. It can treat complex GSV anatomy more effectively than other options like surgery or thermal ablation. OFS allows immediate ambulation, has a high patient satisfaction rate, and may become the ideal treatment for GSV reflux.
Patologia de las arterias pulmonares en cardiopatias congenitas ,por Jose Lui...Fundacion EPIC
Presentación de "Patologia de las arterias pulmonares en cardiopatias congenitas" por Jose Luis Zunzunegui del Hospital Gregorio Marañon, en el I Curso IVP, Intervencionismo Vascular Pulmonar, organizado por EpicLearning (Fundación EPIC) el 23 de marzo de 2021.
This document contains brief summaries of several patients' medical histories and conditions related to thoracic or abdominal aortic aneurysms. It describes patients ranging from ages 38 to 77 with histories of Marfan's syndrome, aortic dissections, previous open or endovascular surgeries, and expanding aneurysms. The patients underwent treatments including custom stent grafts, total endovascular aneurysm repair, robotic cannulation, and hybrid graft procedures.
"How I Do It" Thoracoabdominal Aneurysm Repairuams
This document outlines the surgical plan and procedure for replacing the descending thoracic aorta with a graft. Key steps include: preoperative localization of an important artery; preparing the patient with blood products, lines, and antibiotics; making an incision and removing a rib for exposure; dividing surrounding tissues to access the aorta; clamping and replacing the aorta with a graft from the subclavian artery down; reattaching arteries along the new graft; and closing the chest and monitoring the patient in recovery.
A 74-year-old male with stable angina and a history of inferior wall infarction and prior unsuccessful PCI of the RCA and LAD underwent recanalization of a chronic total occlusion of the RCA. After over 2 hours of unsuccessful retrograde guidewire passage through septal collaterals, an antegrade approach was attempted. Within 30 minutes, the occlusion was crossed antegrade and 4 Absorb bioresorbable vascular scaffolds were implanted with successful recanalization. Key learning points included that not all visible channels are crossable retrograde, switching to antegrade after 30 minutes of retrograde failure, and antegrade wire-based strategies having high success after retrograde failure.
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.
In 3 sentences:
In-stent chronic total occlusions have a prevalence of 5-25% and differ from de novo CTOs in having a more tapered proximal cap and lower success rates of around 63-70%. A hybrid approach including antegrade wire escalation and retrograde recanalization with devices like the CrossBoss catheter has achieved success rates of 83-90% for in-stent CTOs. The case study presented a successful retrograde recanalization of an in-stent CTO followed by implantation of bioresorbable vascular scaffolds with no recurrence at 8 months follow up.
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The WorstEuro CTO Club
This document describes a case of a 59-year-old male patient who presented with exertional angina and dyspnea. Coronary angiography revealed a mid-LAD CTO. Attempts at antegrade recanalization failed. Retrograde recanalization through septal collateral channels resulted in a septal perforation. Coils were implanted but the patient developed cardiac tamponade requiring pericardiocentesis. The perforation persisted and additional coils were implanted, but tamponade recurred requiring emergency cardiac surgery. The perforation was successfully treated with coils and surgery, and the patient was discharged after one week and had an uneventful recovery.
08:15 Lombardi - Learning Antegrade Dissection and Re-entryEuro CTO Club
1. The document discusses techniques for learning antegrade dissection and re-entry (ADR) for chronic total occlusion percutaneous coronary intervention (CTO PCI), including using new devices like the Stingray balloon.
2. It presents an algorithm for provisional and hybrid approaches to CTO PCI incorporating techniques like antegrade and retrograde wiring, dissection, and re-entry.
3. The key to success is acquiring a variety of hybrid skills through teachable and reproducible methods in order to have multiple strategies for challenging cases.
Saturday 1415 – Saghatelyan - Patient with porcelain aortaEuro CTO Club
A 46-year-old man with risk factors of hypertension, hyperlipidemia, and history of chest radiation therapy was referred for PCI of an occluded right coronary artery (RCA). Coronary angiography revealed a heavily calcified proximal RCA occlusion near the origin along with a calcified aorta. The cardiologist attempted a retrograde approach using septal collaterals but had difficulty advancing the guidewire. An anchoring balloon in a side branch provided support to advance the wire through the collaterals. Reverse controlled antegrade and retrograde subintimal tracking (CART) was used to recanalize the occlusion. Stents were placed with difficulty due to heavy calcification. The procedure was successful but
This document discusses treatment of coronary perforations during percutaneous coronary intervention (PCI) procedures. It provides information on the incidence, classification, mechanisms, predictive factors, materials and techniques used to treat perforations. The Bellvitge University Hospital experience with over 350 chronic total occlusion PCI procedures is presented, showing a reduction in perforation rates from 14% to 3.7% as operators gained experience. Several clinical cases are presented demonstrating management of perforations during antegrade and retrograde CTO procedures using techniques such as prolonged balloon inflation, covered stents, coils, thrombin, glues and embolization particles.
14:25 Mashayekhi - Ipsilateral approachEuro CTO Club
This document discusses the ipsilateral retrograde approach for chronic total occlusions of the right coronary artery (RCA). It notes that while contralateral approaches are more common, ipsilateral approaches using septal or epimyocardial collaterals are also feasible routes. The document presents data on four cases of successful ipsilateral RCA recanalization and compares outcomes of ipsilateral versus contralateral approaches. It concludes that the ipsilateral technique can be an alternative for failed attempts and may be safer than contralateral in some clinical settings, but it should be limited to experienced retrograde operators.
The document discusses techniques for using the Crusade guidewire to facilitate complex percutaneous coronary intervention cases. It describes several cases where the Crusade guidewire enabled wiring of complex side branches or bifurcation lesions using techniques like parallel wiring, reverse wiring, and retrograde approaches. It also notes advantages like the ability to infuse contrast or drugs through the over-the-wire lumen and avoiding wire entanglement or delivery outside the stent.
Markus Meyer- Augusta Geßner - Parallel wiretechniqueisnot deadEuro CTO Club
The document discusses the parallel wire technique for chronic total occlusion (CTO) procedures. It was first described in 1995 in Frankfurt, Germany. The technique uses double lumen catheters to support introducing two guidewires in parallel through the occlusion. While controlled dissection reentry can fail, the parallel wire technique has a success rate of 30% in such cases and 17% of the author's own 509 CTO procedures from 2011-2015 used this technique successfully. The conclusion is that despite claims the parallel wire technique is dead, it continues to be an important technique for CTO recanalization.
This case involves treating a long CTO of the right coronary artery (RCA) using an antegrade approach in a 71-year-old man with various cardiovascular risk factors and symptoms. The doctor evaluates options for guiding catheter size and wire strategies like single wire, parallel wires, or IVUS-guided re-entry. An initial angiogram is performed. The doctor discusses when a retrograde strategy may be preferable and outlines treatment options for stenting the complex lesion involving the bifurcation.
Nicolas Boudou - RetrogradeCTO PCI in leftdominant coronaryarteryEuro CTO Club
The document discusses retrograde chronic total occlusion percutaneous coronary intervention in a left dominant coronary artery. It describes using a retrograde approach through a septal collateral into the left circumflex artery and placing a guide catheter extension in the left circumflex to protect the left main while performing a pure retrograde wire crossing and wiring in the guide catheter extension. This technique, known as the "ping pong technique", involves using two guide catheters in the same left coronary artery. The procedure was successfully performed in a patient with a chronic total occlusion of the ostial left anterior descending artery who previously failed intervention at another institution.
Saturday 1030 – lombardi dissection re-entryEuro CTO Club
Bill Lombardi MD discloses financial relationships with multiple companies, including serving as a consultant for Abbott Vascular and Boston Scientific.
The document then summarizes several studies on techniques for chronic total occlusion percutaneous coronary intervention (CTO PCI). It presents data on lesion complexity scores from various CTO PCI registries and compares the hybrid algorithm approach to traditional antegrade and retrograde wiring techniques. The hybrid algorithm was shown to achieve high technical success rates even in very complex lesions.
Friday 08:13 – Joner - Drug-eluting stent thrombosis in the treatment of CTOsEuro CTO Club
1) The document discusses data from the CIBELES trial which compared drug-eluting stents (DES) for the treatment of chronic total occlusions (CTOs).
2) The trial found a low incidence of clinically defined stent thrombosis (ST) of 1.97% after CTO recanalization with DES, similar to rates seen in other conditions.
3) However, systematic angiographic follow-up revealed unrecognized reocclusions in some patients, suggesting the true ST incidence may be greater than clinically apparent.
Friday 08:01 - Gershlick- Basic CTO TerminologyEuro CTO Club
This document contains a list of medical terminology and techniques that may be discussed at an upcoming conference over two days. Terms relate to chronic total occlusion interventions and include names of devices, catheters, guidewires, imaging modalities, procedural techniques, definitions, and complications. The list covers topics such as antegrade and retrograde approaches, dissection re-entry techniques, septal surfing, contrast surfing, CART and reverse-CART techniques, the use of IVUS and CT imaging, and device options like the Tornus catheter.
This document discusses coronary perforation, which occurs when there is extravasation of contrast medium or blood from the coronary artery during or following a percutaneous coronary intervention. Coronary perforations are classified based on location and severity. Risk factors include older age, previous CABG, device-lumen mismatch, oversized balloons, calcification, and chronic total occlusions. Treatment depends on the type and severity of perforation, ranging from conservative measures like balloon inflation, to covered stents or surgery for more severe perforations involving cardiac tamponade. Covered stents help seal the perforation but have limitations including reduced flexibility.
A female newborn with cyanosis and heart murmur was found to have a large ventricular septal defect, severe right ventricular outflow tract obstruction, and pulmonary hypoplasia. She was started on prostaglandin infusion and oxygen to stabilize her saturation. The document discusses various options for palliation in her condition including surgical shunts, PDA stenting, RVOT balloon dilation, and RVOT stenting. RVOT stenting is described as a feasible and generally safe palliative procedure that can augment pulmonary blood flow in critically ill patients who are unfit for surgical palliation. Primary repair is the treatment of choice when feasible, but non-surgical interventions are emerging as effective alternatives to surgical shunts
A 74-year-old male with stable angina and a history of inferior wall infarction and prior unsuccessful PCI of the RCA and LAD underwent recanalization of a chronic total occlusion of the RCA. After over 2 hours of unsuccessful retrograde guidewire passage through septal collaterals, an antegrade approach was attempted. Within 30 minutes, the occlusion was crossed antegrade and 4 Absorb bioresorbable vascular scaffolds were implanted with successful recanalization. Key learning points included that not all visible channels are crossable retrograde, switching to antegrade after 30 minutes of retrograde failure, and antegrade wire-based strategies having high success after retrograde failure.
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.
In 3 sentences:
In-stent chronic total occlusions have a prevalence of 5-25% and differ from de novo CTOs in having a more tapered proximal cap and lower success rates of around 63-70%. A hybrid approach including antegrade wire escalation and retrograde recanalization with devices like the CrossBoss catheter has achieved success rates of 83-90% for in-stent CTOs. The case study presented a successful retrograde recanalization of an in-stent CTO followed by implantation of bioresorbable vascular scaffolds with no recurrence at 8 months follow up.
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The WorstEuro CTO Club
This document describes a case of a 59-year-old male patient who presented with exertional angina and dyspnea. Coronary angiography revealed a mid-LAD CTO. Attempts at antegrade recanalization failed. Retrograde recanalization through septal collateral channels resulted in a septal perforation. Coils were implanted but the patient developed cardiac tamponade requiring pericardiocentesis. The perforation persisted and additional coils were implanted, but tamponade recurred requiring emergency cardiac surgery. The perforation was successfully treated with coils and surgery, and the patient was discharged after one week and had an uneventful recovery.
08:15 Lombardi - Learning Antegrade Dissection and Re-entryEuro CTO Club
1. The document discusses techniques for learning antegrade dissection and re-entry (ADR) for chronic total occlusion percutaneous coronary intervention (CTO PCI), including using new devices like the Stingray balloon.
2. It presents an algorithm for provisional and hybrid approaches to CTO PCI incorporating techniques like antegrade and retrograde wiring, dissection, and re-entry.
3. The key to success is acquiring a variety of hybrid skills through teachable and reproducible methods in order to have multiple strategies for challenging cases.
Saturday 1415 – Saghatelyan - Patient with porcelain aortaEuro CTO Club
A 46-year-old man with risk factors of hypertension, hyperlipidemia, and history of chest radiation therapy was referred for PCI of an occluded right coronary artery (RCA). Coronary angiography revealed a heavily calcified proximal RCA occlusion near the origin along with a calcified aorta. The cardiologist attempted a retrograde approach using septal collaterals but had difficulty advancing the guidewire. An anchoring balloon in a side branch provided support to advance the wire through the collaterals. Reverse controlled antegrade and retrograde subintimal tracking (CART) was used to recanalize the occlusion. Stents were placed with difficulty due to heavy calcification. The procedure was successful but
This document discusses treatment of coronary perforations during percutaneous coronary intervention (PCI) procedures. It provides information on the incidence, classification, mechanisms, predictive factors, materials and techniques used to treat perforations. The Bellvitge University Hospital experience with over 350 chronic total occlusion PCI procedures is presented, showing a reduction in perforation rates from 14% to 3.7% as operators gained experience. Several clinical cases are presented demonstrating management of perforations during antegrade and retrograde CTO procedures using techniques such as prolonged balloon inflation, covered stents, coils, thrombin, glues and embolization particles.
14:25 Mashayekhi - Ipsilateral approachEuro CTO Club
This document discusses the ipsilateral retrograde approach for chronic total occlusions of the right coronary artery (RCA). It notes that while contralateral approaches are more common, ipsilateral approaches using septal or epimyocardial collaterals are also feasible routes. The document presents data on four cases of successful ipsilateral RCA recanalization and compares outcomes of ipsilateral versus contralateral approaches. It concludes that the ipsilateral technique can be an alternative for failed attempts and may be safer than contralateral in some clinical settings, but it should be limited to experienced retrograde operators.
The document discusses techniques for using the Crusade guidewire to facilitate complex percutaneous coronary intervention cases. It describes several cases where the Crusade guidewire enabled wiring of complex side branches or bifurcation lesions using techniques like parallel wiring, reverse wiring, and retrograde approaches. It also notes advantages like the ability to infuse contrast or drugs through the over-the-wire lumen and avoiding wire entanglement or delivery outside the stent.
Markus Meyer- Augusta Geßner - Parallel wiretechniqueisnot deadEuro CTO Club
The document discusses the parallel wire technique for chronic total occlusion (CTO) procedures. It was first described in 1995 in Frankfurt, Germany. The technique uses double lumen catheters to support introducing two guidewires in parallel through the occlusion. While controlled dissection reentry can fail, the parallel wire technique has a success rate of 30% in such cases and 17% of the author's own 509 CTO procedures from 2011-2015 used this technique successfully. The conclusion is that despite claims the parallel wire technique is dead, it continues to be an important technique for CTO recanalization.
This case involves treating a long CTO of the right coronary artery (RCA) using an antegrade approach in a 71-year-old man with various cardiovascular risk factors and symptoms. The doctor evaluates options for guiding catheter size and wire strategies like single wire, parallel wires, or IVUS-guided re-entry. An initial angiogram is performed. The doctor discusses when a retrograde strategy may be preferable and outlines treatment options for stenting the complex lesion involving the bifurcation.
Nicolas Boudou - RetrogradeCTO PCI in leftdominant coronaryarteryEuro CTO Club
The document discusses retrograde chronic total occlusion percutaneous coronary intervention in a left dominant coronary artery. It describes using a retrograde approach through a septal collateral into the left circumflex artery and placing a guide catheter extension in the left circumflex to protect the left main while performing a pure retrograde wire crossing and wiring in the guide catheter extension. This technique, known as the "ping pong technique", involves using two guide catheters in the same left coronary artery. The procedure was successfully performed in a patient with a chronic total occlusion of the ostial left anterior descending artery who previously failed intervention at another institution.
Saturday 1030 – lombardi dissection re-entryEuro CTO Club
Bill Lombardi MD discloses financial relationships with multiple companies, including serving as a consultant for Abbott Vascular and Boston Scientific.
The document then summarizes several studies on techniques for chronic total occlusion percutaneous coronary intervention (CTO PCI). It presents data on lesion complexity scores from various CTO PCI registries and compares the hybrid algorithm approach to traditional antegrade and retrograde wiring techniques. The hybrid algorithm was shown to achieve high technical success rates even in very complex lesions.
Friday 08:13 – Joner - Drug-eluting stent thrombosis in the treatment of CTOsEuro CTO Club
1) The document discusses data from the CIBELES trial which compared drug-eluting stents (DES) for the treatment of chronic total occlusions (CTOs).
2) The trial found a low incidence of clinically defined stent thrombosis (ST) of 1.97% after CTO recanalization with DES, similar to rates seen in other conditions.
3) However, systematic angiographic follow-up revealed unrecognized reocclusions in some patients, suggesting the true ST incidence may be greater than clinically apparent.
Friday 08:01 - Gershlick- Basic CTO TerminologyEuro CTO Club
This document contains a list of medical terminology and techniques that may be discussed at an upcoming conference over two days. Terms relate to chronic total occlusion interventions and include names of devices, catheters, guidewires, imaging modalities, procedural techniques, definitions, and complications. The list covers topics such as antegrade and retrograde approaches, dissection re-entry techniques, septal surfing, contrast surfing, CART and reverse-CART techniques, the use of IVUS and CT imaging, and device options like the Tornus catheter.
This document discusses coronary perforation, which occurs when there is extravasation of contrast medium or blood from the coronary artery during or following a percutaneous coronary intervention. Coronary perforations are classified based on location and severity. Risk factors include older age, previous CABG, device-lumen mismatch, oversized balloons, calcification, and chronic total occlusions. Treatment depends on the type and severity of perforation, ranging from conservative measures like balloon inflation, to covered stents or surgery for more severe perforations involving cardiac tamponade. Covered stents help seal the perforation but have limitations including reduced flexibility.
A female newborn with cyanosis and heart murmur was found to have a large ventricular septal defect, severe right ventricular outflow tract obstruction, and pulmonary hypoplasia. She was started on prostaglandin infusion and oxygen to stabilize her saturation. The document discusses various options for palliation in her condition including surgical shunts, PDA stenting, RVOT balloon dilation, and RVOT stenting. RVOT stenting is described as a feasible and generally safe palliative procedure that can augment pulmonary blood flow in critically ill patients who are unfit for surgical palliation. Primary repair is the treatment of choice when feasible, but non-surgical interventions are emerging as effective alternatives to surgical shunts
Push and Puff Technique for Mechanical ThrombectomyDr Vipul Gupta
This document describes the push and puff technique for mechanical thrombectomy and one physician's experience using this technique with the Solitaire stent retriever. It summarizes a case study of a 65-year-old female patient who presented with left-sided weakness and was found to have a right terminal ICA occlusion that was successfully treated with mechanical thrombectomy using the push and puff technique. The physician's early experience using this technique with the Solitaire device in 7 patients demonstrated a 100% first pass reperfusion rate and modified TICI 3 reperfusion in 85% of patients. Commonly encountered challenges after stent retrieval included vessel spasm and residual thrombus. The conclusion is that the push and puff technique appears very promising for improving outcomes
Georgios Sianos - RETROGRADE STEP BY STEP APPROACHEuro CTO Club
This document provides an overview of retrograde techniques for recanalizing chronic total occlusions (CTOs). It discusses the history and evolution of retrograde techniques, including septal collateral crossing and dilatation. Key steps in the retrograde approach like wire escalation, dissection and re-entry are outlined. Case examples demonstrate the retrograde procedure in detail. Consensus recommendations emphasize the importance of operator experience before performing retrograde CTO PCI independently. Required lab set-up and equipment are also reviewed.
Saturday 1600 di mario - straw and other tricks to enhance bail-out re-entryEuro CTO Club
This document describes techniques for enhancing bail-out re-entry during chronic total occlusion percutaneous coronary intervention (CTO PCI), including the straw technique and use of the Stingray re-entry system. The straw technique uses continuous aspiration through an over-the-wire balloon to remove blood from a subintimal hematoma and restore distal visualization. The Stingray system involves inflating a balloon subintimally to provide leverage for a guidewire to re-enter the true lumen. Several clinical cases demonstrate successful use of these techniques to complete CTO PCI procedures. Further technical advances are needed to improve re-entry success and reduce risks of complications.
Within the past 12 months, the author has received consulting fees or honoraria from Boston Scientific, Medtronic, and Terumo.
The document discusses the advantages of radial artery access over femoral artery access for carotid artery stenting (CAS), including reduced risk of emboli in patients with aortic atherosclerosis, lower rates of access site complications and bleeding, earlier ambulation for patients, and improved patient comfort and satisfaction. Several cases demonstrating transradial CAS procedures are presented. Both radial and ulnar arteries can be used for access. While there is a learning curve for new operators and some procedures may take longer, radial access allows for CAS in complex aortic arch anatomies and avoids complications associated with femoral access
Tim Schäufele - SuccessfultransradialretrogradeCTO revascularisation via an e...Euro CTO Club
A 76-year-old female with recurrent angina underwent a transradial retrograde CTO revascularization via an epicardial collateral using a single 6F guide catheter. Baseline angiography and cMRI showed 3-vessel disease with functional stenosis in the RCA and RCX territories. An antegrade wire escalation approach was unsuccessful, so a retrograde approach via an epicardial collateral was used. The CTO was crossed retrogradely and externalized antegradely using the single 6F guide. Final angiography after stent placement in the RCA, LAD and RCX showed good results and the patient's angina was resolved at 9-month follow-up.
1) Peripheral artery disease (PAD) is common in patients with diabetes and a leading cause of lower limb amputation.
2) Endovascular therapy is now the preferred initial approach for revascularization in diabetic foot patients with PAD, as it is less invasive and risky compared to surgery.
3) Techniques like balloon angioplasty and stenting have high success rates for revascularization and allow salvaging over 90% of threatened limbs, even in high-risk patients, when combined with good diabetic control, wound debridement, and antibiotics.
The document describes the use of the ReeKross catheter to treat an occlusion of the anterior tibial artery (ATA) in an 81-year old female patient presenting with an infected non-healing ulcer on her right foot due to chronic lower limb ischemia. The subintimal plane of the occluded ATA was entered and the ReeKross catheter was used to advance smoothly through the subintimal space to reenter the true lumen beyond the occlusion. Balloon angioplasty with the ReeKross catheter then dilated the entire length of the ATA with easy dilatation and no balloon puncture, restoring blood flow to the foot as seen on follow up angiography. The Ree
Canaloplasty Overview 3 Year Clinical Results Burchfield111510Pickrel777
The document provides an overview of canaloplasty, a non-penetrating glaucoma surgery technique. Canaloplasty aims to restore normal aqueous outflow by accessing and dilating Schlemm's canal using a microcatheter. This allows placement of a tensioning suture to maintain canal patency. Clinical studies show canaloplasty reduces intraocular pressure by 35-41% at 3 years with a low complication rate, providing an alternative to traditional glaucoma surgeries.
This document discusses the benefits of using a radial artery approach for carotid artery stenting (CAS) compared to the traditional femoral artery approach. Some key benefits of the radial approach include avoiding complications associated with femoral access in patients with aorto-iliac disease, allowing for early patient mobilization to reduce bleeding risks, and eliminating vascular access site complications which are a major cause of morbidity and mortality after CAS. The document also presents several case examples demonstrating successful CAS procedures performed via the radial approach. However, it notes there is a significant learning curve for new operators and that the radial approach may not be suitable for all anatomies or allow the use of all devices.
The document discusses the advantages and techniques for performing peripheral vascular interventions via the transradial approach, noting that it is well-suited for interventions in the subclavian, carotid, renal and iliac arteries but current equipment limitations restrict its use for femoral and below-knee interventions; while transfemoral access remains preferable for left carotid and femoral/popliteal interventions. The radial approach reduces access site complications and allows for quicker recovery compared to femoral access.
Percutaneous treatment of communited patellar fracture.pptxAyalewKomande1
The document discusses two percutaneous techniques for treating comminuted patellar fractures: the Pyrford technique and percutaneous cerclage wiring. The Pyrford technique uses circumferential wiring and tension band wiring passed through small incisions to reduce fragments. It achieved union in 28 patients in a mean 13.7 weeks with no major complications. Percutaneous cerclage wiring approximates soft tissues and fragments with cable passed through small incisions, achieving union in 4 of 5 patients. Both techniques allow early mobilization with minimal soft tissue disruption compared to open surgery.
Friday 1500 meyer-gessner - rca ostial cto pciEuro CTO Club
This document discusses the challenges of percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) of the right coronary artery (RCA) ostium. It notes that RCA ostial CTO PCIs have higher anatomical complexity, longer procedure times, higher radiation exposure, and lower success rates compared to non-ostial CTO PCIs. Retrograde wiring is often needed due to unclear anatomy, and reverse controlled antegrade and retrograde tracking (CART), snaring, or wire trapping techniques may be required when microcatheters cannot cross collaterals antegrade. Rotablation can help with severe calcification. The conclusions emphasize that additional imaging is generally needed due to unclear anatomy,
This in vitro study tested the effectiveness of combining rheolytic thrombectomy (RT) and distal protection balloon wires for removing fresh blood clots. Fresh clots were placed in tubes and aspirated using RT or manual aspiration with a protection balloon inflated distal to the clot. RT removed significantly less residual clot than manual aspiration, as RT macerates clots into smaller pieces that can be evacuated, while manual aspiration cannot efficiently remove bulky clots. The study shows RT is compatible with distal protection and more effective than manual aspiration at removing thrombus, suggesting a combination strategy may be beneficial for removing clots in patients with acute myocardial infarction.
- Modern cementing techniques for acetabular cups aim to improve the bone-cement interface through techniques like subchondral bone removal, multiple anchorage holes, thorough cleaning, and sustained cement pressurization.
- Studies show these techniques result in a stronger interface and less early radiolucency compared to classical cementing methods.
- The optimal technique involves removing subchondral bone when possible, drilling multiple anchorage holes, thoroughly cleaning the bone bed, applying cement under sustained pressure until cup insertion.
Basic of PCI through Trans Radial RouteAshok Dutta
1. The document discusses the basics of percutaneous coronary intervention (PCI) through the transradial approach. It covers the history, access routes, procedural steps, guide catheter selection, complications and tips for successful PCI.
2. Key points include that the radial approach has a narrow pathway but fewer complications compared to the femoral approach. Guide catheter size selection depends on the vessel diameter and intended devices. Wiring, balloon angioplasty, stenting and post-dilatation are the standard steps of PCI.
3. Complications include dissection, perforation and stent malapposition. Tips provided to prevent complications and ensure procedural success include proper guide catheter and device selection, gentle manipulation, and frequent
Dr. Abhishek presented on coronary artery perforation during PCI. Key points included:
- Incidence ranges from 0.19-3% with increased mortality risk. Risk factors include complex lesions and older age.
- Perforations are classified anatomically and by severity (Ellis classification). Large vessel perforations are highest risk.
- Management involves balloon inflation, covered stents, or catheter techniques to seal the perforation. Distal perforations can be managed with balloon occlusion or embolization.
- Outcomes depend on severity but type III perforations have high mortality. Monitoring for delayed tamponade is important.
10:50 Ochiai - 10 key points to avoid major complications during CTO PCIEuro CTO Club
1. The 10 key points provide guidance on avoiding major complications during chronic total occlusion percutaneous coronary intervention (CTO PCI).
2. The points emphasize minimizing radiation exposure, using high quality angiograms to plan strategies, monitoring activated clotting time, ensuring all devices are visible on fluoroscopy, using large guiding catheters without stiff tips, identifying the entry point into the CTO, using intravascular ultrasound, employing spring coil wires for collateral tracking, using knuckle wiring when vessel course is unclear, and guaranteeing stent delivery into the left circumflex artery during ostial left anterior descending CTO procedures to avoid complications.
3. The document illustrates each point using images from CTO PCI cases.
This document discusses complications that can occur during percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). It provides information on recognizing, preventing, and managing various complications including perforations, dissections, radiation exposure, contrast-induced nephropathy, and trapped equipment. Specific techniques are outlined for dealing with complications involving the septal channels, donor arteries, and aortic root. The importance of being prepared with the proper equipment and reversing anticoagulation at the right time is emphasized.
Similar to Markus Meyer Gessner - Break through the wall- RCA ostial CTO (20)
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Markus Meyer Gessner - Break through the wall- RCA ostial CTO
1. Break through the wall- RCA ostial CTO
Markus Meyer-Geßner Augusta-Krankenhaus Düsseldorf
Altbier Altstadt/ Rheinpromenade
4 th European Live Summit on Retrograde CTO Revascularization Zürich 8.-9.5.15
13. 13
Concertina effect at ostium, correction by additional stent
Procedure time 209min, fluoro 86,4 min, AK 2474 mGy, contrast 90ml
4 stents, 3,5/100 mm
14. 14
Similar case: Antegrade system from right radial approach
Retrograde system in aortaNo passage in antegrade guide
16. Conclusions
RCA ostial CTO: short or absent stump and high degree of calcification
Limited or no antegrade option, retrograde approach mostly needed
CT-scan tells not always the complete truth, retrograde injection is helpfull
Differential use of microcatheter sometimes necessary for collateral crossing
Child in mother system facilitates stent crossing in severe calcification
RG3 may easily be catched by a large snare in brachiocephalic trunc from right
radial and femoral access
18. Altbier Altstadt/ Rheinpromenade
Thank You
Break through the wall- RCA ostial CTO– 2 cases
Markus Meyer-Geßner Augusta-Krankenhaus Düsseldorf
4 th European Live Summit on Retrograde CTO Revascularization Zürich 8.-9.5.15