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Yoshimachi F - AIMRADIAL 2014 Technical - CTO and radial
1. Tips & Tricks
for CTO intervention
Fuminobu Yoshimachi MD, PhD
Tokai University School of Medicine
2. Problems of Treating CTO
bending
calcification
long lesion
bifurcation
entry
exit
CTO is has various
pathological characters,
therefor sometimes it is
difficult to get success.
3. Problems of Treating CTO
bending
long lesion
bifurcation
entry
calcification
exit
CTO is complex lesion
II
Combination of device selection is needed
4. antegrade approach
Our devices on antegrade approach for CTO are
GuidWires and support catheters.
Sometimes, we need IVUS Guided PCI to check
entry point of occlusion or to control the
GuideWire to insert true lumen.
We have to change the devices according to the
lesion.
5. Guide Wire for treating CTO
XTR
Wizard 78
GAIA series
Miracle
Wizard 3
confianza
1. eel type: soft & floppy
The GW can pass through “Micro
channel” or “ loose tissue”
2. Knife type: good torque performance
The GW can be controlled intentionally,
but making space & modification to
the tissue .
3. spear type: stiff & taper
penetration to straight way
6. Coronary CT
Coronary CT is good for checking not only
occlusion but character of the lesion including
eccentrically-located calcification.
7. Micro Channel in CTO
160~230 μm = 0.16~0.23 mm
60~70% in CTO lesion
tapered > abrupt type
Short > long lesion
Sakuda H et al
Am J Pathol 1992:141(6):1507-16
Katsuragawa M et al.
J Am Coll Cardiol. 1993 Mar 1;21(3):604-11
Kumamoto M et al
Hum Pathol. 1995 Apr;26(4):450-6
Srivatsa SS et al.
Am Coll Cardiol. 1997 Apr;29(5):955-63
Carlino M et al
Catheter Cardiovasc Interv. 2008 Jan 1;71(1):20-6
9. Treating bending & calcified lesion
- controllable GuideWire -
Making space and modifying the tissue by
the GW, sometimes it makes big dissection
lumen.
10. Treating hard lesion
- penetration GuideWire -
Hard and stiff tapered GW makes small
space.
But it goes straight , and it is difficult to
control the direction.
39. retrograde approach
1. channel selection
septal channel
apex channel
epicald channel
2. device selection
GW
support catheter
3. how to make the ante-retro connection
same as TFI
40. retrograde approach
The most important essence for retrograde
approach is to confirm and select retrograde
channel, and to select effective device to pass the
channel.
main branch
small channel
same as TFI
52. Take Home Massage
CTO is complex lesion with calcification, long diffuse
bending ....and so on.
To treat CTO, we have to select GuideWire ,support
catheter and other devices, and adjust the PCI style to
the situation.
The essence of treating CTO including retro grade
approach is the same as the TFI with big diameter GC.
There is no limitation on TRI to treat CTO even if using
a 5Fr GC.
53. Take Home Massage
Why don’t you hesitate TRI for CTO ?
Limitation is just in your mind !