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Chapters (9)
Description
Date : Monday, November 30th -0001 from 12am to 12am (GMT+2)
Honolulu : Monday, November 29th 1999 from 12pm to 12pm (GMT-10)
San Francisco : Monday, November 29th 1999 from 02pm to 02pm (GMT-8)
New York : Monday, November 29th 1999 from 05pm to 05pm (GMT-5)
Buenos Aires : Monday, November 29th 1999 from 07pm to 07pm (GMT-3)
London / Dublin : Monday, November 29th 1999 from 10pm to 10pm (GMT)
Paris / Berlin : Monday, November 29th 1999 from 11pm to 11pm (GMT+1)
Istanbul : Tuesday, November 30th 1999 from 12am to 12am (GMT+2)
Moscou / Dubaï : Tuesday, November 30th 1999 from 02am to 02am (GMT+4)
Bangkok : Tuesday, November 30th 1999 from 05am to 05am (GMT+7)
Shanghai : Tuesday, November 30th 1999 from 06am to 06am (GMT+8)
Tokyo : Tuesday, November 30th 1999 from 07am to 07am (GMT+9)
Sydney : Tuesday, November 30th 1999 from 08am to 08am (GMT+10)
Wellington : Tuesday, November 30th 1999 from 10am to 10am (GMT+12)
Last update : 2019-05-28
Language(s) : English
Views : 18418
This complete didactic procedure concerns a 41 yo male, with multiple cardiovascular risk factors, presenting severe excertional angin...
This complete didactic procedure concerns a 41 yo male, with multiple cardiovascular risk factors, presenting severe excertional angina related to ostial LAD chronic total occlusion.
The LAD CTO was successfully recanalized antegradly using IVUS guided-puncture Technique & Bifurcation Stenting LAD-D1 with DK-Crush Technique.

Educational objectives

  • How to manage diabetic patients with one vessel disease (Proximal LAD CTO): CABG vs PCI.
  • Step-by-Step setup & Access-guiding catheters choice.
  • Application of the Hybrid algorithm in CTO PCI procedures.
  • IVUS guided proximal  CAP puncture technique.
  • Tips & Tricks to gain support and safely advance microcatheters, balloons...in uncrossable lesions.
  • How to Stent bifurcations in CTO lesions.
  • How to perform double Stent Technique: DK-Crush.
  • How to prevent complications during every Step CTO PCI procedure.

Step-by-Step procedure

  • Dual Femoral Access : 8F introducer in Right CFA & 7F introducer in Left CFA.
  • JR 7F  guiding catheter for the RCA & 8F EBU3.0 for the Left main.
  • Proximal CAP engagment using Workhorse guidewire Sionblue (Asahi) then Fielder XT-A (Asahi) & Low profile microcatheter Caravel (Asahi).
  • Advancement of the Filder XT-R into the first diagonal.
  • Trapping the microcather with Trapping dedicated Device: Trapper (Boston Scientific).
  • Predilation toward the Diagonal with small balloon 1.5x20mm.
  • Exchange of the Fielder XT-A (Asahi) with a workhorse guidewire Sionblue (Asahi).
  • IVUS evaluation of the proximal CAP.
  • Echo-guided puncture using a Fielder XT-A Guidewire & Caravel microcatheter (Asahi).
  • Exchange Fielder XT-A guidewire to Gaia Second (Asahi) to cross the occlusion & angiographic control in two orthogonal views.
  • Anchoring balloon technique in the diagonal to advance the Caravel into the LAD.
  • After failing the Anchoring balloon technique, a dilatation of the proximal Cap using a small balloon 1.5x20mm was performed.
  • Exchange  to the microcatheter & Crossing into the true lumen using a workhorse guidewire Runthrough guidewire (Terumo).
  • Predilatation of the Diagonal & the LAD with  2.5x15mm.
  • Angiographic control.
  • Bifurcation two stents technique: LAD-1st Diagonal with DK-Crush Technique.

Biobliography

CTO technics

Linked playlists (4)

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  • Amir ali M. nice job

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    • Naga ganesh K. Great

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      • Mochamad Faishal R. Excellent technique

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        • Pierre D. very educational case

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          • hazem E. excellent comprehensive presentation to the point clear steps

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            • Venkatesa R. very good

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              • Tekten T. thanks

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