×
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

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

                      The journey from femoral to distal radial

                      Episode 2 - The Practice

                      Share
                      Tuesday, March 29th 2022 from 06pm to 07pm (GMT+1)
                      Honolulu : Tuesday, March 29th 2022 from 07am to 08am (GMT-10)
                      San Francisco : Tuesday, March 29th 2022 from 10am to 11am (GMT-7)
                      New York : Tuesday, March 29th 2022 from 01pm to 02pm (GMT-4)
                      Buenos Aires : Tuesday, March 29th 2022 from 02pm to 03pm (GMT-3)
                      Reykjavik : Tuesday, March 29th 2022 from 05pm to 06pm (GMT)
                      London / Dublin : Tuesday, March 29th 2022 from 06pm to 07pm (GMT+1)
                      Paris / Berlin : Tuesday, March 29th 2022 from 07pm to 08pm (GMT+2)
                      Istanbul : Tuesday, March 29th 2022 from 08pm to 09pm (GMT+3)
                      Moscou / Dubaï : Tuesday, March 29th 2022 from 09pm to 10pm (GMT+4)
                      Bangkok : Wednesday, March 30th 2022 from 12am to 01am (GMT+7)
                      Shanghai : Wednesday, March 30th 2022 from 01am to 02am (GMT+8)
                      Tokyo : Wednesday, March 30th 2022 from 02am to 03am (GMT+9)
                      Sydney : Wednesday, March 30th 2022 from 04am to 05am (GMT+11)
                      Wellington : Wednesday, March 30th 2022 from 06am to 07am (GMT+13)

                      The Role of Mechanical Circulatory Support in Complex VT Cases

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

                      Heartpump support for High Risk PCI and Cardiogenic Shock

                      Share
                      Tuesday, June 22nd 2021 from 05pm to 06pm (GMT+1)
                      Honolulu : Tuesday, June 22nd 2021 from 06am to 07am (GMT-10)
                      San Francisco : Tuesday, June 22nd 2021 from 09am to 10am (GMT-7)
                      New York : Tuesday, June 22nd 2021 from 12pm to 01pm (GMT-4)
                      Buenos Aires : Tuesday, June 22nd 2021 from 01pm to 02pm (GMT-3)
                      Reykjavik : Tuesday, June 22nd 2021 from 04pm to 05pm (GMT)
                      London / Dublin : Tuesday, June 22nd 2021 from 05pm to 06pm (GMT+1)
                      Paris / Berlin : Tuesday, June 22nd 2021 from 06pm to 07pm (GMT+2)
                      Istanbul : Tuesday, June 22nd 2021 from 07pm to 08pm (GMT+3)
                      Moscou / Dubaï : Tuesday, June 22nd 2021 from 08pm to 09pm (GMT+4)
                      Bangkok : Tuesday, June 22nd 2021 from 11pm to 12am (GMT+7)
                      Shanghai : Wednesday, June 23rd 2021 from 12am to 01am (GMT+8)
                      Tokyo : Wednesday, June 23rd 2021 from 01am to 02am (GMT+9)
                      Sydney : Wednesday, June 23rd 2021 from 03am to 04am (GMT+11)
                      Wellington : Wednesday, June 23rd 2021 from 05am to 06am (GMT+13)

                      When, why and how to perform an endomyocardial Biopsy?

                      Share
                      Tuesday, June 15th 2021 from 06pm to 07:30pm (GMT+1)
                      Honolulu : Tuesday, June 15th 2021 from 07am to 08:30am (GMT-10)
                      San Francisco : Tuesday, June 15th 2021 from 10am to 11:30am (GMT-7)
                      New York : Tuesday, June 15th 2021 from 01pm to 02:30pm (GMT-4)
                      Buenos Aires : Tuesday, June 15th 2021 from 02pm to 03:30pm (GMT-3)
                      Reykjavik : Tuesday, June 15th 2021 from 05pm to 06:30pm (GMT)
                      London / Dublin : Tuesday, June 15th 2021 from 06pm to 07:30pm (GMT+1)
                      Paris / Berlin : Tuesday, June 15th 2021 from 07pm to 08:30pm (GMT+2)
                      Istanbul : Tuesday, June 15th 2021 from 08pm to 09:30pm (GMT+3)
                      Moscou / Dubaï : Tuesday, June 15th 2021 from 09pm to 10:30pm (GMT+4)
                      Bangkok : Wednesday, June 16th 2021 from 12am to 01:30am (GMT+7)
                      Shanghai : Wednesday, June 16th 2021 from 01am to 02:30am (GMT+8)
                      Tokyo : Wednesday, June 16th 2021 from 02am to 03:30am (GMT+9)
                      Sydney : Wednesday, June 16th 2021 from 04am to 05:30am (GMT+11)
                      Wellington : Wednesday, June 16th 2021 from 06am to 07:30am (GMT+13)

                      Smart Assist and Connect Function

                      Game Changer in Impella Patient Treatment

                      Share
                      Monday, October 30th 2023 from 05pm to 06pm (GMT+1)
                      Honolulu : Monday, October 30th 2023 from 06am to 07am (GMT-10)
                      San Francisco : Monday, October 30th 2023 from 08am to 09am (GMT-8)
                      New York : Monday, October 30th 2023 from 11am to 12pm (GMT-5)
                      Buenos Aires : Monday, October 30th 2023 from 01pm to 02pm (GMT-3)
                      London / Dublin : Monday, October 30th 2023 from 04pm to 05pm (GMT)
                      Paris / Berlin : Monday, October 30th 2023 from 05pm to 06pm (GMT+1)
                      Istanbul : Monday, October 30th 2023 from 06pm to 07pm (GMT+2)
                      Moscou / Dubaï : Monday, October 30th 2023 from 08pm to 09pm (GMT+4)
                      Bangkok : Monday, October 30th 2023 from 11pm to 12am (GMT+7)
                      Shanghai : Tuesday, October 31st 2023 from 12am to 01am (GMT+8)
                      Tokyo : Tuesday, October 31st 2023 from 01am to 02am (GMT+9)
                      Sydney : Tuesday, October 31st 2023 from 02am to 03am (GMT+10)
                      Wellington : Tuesday, October 31st 2023 from 04am to 05am (GMT+12)

                      How do the new antithrombotic recommendations affect your HBR patients?

                      Gain insights from a patient case analysis

                      Share
                      Tuesday, October 26th 2021 from 08:30am to 10am (GMT+1)
                      Honolulu : Monday, October 25th 2021 from 09:30pm to 11pm (GMT-10)
                      San Francisco : Tuesday, October 26th 2021 from 12:30am to 02am (GMT-7)
                      New York : Tuesday, October 26th 2021 from 03:30am to 05am (GMT-4)
                      Buenos Aires : Tuesday, October 26th 2021 from 04:30am to 06am (GMT-3)
                      Reykjavik : Tuesday, October 26th 2021 from 07:30am to 09am (GMT)
                      London / Dublin : Tuesday, October 26th 2021 from 08:30am to 10am (GMT+1)
                      Paris / Berlin : Tuesday, October 26th 2021 from 09:30am to 11am (GMT+2)
                      Istanbul : Tuesday, October 26th 2021 from 10:30am to 12pm (GMT+3)
                      Moscou / Dubaï : Tuesday, October 26th 2021 from 11:30am to 01pm (GMT+4)
                      Bangkok : Tuesday, October 26th 2021 from 02:30pm to 04pm (GMT+7)
                      Shanghai : Tuesday, October 26th 2021 from 03:30pm to 05pm (GMT+8)
                      Tokyo : Tuesday, October 26th 2021 from 04:30pm to 06pm (GMT+9)
                      Sydney : Tuesday, October 26th 2021 from 06:30pm to 08pm (GMT+11)
                      Wellington : Tuesday, October 26th 2021 from 08:30pm to 10pm (GMT+13)

                      Novel approach of coronary microcirculation

                      Absolute coronary flow and micro secular resistances in clinical practice

                      Share
                      Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                      Honolulu : Thursday, March 16th 2023 from 06am to 08:30am (GMT-10)
                      San Francisco : Thursday, March 16th 2023 from 08am to 10:30am (GMT-8)
                      New York : Thursday, March 16th 2023 from 11am to 01:30pm (GMT-5)
                      Buenos Aires : Thursday, March 16th 2023 from 01pm to 03:30pm (GMT-3)
                      London / Dublin : Thursday, March 16th 2023 from 04pm to 06:30pm (GMT)
                      Paris / Berlin : Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                      Istanbul : Thursday, March 16th 2023 from 06pm to 08:30pm (GMT+2)
                      Moscou / Dubaï : Thursday, March 16th 2023 from 08pm to 10:30pm (GMT+4)
                      Bangkok : Thursday, March 16th 2023 from 11pm to 01:30am (GMT+7)
                      Shanghai : Friday, March 17th 2023 from 12am to 02:30am (GMT+8)
                      Tokyo : Friday, March 17th 2023 from 01am to 03:30am (GMT+9)
                      Sydney : Friday, March 17th 2023 from 02am to 04:30am (GMT+10)
                      Wellington : Friday, March 17th 2023 from 04am to 06:30am (GMT+12)

                      Bifurcation PCI - Insights from the Visible Heart® Lab 

                      Share
                      Scroll Up