×
It looks like you're using an obsolete version of internet explorer. Internet explorer is no longer supported by Microsoft since the end of 2015. We invite you to use a newer browser such as Firefox, Google Chrome or Microsoft Edge.
My Player placeholder

Become an Incathlab member and receive full access to its content!

You must be an Incathlab member to access videos without any restrictions. Register for free in one minute and access all services provided by Incathlab.You will also be able to log into Incathlab from your Facebook or twitter account by clicking on login on the top-right corner of Incathlab website.

Registration Login


Worldwide schedules comment Share
31223 views

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

 

Shooting date : 2018-06-29
Last update : 2021-05-11

Our Cases of the Month

The case of the month is a new way for our users to watch, learn, and share with incathlab. They can watch a video that highlights an innovative case and uses excellent pedagogical techniques, lear...

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

      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
      Your browser doesn't have Flash, Silverlight or HTML5 support.


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

        Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
        Your browser doesn't have Flash, Silverlight or HTML5 support.


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

          Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
          Your browser doesn't have Flash, Silverlight or HTML5 support.


        • Bijan B. What happened to larg marginal branch

            Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
            Your browser doesn't have Flash, Silverlight or HTML5 support.


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

              Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
              Your browser doesn't have Flash, Silverlight or HTML5 support.


            • 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 :)

              Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
              Your browser doesn't have Flash, Silverlight or HTML5 support.


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

                Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                Your browser doesn't have Flash, Silverlight or HTML5 support.


              • ahmed S. excellent

                  Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                  Your browser doesn't have Flash, Silverlight or HTML5 support.


                • Phatarpekar A. Naice

                    Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                    Your browser doesn't have Flash, Silverlight or HTML5 support.


                  • Serob M. Thomas Hovasse, super!

                      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                      Your browser doesn't have Flash, Silverlight or HTML5 support.


                    • Mohammed H. excellent case

                        Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                        Your browser doesn't have Flash, Silverlight or HTML5 support.


                      Suggestions

                      Thursday, January 13th 2022 from 05pm to 06pm (GMT+1)
                      Honolulu : Thursday, January 13th 2022 from 06am to 07am (GMT-10)
                      San Francisco : Thursday, January 13th 2022 from 08am to 09am (GMT-8)
                      New York : Thursday, January 13th 2022 from 11am to 12pm (GMT-5)
                      Buenos Aires : Thursday, January 13th 2022 from 01pm to 02pm (GMT-3)
                      London / Dublin : Thursday, January 13th 2022 from 04pm to 05pm (GMT)
                      Paris / Berlin : Thursday, January 13th 2022 from 05pm to 06pm (GMT+1)
                      Istanbul : Thursday, January 13th 2022 from 06pm to 07pm (GMT+2)
                      Moscou / Dubaï : Thursday, January 13th 2022 from 08pm to 09pm (GMT+4)
                      Bangkok : Thursday, January 13th 2022 from 11pm to 12am (GMT+7)
                      Shanghai : Friday, January 14th 2022 from 12am to 01am (GMT+8)
                      Tokyo : Friday, January 14th 2022 from 01am to 02am (GMT+9)
                      Sydney : Friday, January 14th 2022 from 02am to 03am (GMT+10)
                      Wellington : Friday, January 14th 2022 from 04am to 05am (GMT+12)

                      Drug Coated Balloons - Complex Coronary Cases & long term follow up

                      Share
                      Wednesday, October 4th 2023 from 06pm to 06:45pm (GMT+1)
                      Honolulu : Wednesday, October 4th 2023 from 07am to 07:45am (GMT-10)
                      San Francisco : Wednesday, October 4th 2023 from 10am to 10:45am (GMT-7)
                      New York : Wednesday, October 4th 2023 from 01pm to 01:45pm (GMT-4)
                      Buenos Aires : Wednesday, October 4th 2023 from 02pm to 02:45pm (GMT-3)
                      Reykjavik : Wednesday, October 4th 2023 from 05pm to 05:45pm (GMT)
                      London / Dublin : Wednesday, October 4th 2023 from 06pm to 06:45pm (GMT+1)
                      Paris / Berlin : Wednesday, October 4th 2023 from 07pm to 07:45pm (GMT+2)
                      Istanbul : Wednesday, October 4th 2023 from 08pm to 08:45pm (GMT+3)
                      Moscou / Dubaï : Wednesday, October 4th 2023 from 09pm to 09:45pm (GMT+4)
                      Bangkok : Thursday, October 5th 2023 from 12am to 12:45am (GMT+7)
                      Shanghai : Thursday, October 5th 2023 from 01am to 01:45am (GMT+8)
                      Tokyo : Thursday, October 5th 2023 from 02am to 02:45am (GMT+9)
                      Sydney : Thursday, October 5th 2023 from 04am to 04:45am (GMT+11)
                      Wellington : Thursday, October 5th 2023 from 06am to 06:45am (GMT+13)

                      Guides de 1ère intention :

                      algorithme décisionnel de la lésion simple à la lésion complexe

                      Share
                      Tuesday, May 31st 2022 from 06pm to 07pm (GMT+1)
                      Honolulu : Tuesday, May 31st 2022 from 07am to 08am (GMT-10)
                      San Francisco : Tuesday, May 31st 2022 from 10am to 11am (GMT-7)
                      New York : Tuesday, May 31st 2022 from 01pm to 02pm (GMT-4)
                      Buenos Aires : Tuesday, May 31st 2022 from 02pm to 03pm (GMT-3)
                      Reykjavik : Tuesday, May 31st 2022 from 05pm to 06pm (GMT)
                      London / Dublin : Tuesday, May 31st 2022 from 06pm to 07pm (GMT+1)
                      Paris / Berlin : Tuesday, May 31st 2022 from 07pm to 08pm (GMT+2)
                      Istanbul : Tuesday, May 31st 2022 from 08pm to 09pm (GMT+3)
                      Moscou / Dubaï : Tuesday, May 31st 2022 from 09pm to 10pm (GMT+4)
                      Bangkok : Wednesday, June 1st 2022 from 12am to 01am (GMT+7)
                      Shanghai : Wednesday, June 1st 2022 from 01am to 02am (GMT+8)
                      Tokyo : Wednesday, June 1st 2022 from 02am to 03am (GMT+9)
                      Sydney : Wednesday, June 1st 2022 from 04am to 05am (GMT+11)
                      Wellington : Wednesday, June 1st 2022 from 06am to 07am (GMT+13)

                      The Role of Mechanical Circulatory Support in High-Risk PCI

                      Impella Case Club

                      Share
                      Tuesday, May 11th 2021 from 07pm to 08:30pm (GMT+1)
                      Honolulu : Tuesday, May 11th 2021 from 08am to 09:30am (GMT-10)
                      San Francisco : Tuesday, May 11th 2021 from 11am to 12:30pm (GMT-7)
                      New York : Tuesday, May 11th 2021 from 02pm to 03:30pm (GMT-4)
                      Buenos Aires : Tuesday, May 11th 2021 from 03pm to 04:30pm (GMT-3)
                      Reykjavik : Tuesday, May 11th 2021 from 06pm to 07:30pm (GMT)
                      London / Dublin : Tuesday, May 11th 2021 from 07pm to 08:30pm (GMT+1)
                      Paris / Berlin : Tuesday, May 11th 2021 from 08pm to 09:30pm (GMT+2)
                      Istanbul : Tuesday, May 11th 2021 from 09pm to 10:30pm (GMT+3)
                      Moscou / Dubaï : Tuesday, May 11th 2021 from 10pm to 11:30pm (GMT+4)
                      Bangkok : Wednesday, May 12th 2021 from 01am to 02:30am (GMT+7)
                      Shanghai : Wednesday, May 12th 2021 from 02am to 03:30am (GMT+8)
                      Tokyo : Wednesday, May 12th 2021 from 03am to 04:30am (GMT+9)
                      Sydney : Wednesday, May 12th 2021 from 05am to 06:30am (GMT+11)
                      Wellington : Wednesday, May 12th 2021 from 07am to 08:30am (GMT+13)

                      Royal Brompton & Harefield Masterclass

                      Focus on High Risk PCI

                      Share
                      Wednesday, November 24th 2021 from 12:30pm to 01:30pm (GMT+1)
                      Honolulu : Wednesday, November 24th 2021 from 01:30am to 02:30am (GMT-10)
                      San Francisco : Wednesday, November 24th 2021 from 03:30am to 04:30am (GMT-8)
                      New York : Wednesday, November 24th 2021 from 06:30am to 07:30am (GMT-5)
                      Buenos Aires : Wednesday, November 24th 2021 from 08:30am to 09:30am (GMT-3)
                      London / Dublin : Wednesday, November 24th 2021 from 11:30am to 12:30pm (GMT)
                      Paris / Berlin : Wednesday, November 24th 2021 from 12:30pm to 01:30pm (GMT+1)
                      Istanbul : Wednesday, November 24th 2021 from 01:30pm to 02:30pm (GMT+2)
                      Moscou / Dubaï : Wednesday, November 24th 2021 from 03:30pm to 04:30pm (GMT+4)
                      Bangkok : Wednesday, November 24th 2021 from 06:30pm to 07:30pm (GMT+7)
                      Shanghai : Wednesday, November 24th 2021 from 07:30pm to 08:30pm (GMT+8)
                      Tokyo : Wednesday, November 24th 2021 from 08:30pm to 09:30pm (GMT+9)
                      Sydney : Wednesday, November 24th 2021 from 09:30pm to 10:30pm (GMT+10)
                      Wellington : Wednesday, November 24th 2021 from 11:30pm to 12:30am (GMT+12)

                      The Fabulous Complex PCI Tournament

                      A search for rare, challenging and complicated PCI Cases

                      Share
                      Scroll Up