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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 : 2018-08-31
Language(s) : English

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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See previous comments (5)
  • 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

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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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                    May 2017
                    Honolulu : Tuesday, May 16th 2017 from 11:30pm to 12:30am (GMT-10)
                    San Francisco : Wednesday, May 17th 2017 from 02:30am to 03:30am (GMT-7)
                    New York : Wednesday, May 17th 2017 from 05:30am to 06:30am (GMT-4)
                    Buenos Aires : Wednesday, May 17th 2017 from 06:30am to 07:30am (GMT-3)
                    Reykjavik : Wednesday, May 17th 2017 from 09:30am to 10:30am (GMT)
                    London / Dublin : Wednesday, May 17th 2017 from 10:30am to 11:30am (GMT+1)
                    Paris / Berlin : Wednesday, May 17th 2017 from 11:30am to 12:30pm (GMT+2)
                    Istanbul : Wednesday, May 17th 2017 from 12:30pm to 01:30pm (GMT+3)
                    Moscou / Dubaï : Wednesday, May 17th 2017 from 01:30pm to 02:30pm (GMT+4)
                    Bangkok : Wednesday, May 17th 2017 from 04:30pm to 05:30pm (GMT+7)
                    Shanghai : Wednesday, May 17th 2017 from 05:30pm to 06:30pm (GMT+8)
                    Tokyo : Wednesday, May 17th 2017 from 06:30pm to 07:30pm (GMT+9)
                    Sydney : Wednesday, May 17th 2017 from 08:30pm to 09:30pm (GMT+11)
                    Wellington : Wednesday, May 17th 2017 from 10:30pm to 11:30pm (GMT+13)

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

                    New Fundamentals & Perspectives in coronary stenting

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                    Wednesday, April 18th 2018 from 12:30pm to 02:30pm (GMT+1)
                    Honolulu : Wednesday, April 18th 2018 from 01:30am to 03:30am (GMT-10)
                    San Francisco : Wednesday, April 18th 2018 from 04:30am to 06:30am (GMT-7)
                    New York : Wednesday, April 18th 2018 from 07:30am to 09:30am (GMT-4)
                    Buenos Aires : Wednesday, April 18th 2018 from 08:30am to 10:30am (GMT-3)
                    Reykjavik : Wednesday, April 18th 2018 from 11:30am to 01:30pm (GMT)
                    London / Dublin : Wednesday, April 18th 2018 from 12:30pm to 02:30pm (GMT+1)
                    Paris / Berlin : Wednesday, April 18th 2018 from 01:30pm to 03:30pm (GMT+2)
                    Istanbul : Wednesday, April 18th 2018 from 02:30pm to 04:30pm (GMT+3)
                    Moscou / Dubaï : Wednesday, April 18th 2018 from 03:30pm to 05:30pm (GMT+4)
                    Bangkok : Wednesday, April 18th 2018 from 06:30pm to 08:30pm (GMT+7)
                    Shanghai : Wednesday, April 18th 2018 from 07:30pm to 09:30pm (GMT+8)
                    Tokyo : Wednesday, April 18th 2018 from 08:30pm to 10:30pm (GMT+9)
                    Sydney : Wednesday, April 18th 2018 from 10:30pm to 12:30am (GMT+11)
                    Wellington : Thursday, April 19th 2018 from 12:30am to 02:30am (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+1)
                    Honolulu : Tuesday, May 15th 2018 from 01:30am to 03am (GMT-10)
                    San Francisco : Tuesday, May 15th 2018 from 04:30am to 06am (GMT-7)
                    New York : Tuesday, May 15th 2018 from 07:30am to 09am (GMT-4)
                    Buenos Aires : Tuesday, May 15th 2018 from 08:30am to 10am (GMT-3)
                    Reykjavik : Tuesday, May 15th 2018 from 11:30am to 01pm (GMT)
                    London / Dublin : Tuesday, May 15th 2018 from 12:30pm to 02pm (GMT+1)
                    Paris / Berlin : Tuesday, May 15th 2018 from 01:30pm to 03pm (GMT+2)
                    Istanbul : Tuesday, May 15th 2018 from 02:30pm to 04pm (GMT+3)
                    Moscou / Dubaï : Tuesday, May 15th 2018 from 03:30pm to 05pm (GMT+4)
                    Bangkok : Tuesday, May 15th 2018 from 06:30pm to 08pm (GMT+7)
                    Shanghai : Tuesday, May 15th 2018 from 07:30pm to 09pm (GMT+8)
                    Tokyo : Tuesday, May 15th 2018 from 08:30pm to 10pm (GMT+9)
                    Sydney : Tuesday, May 15th 2018 from 10:30pm to 12am (GMT+11)
                    Wellington : Wednesday, May 16th 2018 from 12:30am to 02am (GMT+13)

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