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Dr. Prathap kumar.N Meditrina hospitals India Course ... · Dr. Prathap kumar.N Meditrina hospitals...
Transcript of Dr. Prathap kumar.N Meditrina hospitals India Course ... · Dr. Prathap kumar.N Meditrina hospitals...
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Dr. Prathap kumar.N Meditrina hospitals
IndiaCourse director-
IJCTO
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Passive: higher size guide
amplatz guide
Active: deep engagement
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Others:
1.Buddy wire
2.Guideliner
3.Guidewire
support cath
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Case: 1
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Double catheter
amplatz in the right
Failed antegrade intervention
from outside
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Retrograde attempt first
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Microcatheter with fielder XT R wire
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Other micro catheters:
Corsair pro
Caravel
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Other devices
• Dual lumen micro catheter
• crusade
• sazuke
• Rotablator
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case : 2
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Rotablator #1
CTO - LAD
Guidewire did not cross to LAD
both antegrade & retrograde
But the wire crossed to D1
No micro catheter crossed
Finally rotawire crossed to D1
case:3
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case :4
Rotablator #2
Post CABG case
angiogram 18 mo back
95% ostial disease at CX
S.creatinine - 1.8mg%
Not done PTCA due to fear of CIN
Now refractory angina
Plan for PTCA
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ANCHOR TECHNIQUES
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RCA - CTO
Case: 5
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Gaia 2nd wire
crossed distally
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Second wire ..
Fielder FC with 1.25 x10 balloon
First wire with finecross
Balloon can not
cross the lesion
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With anchor by micro catheter distally,
lesion could cross with 1.5x15 balloon
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With guideliner only
stent could be pushed
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CTO CX:
Gaia first not crossed ,
Tried with Gaia 2nd
Case: 6
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redirecting the wire/
parallel wire technique
Gaia 2nd wire
out of track
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Case:7
LAD- CTO
Lesion not crossed with filelder FC
Gaia 2nd tried
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Gaia 3rd wire
parallel wire technique
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LAD -CTO
Case : 8
Side branch opening
may help in opening CTO
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Fielder FC , finecross not crossed
miracle 6 crossed
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Finecross , fielder FCDilated with 1.5x15 balloon
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Miracle 6, Fielder XT R
then Gaia second
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Gaia 2nd
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Case : 1CAD, TVD
PCI to RCA done
admitted for PCI to LAD
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mid LAD occludedBranch at the site of occlusion
JCTO -score -1
Vessel has an
angulated entry.
No calcium seen
Nearly 20 mm length
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Wire is in LAD after septal A
And went beyond diagonal A
Another 15 mm to reach
Distal segment seen from RCA
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Distal wire is in
lumen
But junction with
LAD??
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Sion black
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Gaia 2nd,
fielder XT-R tried
Both wires in different planes
1.Both can be in sub-intima
Or
2.Ante-grade in sub-intima
and retrograde in intima
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Miracle 6 with corsair retrograde
and guideliner antegrade
Gaia 3rd with corsair retrograde
not crossed
and guideliner antegrade
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Both wires in one plane
Both wires in one planeRetrograde wire near guideliner
Retrograde wire near guideliner
Retrograde wire enter guideliner
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Corsair pushed to guideliner
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Guideliner removed
Corsair in antegrade
Catheter
Miracle wire
exchanged to RG3
Corsair taken back
to septal A
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Removal of wire with corsair
Avoid deep seating of both
antegrade and retrograde
catheters
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Final result
Check septal A by
retrograde injection
Final angiographic result
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Conclusion..
• Impenetrable cap is a challenge in CTO
intervention
• Proper devices will make success better
• Skill and experience matters
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Thank you for the kind attention
Next IJCTO meeting at New
Delhi
on 12,13 & 14 June 2020
www.ijcto.com
+917025222244
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Thank you for the kind attention
Next IJCTO meeting at New
Delhi
on 12,13 & 14 June 2020
www.ijcto.com
+917025222244