IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston)...
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Transcript of IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston)...
![Page 1: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/1.jpg)
IVUS Guided CTO PCI
Fu Wai Hospital
Jie Qian
![Page 2: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/2.jpg)
Different IVUS Catheter
Atlantis SR pro2 (Boston)Atlantis SR pro2 (Boston)
Eagle Eye (Volcano)Eagle Eye (Volcano)
![Page 3: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/3.jpg)
IVUS Guided CTO PCI
• Wiring Technique
• Optimized CTO PCI
![Page 4: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/4.jpg)
Antegrade Technique
• To detect the entry point
• Define true or false lumen
• To navigate guidewire from false lumen to true lumen
![Page 5: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/5.jpg)
Finding entry point
micro catheter
guide wire
![Page 6: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/6.jpg)
Case 1
![Page 7: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/7.jpg)
Case 1
Lad come in
![Page 8: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/8.jpg)
Case 1
![Page 9: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/9.jpg)
Define true or false lumen
• Three layer structure
• Side branch
![Page 10: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/10.jpg)
Case 2
![Page 11: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/11.jpg)
Case 2
![Page 12: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/12.jpg)
Case 2
![Page 13: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/13.jpg)
Case 2
Wire hematoma
Huge hematoma
Huge dissection
![Page 14: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/14.jpg)
Case 3
![Page 15: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/15.jpg)
To navigate guidewire from false lumen to true lumen
![Page 16: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/16.jpg)
Case 4True lumen
Re-entry point
Proximal
![Page 17: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/17.jpg)
Retrograde Technique
Tracking the retrograde wire route and verify wire cross into true or false lumen
Reverse CART ( or with stenting), assess proximal vessel size and decide balloon size
![Page 18: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/18.jpg)
Case 5
![Page 19: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/19.jpg)
Case 5
![Page 20: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/20.jpg)
Case 5
Retrograde wire
Wire in plaque
Wire Out
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Case 5
![Page 22: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/22.jpg)
Case 6
![Page 23: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/23.jpg)
Case 6
![Page 24: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/24.jpg)
Case 6
![Page 25: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/25.jpg)
Case 6
True lumen
Retrograde wire
![Page 26: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/26.jpg)
Case 6
Hematoma
![Page 27: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/27.jpg)
Case 6
![Page 28: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/28.jpg)
IVUS Guided CTO PCI
• Wiring Technique
• Optimized CTO PCI
![Page 29: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/29.jpg)
Ante group (n=23) Retro group (n=25)
p=0.50
p=0.49
0
10
20
30
40
50
60
70
Subintimalwiring
Intramuralcoronary
hematoma
Extramural
hematoma
IVUS-detectedcoronary
perforation
Angiographicextravazation
2(8%)
0 (0%)
11(44%)
6(26%)
3(12%)2
(9%)
p>0.996
(24%)
3(13%)
p=0.47
10(40%)
2(9%)
p=0.02
Inci
den
ce
(%
)
coronary
Comparison of Qualitative DataComparison of Qualitative Data
Tsujita JACC Interv 2009
![Page 30: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/30.jpg)
Stent
![Page 31: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/31.jpg)
LAD Plaque DistributionLAD Plaque Distribution
![Page 32: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/32.jpg)
5 mm forward
5 mm radius
Field of View
• 5 mm forward
1 mm 5 mm to the side
“Tick marks” are 1 mm in cross-sectional plane for easy diameter sizing This artery measures 9 mm
Investigational Device, not for human use
![Page 33: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/33.jpg)
FL.IVUS with RF TunnelingFL.IVUS with RF Tunneling designed to provide:
• CTO Visualization– IVUS imaging will show proximal CTO cap and
vessel borders and position of catheter within lesion
• Steering – Rotating the tip of the catheter will direct the RF
electrode to desired target
– Angled RF beam will allow operator to steer away from vessel walls
• Lesion penetration– RF waves will ablate tissue allowing tunneling
through lesion
Investigational Device, not for human use
![Page 34: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/34.jpg)
Example of View
Investigational Device, not for human use
![Page 35: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/35.jpg)
Summary ( 1 )• With suitable side branch, IVUS-guided wiring is helpful t
o find entry point in no stump CTO lesions.• Define true or false lumen can help to decide stenting or
not. It also can help to find true and false lumen crossover point, navigate wire from false to true lumen.
• In retrograde technique, IVUS is a very helpful tool especially in Retrograde Wire Cross and Reverse CART (or stenting).
• To get successful result in CTO-PCI, we should be familiar with IVUS imaging of CTO and use it with proper way.
![Page 36: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/36.jpg)
Summary ( 2 )• CTO procedure (especially retrograde
approach) cause perivascular trauma which can be detected by IVUS, though angiographically silent.
• Distal coronary artery spares plaque accumulation and IVUS can help to decide the stent landing area.
![Page 37: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/37.jpg)
THANKS!
![Page 38: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/38.jpg)
Case 7
![Page 39: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/39.jpg)
Reverse CART with Stenting
![Page 40: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/40.jpg)
Perivascular Hematoma
New Layer Formation
Perivascular Blood Speckle
IVUS findings Perivascular TraumaIVUS findings Perivascular Trauma
![Page 41: IVUS Guided CTO PCI Fu Wai Hospital Jie Qian. Different IVUS Catheter Atlantis SR pro2 (Boston) Eagle Eye (Volcano)](https://reader035.fdocuments.us/reader035/viewer/2022062500/5697bff71a28abf838cbea97/html5/thumbnails/41.jpg)
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0 10 20 30 40 50 60 70 80
Distance from Ostium
Ave
rag
e P
laq
ue
Bu
rden
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0 10 20 30 40 50 60 70 80 90 100
RCA
LAD
Ave
rag
e P
laq
ue
Bu
rden
(mm)
(mm)
(%)
(%)
Distance from Ostium
Plaque DistributionPlaque Distribution n=75
n=61