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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 : 17094

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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                      Thursday, December 7th 2017 from 12pm to 02pm (GMT+2)
                      Honolulu : Thursday, December 7th 2017 from 12am to 02am (GMT-10)
                      San Francisco : Thursday, December 7th 2017 from 02am to 04am (GMT-8)
                      New York : Thursday, December 7th 2017 from 05am to 07am (GMT-5)
                      Buenos Aires : Thursday, December 7th 2017 from 07am to 09am (GMT-3)
                      London / Dublin : Thursday, December 7th 2017 from 10am to 12pm (GMT)
                      Paris / Berlin : Thursday, December 7th 2017 from 11am to 01pm (GMT+1)
                      Istanbul : Thursday, December 7th 2017 from 12pm to 02pm (GMT+2)
                      Moscou / Dubaï : Thursday, December 7th 2017 from 02pm to 04pm (GMT+4)
                      Bangkok : Thursday, December 7th 2017 from 05pm to 07pm (GMT+7)
                      Shanghai : Thursday, December 7th 2017 from 06pm to 08pm (GMT+8)
                      Tokyo : Thursday, December 7th 2017 from 07pm to 09pm (GMT+9)
                      Sydney : Thursday, December 7th 2017 from 08pm to 10pm (GMT+10)
                      Wellington : Thursday, December 7th 2017 from 10pm to 12am (GMT+12)

                      Lésions dangereuses : apport de l’OFDI

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                      Wednesday, October 31st 2018 from 12:30pm to 02pm (GMT+2)
                      Honolulu : Wednesday, October 31st 2018 from 12:30am to 02am (GMT-10)
                      San Francisco : Wednesday, October 31st 2018 from 02:30am to 04am (GMT-8)
                      New York : Wednesday, October 31st 2018 from 05:30am to 07am (GMT-5)
                      Buenos Aires : Wednesday, October 31st 2018 from 07:30am to 09am (GMT-3)
                      London / Dublin : Wednesday, October 31st 2018 from 10:30am to 12pm (GMT)
                      Paris / Berlin : Wednesday, October 31st 2018 from 11:30am to 01pm (GMT+1)
                      Istanbul : Wednesday, October 31st 2018 from 12:30pm to 02pm (GMT+2)
                      Moscou / Dubaï : Wednesday, October 31st 2018 from 02:30pm to 04pm (GMT+4)
                      Bangkok : Wednesday, October 31st 2018 from 05:30pm to 07pm (GMT+7)
                      Shanghai : Wednesday, October 31st 2018 from 06:30pm to 08pm (GMT+8)
                      Tokyo : Wednesday, October 31st 2018 from 07:30pm to 09pm (GMT+9)
                      Sydney : Wednesday, October 31st 2018 from 08:30pm to 10pm (GMT+10)
                      Wellington : Wednesday, October 31st 2018 from 10:30pm to 12am (GMT+12)

                      CHIP : The Italian Way

                      Complex and High Risk Indicated Patients

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                      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

                      Share
                      Tuesday, February 6th 2018 from 02pm to 03:30pm (GMT+2)
                      Honolulu : Tuesday, February 6th 2018 from 02am to 03:30am (GMT-10)
                      San Francisco : Tuesday, February 6th 2018 from 04am to 05:30am (GMT-8)
                      New York : Tuesday, February 6th 2018 from 07am to 08:30am (GMT-5)
                      Buenos Aires : Tuesday, February 6th 2018 from 09am to 10:30am (GMT-3)
                      London / Dublin : Tuesday, February 6th 2018 from 12pm to 01:30pm (GMT)
                      Paris / Berlin : Tuesday, February 6th 2018 from 01pm to 02:30pm (GMT+1)
                      Istanbul : Tuesday, February 6th 2018 from 02pm to 03:30pm (GMT+2)
                      Moscou / Dubaï : Tuesday, February 6th 2018 from 04pm to 05:30pm (GMT+4)
                      Bangkok : Tuesday, February 6th 2018 from 07pm to 08:30pm (GMT+7)
                      Shanghai : Tuesday, February 6th 2018 from 08pm to 09:30pm (GMT+8)
                      Tokyo : Tuesday, February 6th 2018 from 09pm to 10:30pm (GMT+9)
                      Sydney : Tuesday, February 6th 2018 from 10pm to 11:30pm (GMT+10)
                      Wellington : Wednesday, February 7th 2018 from 12am to 01:30am (GMT+12)

                      Live case: Challenges of PCI and DAPT in an elderly patient with ASA allergy

                      Dr Alexandre Avran invites Dr Georgios Sideris

                      First live with Sonar© System
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                      June 2017
                      Honolulu : Thursday, June 1st 2017 from 12:30am to 02am (GMT-10)
                      San Francisco : Thursday, June 1st 2017 from 03:30am to 05am (GMT-7)
                      New York : Thursday, June 1st 2017 from 06:30am to 08am (GMT-4)
                      Buenos Aires : Thursday, June 1st 2017 from 07:30am to 09am (GMT-3)
                      Reykjavik : Thursday, June 1st 2017 from 10:30am to 12pm (GMT)
                      London / Dublin : Thursday, June 1st 2017 from 11:30am to 01pm (GMT+1)
                      Paris / Berlin : Thursday, June 1st 2017 from 12:30pm to 02pm (GMT+2)
                      Istanbul : Thursday, June 1st 2017 from 01:30pm to 03pm (GMT+3)
                      Moscou / Dubaï : Thursday, June 1st 2017 from 02:30pm to 04pm (GMT+4)
                      Bangkok : Thursday, June 1st 2017 from 05:30pm to 07pm (GMT+7)
                      Shanghai : Thursday, June 1st 2017 from 06:30pm to 08pm (GMT+8)
                      Tokyo : Thursday, June 1st 2017 from 07:30pm to 09pm (GMT+9)
                      Sydney : Thursday, June 1st 2017 from 09:30pm to 11pm (GMT+11)
                      Wellington : Thursday, June 1st 2017 from 11:30pm to 01am (GMT+13)

                      New Fundamentals & Perspectives in coronary stenting

                      Mastering complex patients and complex lesions

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                      Thursday, December 12th 2019 from 12:30pm to 01:30pm (GMT+2)
                      Honolulu : Thursday, December 12th 2019 from 12:30am to 01:30am (GMT-10)
                      San Francisco : Thursday, December 12th 2019 from 02:30am to 03:30am (GMT-8)
                      New York : Thursday, December 12th 2019 from 05:30am to 06:30am (GMT-5)
                      Buenos Aires : Thursday, December 12th 2019 from 07:30am to 08:30am (GMT-3)
                      London / Dublin : Thursday, December 12th 2019 from 10:30am to 11:30am (GMT)
                      Paris / Berlin : Thursday, December 12th 2019 from 11:30am to 12:30pm (GMT+1)
                      Istanbul : Thursday, December 12th 2019 from 12:30pm to 01:30pm (GMT+2)
                      Moscou / Dubaï : Thursday, December 12th 2019 from 02:30pm to 03:30pm (GMT+4)
                      Bangkok : Thursday, December 12th 2019 from 05:30pm to 06:30pm (GMT+7)
                      Shanghai : Thursday, December 12th 2019 from 06:30pm to 07:30pm (GMT+8)
                      Tokyo : Thursday, December 12th 2019 from 07:30pm to 08:30pm (GMT+9)
                      Sydney : Thursday, December 12th 2019 from 08:30pm to 09:30pm (GMT+10)
                      Wellington : Thursday, December 12th 2019 from 10:30pm to 11:30pm (GMT+12)

                      Proximal coronary severely calcified lesion: imaging and tailored optimal stenting with Megatron

                      Live case performed by Dr Bruno Garcia del Blanco

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                      Thursday, June 28th 2018 from 09:25am to 11am (GMT+2)
                      Honolulu : Wednesday, June 27th 2018 from 09:25pm to 11pm (GMT-10)
                      San Francisco : Thursday, June 28th 2018 from 12:25am to 02am (GMT-7)
                      New York : Thursday, June 28th 2018 from 03:25am to 05am (GMT-4)
                      Buenos Aires : Thursday, June 28th 2018 from 04:25am to 06am (GMT-3)
                      Reykjavik : Thursday, June 28th 2018 from 07:25am to 09am (GMT)
                      London / Dublin : Thursday, June 28th 2018 from 08:25am to 10am (GMT+1)
                      Paris / Berlin : Thursday, June 28th 2018 from 09:25am to 11am (GMT+2)
                      Istanbul : Thursday, June 28th 2018 from 10:25am to 12pm (GMT+3)
                      Moscou / Dubaï : Thursday, June 28th 2018 from 11:25am to 01pm (GMT+4)
                      Bangkok : Thursday, June 28th 2018 from 02:25pm to 04pm (GMT+7)
                      Shanghai : Thursday, June 28th 2018 from 03:25pm to 05pm (GMT+8)
                      Tokyo : Thursday, June 28th 2018 from 04:25pm to 06pm (GMT+9)
                      Sydney : Thursday, June 28th 2018 from 06:25pm to 08pm (GMT+11)
                      Wellington : Thursday, June 28th 2018 from 08:25pm to 10pm (GMT+13)

                      MLCTO 2018 - Live Case #1 & #2: Discover CTO PCI

                      From Heart Center Bad Krozingen

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                      Thursday, June 4th 2020 from 05:30pm to 06:30pm (GMT+2)
                      Honolulu : Thursday, June 4th 2020 from 05:30am to 06:30am (GMT-10)
                      San Francisco : Thursday, June 4th 2020 from 08:30am to 09:30am (GMT-7)
                      New York : Thursday, June 4th 2020 from 11:30am to 12:30pm (GMT-4)
                      Buenos Aires : Thursday, June 4th 2020 from 12:30pm to 01:30pm (GMT-3)
                      Reykjavik : Thursday, June 4th 2020 from 03:30pm to 04:30pm (GMT)
                      London / Dublin : Thursday, June 4th 2020 from 04:30pm to 05:30pm (GMT+1)
                      Paris / Berlin : Thursday, June 4th 2020 from 05:30pm to 06:30pm (GMT+2)
                      Istanbul : Thursday, June 4th 2020 from 06:30pm to 07:30pm (GMT+3)
                      Moscou / Dubaï : Thursday, June 4th 2020 from 07:30pm to 08:30pm (GMT+4)
                      Bangkok : Thursday, June 4th 2020 from 10:30pm to 11:30pm (GMT+7)
                      Shanghai : Thursday, June 4th 2020 from 11:30pm to 12:30am (GMT+8)
                      Tokyo : Friday, June 5th 2020 from 12:30am to 01:30am (GMT+9)
                      Sydney : Friday, June 5th 2020 from 02:30am to 03:30am (GMT+11)
                      Wellington : Friday, June 5th 2020 from 04:30am to 05:30am (GMT+13)

                      Right tools for the Left Main: Imaging, Technique, Device selection

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