CTO

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DR . R. Vishwanath

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CTO

  1. 1. DISTAL CAP PENETRATION – Cart Vs REVERSE CART Dr .V. Surya Prakasa Rao HOD – Cardiology Department Apollo Hospitals –Hyderguda, Hyderabad.
  2. 2. Antegrade Retrograde Approach
  3. 3. CLASSIFICATION – Retrograde Procedures
  4. 4. CART Technique
  5. 5. Position of Retrograde wire.
  6. 6. A B C D E
  7. 7. Retro Grade Strategy
  8. 8. A B CD E
  9. 9. CTO
  10. 10. Corsair Difficult to Negotiate at an Acute Bend
  11. 11. Corsair induced Subintimal Haematoma
  12. 12. CTO WireFeatures required for CTO wires1. Penetration force for penetrating proximal fibrous cap and advancing into true lumen2. Pushability for crossing chronic occlusions and complex lesions with heavy calcifications and tough fibrous tissues.3. Steerability for easy manipulate in various directions with good torque transmission4. Shaping Memory of the tip
  13. 13. CTO Wire
  14. 14. CTO Wire
  15. 15. CTO Wire
  16. 16. CTO Wiring
  17. 17. CTO Wiring – Tip Shaping
  18. 18. CTO – Wire Manipulation
  19. 19. 1st CTO LIVE SUMMITJune 8th and 9th 2013 at MUMBAI
  20. 20. COMPLEX CTO – CHOOSING THE RIGHT HARDWARE. Dr .V. Surya Prakasa Rao HOD – Cardiology Department Apollo Hospitals –Hyderguda, Hyder
  21. 21. CTO Wiring
  22. 22. CTO
  23. 23. CTO
  24. 24. CTO
  25. 25. CTO
  26. 26. Low Profile Balloons• ACROSTAT – 1.1mm.• FALCON – 1.0mm.• SAPHIRE- 1.0mm.• MINI TREK – 1.25mm (Hydrophilic).• TERUMO - 1.25mm.
  27. 27. Antegrade Parallel Wire Technique
  28. 28. Strategy :• 7F Femoral approach and 5F Trans Radial for Contralateral Injection.• XB / EBU / Amplatz.• Plastic Jacket: Fielder XT.• Conquest / Confluenza / Miracle – Parallel wire.• Micro catheter – Corsair.• Low Profile Balloons.• DES
  29. 29. CTO
  30. 30. CTO Wire
  31. 31. CTO Wire
  32. 32. CTO Wire
  33. 33. SB Parallel wire with GAIA crossing
  34. 34. CRUSADE
  35. 35. GAIA Wire
  36. 36. Antegrade IVUS guided.
  37. 37. CTO Wiring
  38. 38. Star Technique
  39. 39. Cont..
  40. 40. Cross Boss catheter
  41. 41. String Ray
  42. 42. TORNUS
  43. 43. TORNUS
  44. 44. ISR - CTO Fielder XT with Contralateral Injection
  45. 45. ISR - CTO
  46. 46. Retro Grade Strategy
  47. 47. Ostial LAD CTO – Reverse CART• 7F / 8F – short guiding ( customized / self made) with SH.• 135 / 154 cm Corsair.• SION Blue - 0.014 ( Fielder XT, Conquest Pro12, Miracle3 / 9, Fielder XTR)• RG3 – 300cms.• Volcano IVUS – Eagle Eye Gold.• 2.5 / 3.0 mm NC Balloons.• Snare.• Coils.• Covered Stent
  48. 48. Snare: Gooseneck
  49. 49. Covered Stent
  50. 50. COILS WITH DELIVERY CATHETER
  51. 51. Pericardiocentesis Tray
  52. 52. CTO – CACTO Experience• Total No of CTO’S-2006 to Dec 2012 : 326 cases• Success rate 89.9 %• Major complications: < 1%
  53. 53. 1st CTO LIVE SUMMITJune 8th and 9th 2013 at MUMBAI
  54. 54. GUIDEWIRES - CTO

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