CTO
70
DISTAL CAP PENETRATION – Cart Vs REVERSE CART Dr .V. Surya Prakasa Rao HOD – Cardiology Department Apollo Hospitals –Hyderguda, Hyderabad.
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DR . R. Vishwanath
Transcript of CTO
DISTAL CAP PENETRATION –Cart Vs REVERSE CART
Dr .V. Surya Prakasa RaoHOD – Cardiology Department
Apollo Hospitals –Hyderguda, Hyderabad.
Antegrade Retrograde Approach
CLASSIFICATION – Retrograde Procedures
CART Technique
Position of Retrograde wire.
A B C
D E
Retro Grade Strategy
A B C
DE
CTO
Corsair Difficult to Negotiate at an Acute Bend
Corsair induced SubintimalHaematoma
Features required for CTO wires
1. Penetration force for penetrating proximal fibrous cap and advancing into true lumen
2. 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 transmission
4. Shaping Memory of the tip
CTO Wire
CTO Wire
CTO Wire
CTO Wire
CTO Wiring
CTO Wiring – Tip Shaping
CTO – Wire Manipulation
1st CTO LIVE SUMMITJune 8th and 9th 2013
atMUMBAI
COMPLEX CTO – CHOOSING THE RIGHT HARDWARE.
Dr .V. Surya Prakasa Rao
HOD – Cardiology Department
Apollo Hospitals –Hyderguda, Hyder
CTO Wiring
CTO
CTO
CTO
CTO
Low Profile Balloons
• ACROSTAT – 1.1mm.
• FALCON – 1.0mm.
• SAPHIRE- 1.0mm.
• MINI TREK – 1.25mm (Hydrophilic).
• TERUMO - 1.25mm.
Antegrade Parallel Wire Technique
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
CTO
CTO Wire
CTO Wire
CTO Wire
SB Parallel wire with GAIA crossing
CRUSADE
GAIA Wire
Antegrade IVUS guided.
CTO Wiring
Star Technique
Cont..
Cross Boss catheter
String Ray
TORNUS
TORNUS
ISR - CTO
Fielder XT with Contralateral Injection
ISR - CTO
Retro Grade Strategy
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
Snare: Gooseneck
Covered Stent
COILS WITH DELIVERY CATHETER
Pericardiocentesis Tray
• Total No of CTO’S-2006 to Dec 2012 : 326 cases
• Success rate 89.9 %
• Major complications: < 1%
CTO – CACTO Experience
1st CTO LIVE SUMMITJune 8th and 9th 2013
atMUMBAI
GUIDEWIRES - CTO
