Nicolas Boudou - RetrogradeCTO PCI in leftdominant coronaryartery
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Transcript of Nicolas Boudou - RetrogradeCTO PCI in leftdominant coronaryartery
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Retrograde CTO PCI in leftdominant coronary arteryRetrograde CTO PCI in leftdominant coronary artery
Nicolas Boudou, MD,
Cardiology department
Rangueil university hospital
Toulouse, France
Pôle Cardiovasculaire et Métabolique
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Pôle Cardiovasculaire et Métabolique
Potential conflicts of interest
Speaker's name: Dr Nicolas Boudou
I do not have any potential conflict of interest
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LAD occlusion and collaterals
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Conus artery
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Guide catheter extension for ping pongtechnique
Monorail, rapid exchange:
- Guidezilla®, Boston SC 5F dans 6F- Guidion®, IMDS…
Guideliner®, Vascular Solutions 5F dans 6F
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• Coaxial, over the wire:
5F in 6F, 120 cm
Heartrail II®, Terumo
Guide catheter extension for ping pongtechnique
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Ping Pong technique: 2 guiding catheters in the same coronary artery
Brilakis ES, Grantham JA, Banerjee S. “Ping-pong” guide catheter technique for retrogradeintervention of a chronic total occlusion through an ipsilateral collateral.
Catheter Cardiovasc Interv 2011;78:3959.
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• Retrograde approach through a septal colllateral• Guide catheter extension in LCx to protect the left main• Pure retrograde wire crossing and wiring in the Guide cath extension
Ping Pong technique: 2 guiding catheters in the Left coronary artery
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CTO in ostial LAD
• Previous failure in another institution with dissection and haematoma of the proximal LAD
• Retrograde approach through septal from LCx
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Retro CART with Guide extension
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FU @ 3 months
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Key points
• Retrograde in same coronary artery: left dominant
artery
• Septal or epicardial collateral
• Ping Pong technique
• Guide catheter extension
– To protect a branch not diseased
– To secure retrograde crossing