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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

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

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                    Tuesday, September 4th 2018 from 02pm to 04pm (GMT+2)
                    Honolulu : Tuesday, September 4th 2018 from 02am to 04am (GMT-10)
                    San Francisco : Tuesday, September 4th 2018 from 05am to 07am (GMT-7)
                    New York : Tuesday, September 4th 2018 from 08am to 10am (GMT-4)
                    Buenos Aires : Tuesday, September 4th 2018 from 09am to 11am (GMT-3)
                    Reykjavik : Tuesday, September 4th 2018 from 12pm to 02pm (GMT)
                    London / Dublin : Tuesday, September 4th 2018 from 01pm to 03pm (GMT+1)
                    Paris / Berlin : Tuesday, September 4th 2018 from 02pm to 04pm (GMT+2)
                    Istanbul : Tuesday, September 4th 2018 from 03pm to 05pm (GMT+3)
                    Moscou / Dubaï : Tuesday, September 4th 2018 from 04pm to 06pm (GMT+4)
                    Bangkok : Tuesday, September 4th 2018 from 07pm to 09pm (GMT+7)
                    Shanghai : Tuesday, September 4th 2018 from 08pm to 10pm (GMT+8)
                    Tokyo : Tuesday, September 4th 2018 from 09pm to 11pm (GMT+9)
                    Sydney : Tuesday, September 4th 2018 from 11pm to 01am (GMT+11)
                    Wellington : Wednesday, September 5th 2018 from 01am to 03am (GMT+13)

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                    Live case on a patient with a very large calcified ostial RCA stenosis

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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)

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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

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

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                    Monday, October 23rd 2017 from 01pm to 02pm (GMT+2)
                    Honolulu : Monday, October 23rd 2017 from 01am to 02am (GMT-10)
                    San Francisco : Monday, October 23rd 2017 from 04am to 05am (GMT-7)
                    New York : Monday, October 23rd 2017 from 07am to 08am (GMT-4)
                    Buenos Aires : Monday, October 23rd 2017 from 08am to 09am (GMT-3)
                    Reykjavik : Monday, October 23rd 2017 from 11am to 12pm (GMT)
                    London / Dublin : Monday, October 23rd 2017 from 12pm to 01pm (GMT+1)
                    Paris / Berlin : Monday, October 23rd 2017 from 01pm to 02pm (GMT+2)
                    Istanbul : Monday, October 23rd 2017 from 02pm to 03pm (GMT+3)
                    Moscou / Dubaï : Monday, October 23rd 2017 from 03pm to 04pm (GMT+4)
                    Bangkok : Monday, October 23rd 2017 from 06pm to 07pm (GMT+7)
                    Shanghai : Monday, October 23rd 2017 from 07pm to 08pm (GMT+8)
                    Tokyo : Monday, October 23rd 2017 from 08pm to 09pm (GMT+9)
                    Sydney : Monday, October 23rd 2017 from 10pm to 11pm (GMT+11)
                    Wellington : Tuesday, October 24th 2017 from 12am to 01am (GMT+13)

                    Best practice use of Resorbable Magnesium Scaffold technology (RMS)

                    Magmaris in a class of its own

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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

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                    Saturday, June 30th 2018 from 09:30am to 11am (GMT+2)
                    Honolulu : Friday, June 29th 2018 from 09:30pm to 11pm (GMT-10)
                    San Francisco : Saturday, June 30th 2018 from 12:30am to 02am (GMT-7)
                    New York : Saturday, June 30th 2018 from 03:30am to 05am (GMT-4)
                    Buenos Aires : Saturday, June 30th 2018 from 04:30am to 06am (GMT-3)
                    Reykjavik : Saturday, June 30th 2018 from 07:30am to 09am (GMT)
                    London / Dublin : Saturday, June 30th 2018 from 08:30am to 10am (GMT+1)
                    Paris / Berlin : Saturday, June 30th 2018 from 09:30am to 11am (GMT+2)
                    Istanbul : Saturday, June 30th 2018 from 10:30am to 12pm (GMT+3)
                    Moscou / Dubaï : Saturday, June 30th 2018 from 11:30am to 01pm (GMT+4)
                    Bangkok : Saturday, June 30th 2018 from 02:30pm to 04pm (GMT+7)
                    Shanghai : Saturday, June 30th 2018 from 03:30pm to 05pm (GMT+8)
                    Tokyo : Saturday, June 30th 2018 from 04:30pm to 06pm (GMT+9)
                    Sydney : Saturday, June 30th 2018 from 06:30pm to 08pm (GMT+11)
                    Wellington : Saturday, June 30th 2018 from 08:30pm to 10pm (GMT+13)

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