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Chapters (10)
Description
Date : Friday, June 29th 2018 from 09:40am to 11am (GMT+1)
Honolulu : Thursday, June 28th 2018 from 10:40pm to 12am (GMT-10)
San Francisco : Friday, June 29th 2018 from 01:40am to 03am (GMT-7)
New York : Friday, June 29th 2018 from 04:40am to 06am (GMT-4)
Buenos Aires : Friday, June 29th 2018 from 05:40am to 07am (GMT-3)
Reykjavik : Friday, June 29th 2018 from 08:40am to 10am (GMT)
London / Dublin : Friday, June 29th 2018 from 09:40am to 11am (GMT+1)
Paris / Berlin : Friday, June 29th 2018 from 10:40am to 12pm (GMT+2)
Istanbul : Friday, June 29th 2018 from 11:40am to 01pm (GMT+3)
Moscou / Dubaï : Friday, June 29th 2018 from 12:40pm to 02pm (GMT+4)
Bangkok : Friday, June 29th 2018 from 03:40pm to 05pm (GMT+7)
Shanghai : Friday, June 29th 2018 from 04:40pm to 06pm (GMT+8)
Tokyo : Friday, June 29th 2018 from 05:40pm to 07pm (GMT+9)
Sydney : Friday, June 29th 2018 from 07:40pm to 09pm (GMT+11)
Wellington : Friday, June 29th 2018 from 09:40pm to 11pm (GMT+13)
Last update : 2018-12-19
Language(s) : English
Views : 20379

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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  • 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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                      Wednesday, September 2nd 2020 | 06:30pm - 08pm (Dubai Time) / 04:30pm - 06pm (CET)
                      Honolulu : Wednesday, September 2nd 2020 from 05:30am to 07am (GMT-10)
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                      Honolulu : Tuesday, September 11th 2018 from 01:30am to 03am (GMT-10)
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                      Sydney : Tuesday, September 11th 2018 from 10:30pm to 12am (GMT+11)
                      Wellington : Wednesday, September 12th 2018 from 12:30am to 02am (GMT+13)

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                      Tuesday, November 10th 2020 from 06pm to 07:15pm (GMT+1)
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                      Wednesday, November 7th 2018 from 06pm to 07:30pm (GMT+1)
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                      Thursday, January 28th 2021 from 06pm to 07:30pm (GMT+1)
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