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Chapters (10)
Description
Date : Friday, June 29th 2018 from 09:40am to 11am (GMT+2)
Honolulu : Thursday, June 28th 2018 from 09:40pm to 11pm (GMT-10)
San Francisco : Friday, June 29th 2018 from 12:40am to 02am (GMT-7)
New York : Friday, June 29th 2018 from 03:40am to 05am (GMT-4)
Buenos Aires : Friday, June 29th 2018 from 04:40am to 06am (GMT-3)
Reykjavik : Friday, June 29th 2018 from 07:40am to 09am (GMT)
London / Dublin : Friday, June 29th 2018 from 08:40am to 10am (GMT+1)
Paris / Berlin : Friday, June 29th 2018 from 09:40am to 11am (GMT+2)
Istanbul : Friday, June 29th 2018 from 10:40am to 12pm (GMT+3)
Moscou / Dubaï : Friday, June 29th 2018 from 11:40am to 01pm (GMT+4)
Bangkok : Friday, June 29th 2018 from 02:40pm to 04pm (GMT+7)
Shanghai : Friday, June 29th 2018 from 03:40pm to 05pm (GMT+8)
Tokyo : Friday, June 29th 2018 from 04:40pm to 06pm (GMT+9)
Sydney : Friday, June 29th 2018 from 06:40pm to 08pm (GMT+11)
Wellington : Friday, June 29th 2018 from 08:40pm to 10pm (GMT+13)
Last update : 2018-12-19
Language(s) : English
Views : 18636

This complete didactic procedure concerns a 72 yo male, with history of lateral STEMI (OM Stenting). The coronary angiography has also shown proximal RCA Chronic total occlusion with residual proven ischemia.

This RCA Chronic total occlusion was recanalized antegradly using antegrade-dissection-reentry (ADR) technique explained step-by-step by a Proctor expert in ADR.

Educational objectives

  • How to manage patients with Coronary Chronic total occlusions.
  • How to  plan intervention strategy using the Hybrid algorithm.
  • How to perform Knuckle wire technique.
  • Optimal application of the  antergrade controlled dissecion using the CossBoss microcatheter.
  • Optimal preparation of the Stingray balloon.
  • How to perform reentry technique with Stingray guidewire.
  • Proctoring importance in optimal learning  curve of ADR technique.

Step-by-Step procedure

  • Dual Radial access : Left Radial 7F for the right & Right radial 6F for the left system.
  • AL0.75 7F in the RCA & EBU 4.0 6F in the LM.
  • Dual lumen injections and angiographic studying of the lesion (Proximal CAP, Length, Distal vessel, Collaterals).
  • Approach :antegrade wire escalation, if failed : Antegrade-Dissection-reentry as first strategy.
  • Pilot 200 Guidewire with a MAMBA  microcatheter (Boston Scientific) failed to engage the Proximal CAP.
  • Engaging the Proximal CAP with Confianza Pro 12 guidewire.and switch again to Pilot200.
  • Advancing the Pilot 200 as Knuckle wire Technique.
  • Retreiving the MAMBA microcatheter using the Trapper Catheter (Boston Scientific) to limit the risk of significant hematoma.
  • Advancing the CrosBoss catheter in the subintimal space with Pilot 200 guidewire inside.
  • Stingray preparation while CrossBoss is in the Subintimal space.
  • Retreiving the CrosBoss Catheter using the Trapper and advancing the Stingray balloon.
  • Getting the optimal Stingray Projection for reentry.
  • Reentry technque using the Stingray guidewire.
  • Retreiving the Stingray balloon using Trapper & Advancing the MAMBA microcatheter over the Stingray guidewire.
  • Advancing a regular guidewire to the distal RCA.
  • Predilatation with a 4.0x20mm.
  • Stenting with two 4.0x38mm Synergy stents. and additional 4.0x24mm Synergy stent.

Biobliography

 

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Comments(12)
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See previous comments (7)
  • abdallah A. too much metal for a rather shorter lesion !!!!!

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    • mariwan S. GREAT JOB WELL DONE
      What was the cause of ostial dissection ?

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      • Marc H. Could you have pulled your retrograde gear once your wire was in the true lumen

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        • Bijan B. What happened to larg marginal branch

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          • Amr A. what about 7fr sheath on transradial
            do you need pre procedure radial duplex or angio

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            • Anselmo B. The right ventricular branches were all occluded. They didn’t try to recanalize anterograde, really possible, in my experience. Subintimal is a last resource

              • Serob M. I guess it has retrograde flow :)

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            • Narinder B. Why do you Need to be so Farm to reenter

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              • ahmed S. excellent

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                • Phatarpekar A. Naice

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                  • Serob M. Thomas Hovasse, super!

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                    • Mohammed H. excellent case

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                      Tuesday, October 13th 2020 from 05pm to 06:30pm (GMT+2)
                      Honolulu : Tuesday, October 13th 2020 from 05am to 06:30am (GMT-10)
                      San Francisco : Tuesday, October 13th 2020 from 08am to 09:30am (GMT-7)
                      New York : Tuesday, October 13th 2020 from 11am to 12:30pm (GMT-4)
                      Buenos Aires : Tuesday, October 13th 2020 from 12pm to 01:30pm (GMT-3)
                      Reykjavik : Tuesday, October 13th 2020 from 03pm to 04:30pm (GMT)
                      London / Dublin : Tuesday, October 13th 2020 from 04pm to 05:30pm (GMT+1)
                      Paris / Berlin : Tuesday, October 13th 2020 from 05pm to 06:30pm (GMT+2)
                      Istanbul : Tuesday, October 13th 2020 from 06pm to 07:30pm (GMT+3)
                      Moscou / Dubaï : Tuesday, October 13th 2020 from 07pm to 08:30pm (GMT+4)
                      Bangkok : Tuesday, October 13th 2020 from 10pm to 11:30pm (GMT+7)
                      Shanghai : Tuesday, October 13th 2020 from 11pm to 12:30am (GMT+8)
                      Tokyo : Wednesday, October 14th 2020 from 12am to 01:30am (GMT+9)
                      Sydney : Wednesday, October 14th 2020 from 02am to 03:30am (GMT+11)
                      Wellington : Wednesday, October 14th 2020 from 04am to 05:30am (GMT+13)

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                      Expert discussion during a Complex bifurcation PCI live case from ICPS, Massy, France, with simultan...

                      Wednesday, November 7th 2018 from 06pm to 07:30pm (GMT+2)
                      Honolulu : Wednesday, November 7th 2018 from 06am to 07:30am (GMT-10)
                      San Francisco : Wednesday, November 7th 2018 from 08am to 09:30am (GMT-8)
                      New York : Wednesday, November 7th 2018 from 11am to 12:30pm (GMT-5)
                      Buenos Aires : Wednesday, November 7th 2018 from 01pm to 02:30pm (GMT-3)
                      London / Dublin : Wednesday, November 7th 2018 from 04pm to 05:30pm (GMT)
                      Paris / Berlin : Wednesday, November 7th 2018 from 05pm to 06:30pm (GMT+1)
                      Istanbul : Wednesday, November 7th 2018 from 06pm to 07:30pm (GMT+2)
                      Moscou / Dubaï : Wednesday, November 7th 2018 from 08pm to 09:30pm (GMT+4)
                      Bangkok : Wednesday, November 7th 2018 from 11pm to 12:30am (GMT+7)
                      Shanghai : Thursday, November 8th 2018 from 12am to 01:30am (GMT+8)
                      Tokyo : Thursday, November 8th 2018 from 01am to 02:30am (GMT+9)
                      Sydney : Thursday, November 8th 2018 from 02am to 03:30am (GMT+10)
                      Wellington : Thursday, November 8th 2018 from 04am to 05:30am (GMT+12)

                      Bifurcation - Multivessels - Calcifications: How to treat the complex?

                      Complex PTCA: Experts' analysis

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                      Tuesday, November 27th 2018 from 02pm to 04:41pm (GMT+2)
                      Honolulu : Tuesday, November 27th 2018 from 02am to 04:41am (GMT-10)
                      San Francisco : Tuesday, November 27th 2018 from 04am to 06:41am (GMT-8)
                      New York : Tuesday, November 27th 2018 from 07am to 09:41am (GMT-5)
                      Buenos Aires : Tuesday, November 27th 2018 from 09am to 11:41am (GMT-3)
                      London / Dublin : Tuesday, November 27th 2018 from 12pm to 02:41pm (GMT)
                      Paris / Berlin : Tuesday, November 27th 2018 from 01pm to 03:41pm (GMT+1)
                      Istanbul : Tuesday, November 27th 2018 from 02pm to 04:41pm (GMT+2)
                      Moscou / Dubaï : Tuesday, November 27th 2018 from 04pm to 06:41pm (GMT+4)
                      Bangkok : Tuesday, November 27th 2018 from 07pm to 09:41pm (GMT+7)
                      Shanghai : Tuesday, November 27th 2018 from 08pm to 10:41pm (GMT+8)
                      Tokyo : Tuesday, November 27th 2018 from 09pm to 11:41pm (GMT+9)
                      Sydney : Tuesday, November 27th 2018 from 10pm to 12:41am (GMT+10)
                      Wellington : Wednesday, November 28th 2018 from 12am to 02:41am (GMT+12)

                      A long mid calcified RCA CTO with ambiguous proximal cap

                      Live case performed by Dr Avran & Dr Carlino

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                      Tuesday, January 30th 2018 from 01pm to 02:30pm (GMT+2)
                      Honolulu : Tuesday, January 30th 2018 from 01am to 02:30am (GMT-10)
                      San Francisco : Tuesday, January 30th 2018 from 03am to 04:30am (GMT-8)
                      New York : Tuesday, January 30th 2018 from 06am to 07:30am (GMT-5)
                      Buenos Aires : Tuesday, January 30th 2018 from 08am to 09:30am (GMT-3)
                      London / Dublin : Tuesday, January 30th 2018 from 11am to 12:30pm (GMT)
                      Paris / Berlin : Tuesday, January 30th 2018 from 12pm to 01:30pm (GMT+1)
                      Istanbul : Tuesday, January 30th 2018 from 01pm to 02:30pm (GMT+2)
                      Moscou / Dubaï : Tuesday, January 30th 2018 from 03pm to 04:30pm (GMT+4)
                      Bangkok : Tuesday, January 30th 2018 from 06pm to 07:30pm (GMT+7)
                      Shanghai : Tuesday, January 30th 2018 from 07pm to 08:30pm (GMT+8)
                      Tokyo : Tuesday, January 30th 2018 from 08pm to 09:30pm (GMT+9)
                      Sydney : Tuesday, January 30th 2018 from 09pm to 10:30pm (GMT+10)
                      Wellington : Tuesday, January 30th 2018 from 11pm to 12:30am (GMT+12)

                      DES and RMS: Why do you need both?

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                      Wednesday, April 18th 2018 from 12:30pm to 02:30pm (GMT+2)
                      Honolulu : Wednesday, April 18th 2018 from 12:30am to 02:30am (GMT-10)
                      San Francisco : Wednesday, April 18th 2018 from 03:30am to 05:30am (GMT-7)
                      New York : Wednesday, April 18th 2018 from 06:30am to 08:30am (GMT-4)
                      Buenos Aires : Wednesday, April 18th 2018 from 07:30am to 09:30am (GMT-3)
                      Reykjavik : Wednesday, April 18th 2018 from 10:30am to 12:30pm (GMT)
                      London / Dublin : Wednesday, April 18th 2018 from 11:30am to 01:30pm (GMT+1)
                      Paris / Berlin : Wednesday, April 18th 2018 from 12:30pm to 02:30pm (GMT+2)
                      Istanbul : Wednesday, April 18th 2018 from 01:30pm to 03:30pm (GMT+3)
                      Moscou / Dubaï : Wednesday, April 18th 2018 from 02:30pm to 04:30pm (GMT+4)
                      Bangkok : Wednesday, April 18th 2018 from 05:30pm to 07:30pm (GMT+7)
                      Shanghai : Wednesday, April 18th 2018 from 06:30pm to 08:30pm (GMT+8)
                      Tokyo : Wednesday, April 18th 2018 from 07:30pm to 09:30pm (GMT+9)
                      Sydney : Wednesday, April 18th 2018 from 09:30pm to 11:30pm (GMT+11)
                      Wellington : Wednesday, April 18th 2018 from 11:30pm to 01:30am (GMT+13)

                      Simplify Bifurcation Stenting

                      BiOSS LIM C sirolimus eluting stent

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                      Tuesday, May 15th 2018 from 12:30pm to 02pm (GMT+2)
                      Honolulu : Tuesday, May 15th 2018 from 12:30am to 02am (GMT-10)
                      San Francisco : Tuesday, May 15th 2018 from 03:30am to 05am (GMT-7)
                      New York : Tuesday, May 15th 2018 from 06:30am to 08am (GMT-4)
                      Buenos Aires : Tuesday, May 15th 2018 from 07:30am to 09am (GMT-3)
                      Reykjavik : Tuesday, May 15th 2018 from 10:30am to 12pm (GMT)
                      London / Dublin : Tuesday, May 15th 2018 from 11:30am to 01pm (GMT+1)
                      Paris / Berlin : Tuesday, May 15th 2018 from 12:30pm to 02pm (GMT+2)
                      Istanbul : Tuesday, May 15th 2018 from 01:30pm to 03pm (GMT+3)
                      Moscou / Dubaï : Tuesday, May 15th 2018 from 02:30pm to 04pm (GMT+4)
                      Bangkok : Tuesday, May 15th 2018 from 05:30pm to 07pm (GMT+7)
                      Shanghai : Tuesday, May 15th 2018 from 06:30pm to 08pm (GMT+8)
                      Tokyo : Tuesday, May 15th 2018 from 07:30pm to 09pm (GMT+9)
                      Sydney : Tuesday, May 15th 2018 from 09:30pm to 11pm (GMT+11)
                      Wellington : Tuesday, May 15th 2018 from 11:30pm to 01am (GMT+13)

                      La coronaire à la parisienne : de l'aigüe au chronique

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                      Thursday, February 13th 2020 from 01pm to 02:30pm (GMT+2)
                      Honolulu : Thursday, February 13th 2020 from 01am to 02:30am (GMT-10)
                      San Francisco : Thursday, February 13th 2020 from 03am to 04:30am (GMT-8)
                      New York : Thursday, February 13th 2020 from 06am to 07:30am (GMT-5)
                      Buenos Aires : Thursday, February 13th 2020 from 08am to 09:30am (GMT-3)
                      London / Dublin : Thursday, February 13th 2020 from 11am to 12:30pm (GMT)
                      Paris / Berlin : Thursday, February 13th 2020 from 12pm to 01:30pm (GMT+1)
                      Istanbul : Thursday, February 13th 2020 from 01pm to 02:30pm (GMT+2)
                      Moscou / Dubaï : Thursday, February 13th 2020 from 03pm to 04:30pm (GMT+4)
                      Bangkok : Thursday, February 13th 2020 from 06pm to 07:30pm (GMT+7)
                      Shanghai : Thursday, February 13th 2020 from 07pm to 08:30pm (GMT+8)
                      Tokyo : Thursday, February 13th 2020 from 08pm to 09:30pm (GMT+9)
                      Sydney : Thursday, February 13th 2020 from 09pm to 10:30pm (GMT+10)
                      Wellington : Thursday, February 13th 2020 from 11pm to 12:30am (GMT+12)

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                      Saturday, June 23rd 2018 from 12am to 04:30pm (GMT+2)
                      Honolulu : Friday, June 22nd 2018 from 12pm to 04:30am (GMT-10)
                      San Francisco : Friday, June 22nd 2018 from 03pm to 07:30am (GMT-7)
                      New York : Friday, June 22nd 2018 from 06pm to 10:30am (GMT-4)
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                      Reykjavik : Friday, June 22nd 2018 from 10pm to 02:30pm (GMT)
                      London / Dublin : Friday, June 22nd 2018 from 11pm to 03:30pm (GMT+1)
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                      Istanbul : Saturday, June 23rd 2018 from 01am to 05:30pm (GMT+3)
                      Moscou / Dubaï : Saturday, June 23rd 2018 from 02am to 06:30pm (GMT+4)
                      Bangkok : Saturday, June 23rd 2018 from 05am to 09:30pm (GMT+7)
                      Shanghai : Saturday, June 23rd 2018 from 06am to 10:30pm (GMT+8)
                      Tokyo : Saturday, June 23rd 2018 from 07am to 11:30pm (GMT+9)
                      Sydney : Saturday, June 23rd 2018 from 09am to 01:30am (GMT+11)
                      Wellington : Saturday, June 23rd 2018 from 11am to 03:30am (GMT+13)

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