Live Cases from Rome and Florence From San Camillo Hospital, Rome Operators: Gabriele Gasparini (Milan), Roberto Garbo (Turin), Rocco Stio (Rome) From Careggi University Hospital, Florence Operators: Gerald Werner (Darmstadt - D), Jaroslaw Wójcik (Lublin - PL), Carlo Di Mario (Florence) Flash Highlight Progress in dedicated novel CTO material Shunsuke Matsuno (Tokyo - J) ___________________________________________ PLENARY SESSION Live Cases from Rome and Florence + Flash Highlight Auditorium Zubin Mehta - Saturday 11:30 - 13:00 Coordinator: Roberto Garbo (Turin) Chairperson: Alexander Bufe (Krepeld - D) Discussants: Claudia Cosgrove (London - UK), Gorgulu Sevket (Istanbul - TR) Challengers: Pierfrancesco Agostoni (Antwerp - B), John Davies (Basildon - UK) ___________________________________________ 15th Experts Live CTO, EUROCTO Club meeting in partnership with the GISE CTO meeting. September 8th - 9th, 2023 Florence, Italy

1. Shunsuke Matsuno, MD
The Cardiovascular Institute, Japan
Progress in dedicated
novel CTO material

2. COI disclosure
• I DO NOT have any relevant financial relationships to disclose.

3. Today’s agenda
• Novel wire to be approved
- Plasma-mediated ablation system
• New technology recently launched
- ECG-synchronized fluoroscopy

4. Today’s agenda
• Novel wire to be approved
- Plasma-mediated ablation system
• New technology recently launched
- ECG-synchronized fluoroscopy

5. Lack of penetration efficiency is a limitation of CTO guidewires

6. Plasma-mediated ablation (PMA) system
“Plasma-mediated ablation system” in this presentation is not regulatory approved in Japan.
Plasma wire
Plasma catheter
RF generator
ECG trigger monitor
(Synchronized w/ RF generator)
Distal electrode
of plasma wire
Distal electrode of
plasma catheter

7. What distinguishes PMA system from conventional wires?
If the tip of the wire touches the object, penetration is possible
by ablation.

8. Situations where PMA system is potentially effective
When the conventional CTO wires fail to penetrate:
• The distal cap due to lack of penetration force
• The target plaque or distal true lumen due to enlarged peri-wire space
• The proximal cap from a large space due to lack of penetration efficiency

9. Today’s agenda
• Novel wire to be approved
- Plasma-mediated ablation system
• New technology recently launched
- ECG-synchronized fluoroscopy

10. Image movement on the conventional angiography

11. Mechanism and advantages of ECG-synchronized fluoroscopy
ECG-synchronization (-) ECG-synchronization (+)
Irradiate at the specified pulse rate
irrespective of heartbeat
Irradiate only at the specific timing of the
cardiac cycle synchronized with ECG
7.5 irradiation
per heartbeat
1 irradiation
per heartbeat
in the patient of HR 60bpm (= 1 heartbeat per 1 second)
Stopped images
≈80% reduction in
radiation exposure

12. Parallel wiring for proximal LAD CTO w/ ECG-synchronized fluoroscopy

13. Conclusions
• PMA system could help overcome challenging situations where mechanical
penetration with conventional CTO wires doesn’t work well.
• ECG-synchronized fluoroscopy is expected to contribute not only to more
accurate wire control but also to the reduction of radiation exposure.

14. Thank you for your kind attention.
Shunsuke Matsuno, MD
The Cardiovascular Institute
E-mail: matsuno@cvi.or.jp