×
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.

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
19710 views
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

Last update : 2019-05-28
Khaldoon Alaswad
Detroit, United States
Owayed Al Shammeri
Riyadh, Saudi Arabia, Saudi Arabia

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
7 comments
Join the Discussion
See previous comments (3)
  • Amir ali M. nice job

      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.


    • Naga ganesh K. Great

        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.


      • Mochamad Faishal R. Excellent technique

          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.


        • Pierre D. very educational 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.


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

              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.


            • Venkatesa R. very good

                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.


              • Tekten T. thanks

                  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, July 16th 2020 from 05:30pm to 06:45pm (GMT+2)
                Honolulu : Thursday, July 16th 2020 from 05:30am to 06:45am (GMT-10)
                San Francisco : Thursday, July 16th 2020 from 08:30am to 09:45am (GMT-7)
                New York : Thursday, July 16th 2020 from 11:30am to 12:45pm (GMT-4)
                Buenos Aires : Thursday, July 16th 2020 from 12:30pm to 01:45pm (GMT-3)
                Reykjavik : Thursday, July 16th 2020 from 03:30pm to 04:45pm (GMT)
                London / Dublin : Thursday, July 16th 2020 from 04:30pm to 05:45pm (GMT+1)
                Paris / Berlin : Thursday, July 16th 2020 from 05:30pm to 06:45pm (GMT+2)
                Istanbul : Thursday, July 16th 2020 from 06:30pm to 07:45pm (GMT+3)
                Moscou / Dubaï : Thursday, July 16th 2020 from 07:30pm to 08:45pm (GMT+4)
                Bangkok : Thursday, July 16th 2020 from 10:30pm to 11:45pm (GMT+7)
                Shanghai : Thursday, July 16th 2020 from 11:30pm to 12:45am (GMT+8)
                Tokyo : Friday, July 17th 2020 from 12:30am to 01:45am (GMT+9)
                Sydney : Friday, July 17th 2020 from 02:30am to 03:45am (GMT+11)
                Wellington : Friday, July 17th 2020 from 04:30am to 05:45am (GMT+13)

                State of the art PCI for calcified coronary lesions - the right tools

                A cased based discussion

                Share
                Wednesday, November 7th 2018 from 06pm to 07:30pm (GMT+2)
                Honolulu : Wednesday, November 7th 2018 from 06am to 07:30am (GMT-10)
                San Francisco : Wednesday, November 7th 2018 from 08am to 09:30am (GMT-8)
                New York : Wednesday, November 7th 2018 from 11am to 12:30pm (GMT-5)
                Buenos Aires : Wednesday, November 7th 2018 from 01pm to 02:30pm (GMT-3)
                London / Dublin : Wednesday, November 7th 2018 from 04pm to 05:30pm (GMT)
                Paris / Berlin : Wednesday, November 7th 2018 from 05pm to 06:30pm (GMT+1)
                Istanbul : Wednesday, November 7th 2018 from 06pm to 07:30pm (GMT+2)
                Moscou / Dubaï : Wednesday, November 7th 2018 from 08pm to 09:30pm (GMT+4)
                Bangkok : Wednesday, November 7th 2018 from 11pm to 12:30am (GMT+7)
                Shanghai : Thursday, November 8th 2018 from 12am to 01:30am (GMT+8)
                Tokyo : Thursday, November 8th 2018 from 01am to 02:30am (GMT+9)
                Sydney : Thursday, November 8th 2018 from 02am to 03:30am (GMT+10)
                Wellington : Thursday, November 8th 2018 from 04am to 05:30am (GMT+12)

                Bifurcation - Multivessels - Calcifications: How to treat the complex?

                Complex PTCA: Experts' analysis

                Share
                Thursday, September 12th 2019 from 12pm to 01:30pm (GMT+2)
                Honolulu : Thursday, September 12th 2019 from 12am to 01:30am (GMT-10)
                San Francisco : Thursday, September 12th 2019 from 03am to 04:30am (GMT-7)
                New York : Thursday, September 12th 2019 from 06am to 07:30am (GMT-4)
                Buenos Aires : Thursday, September 12th 2019 from 07am to 08:30am (GMT-3)
                Reykjavik : Thursday, September 12th 2019 from 10am to 11:30am (GMT)
                London / Dublin : Thursday, September 12th 2019 from 11am to 12:30pm (GMT+1)
                Paris / Berlin : Thursday, September 12th 2019 from 12pm to 01:30pm (GMT+2)
                Istanbul : Thursday, September 12th 2019 from 01pm to 02:30pm (GMT+3)
                Moscou / Dubaï : Thursday, September 12th 2019 from 02pm to 03:30pm (GMT+4)
                Bangkok : Thursday, September 12th 2019 from 05pm to 06:30pm (GMT+7)
                Shanghai : Thursday, September 12th 2019 from 06pm to 07:30pm (GMT+8)
                Tokyo : Thursday, September 12th 2019 from 07pm to 08:30pm (GMT+9)
                Sydney : Thursday, September 12th 2019 from 09pm to 10:30pm (GMT+11)
                Wellington : Thursday, September 12th 2019 from 11pm to 12:30am (GMT+13)

                Coronary Microcirculation: How and Why?

                Daily Practice Measurement - Technics and Indications

                Share
                Thursday, January 28th 2021 from 06pm to 07:30pm (GMT+2)
                Honolulu : Thursday, January 28th 2021 from 06am to 07:30am (GMT-10)
                San Francisco : Thursday, January 28th 2021 from 08am to 09:30am (GMT-8)
                New York : Thursday, January 28th 2021 from 11am to 12:30pm (GMT-5)
                Buenos Aires : Thursday, January 28th 2021 from 01pm to 02:30pm (GMT-3)
                London / Dublin : Thursday, January 28th 2021 from 04pm to 05:30pm (GMT)
                Paris / Berlin : Thursday, January 28th 2021 from 05pm to 06:30pm (GMT+1)
                Istanbul : Thursday, January 28th 2021 from 06pm to 07:30pm (GMT+2)
                Moscou / Dubaï : Thursday, January 28th 2021 from 08pm to 09:30pm (GMT+4)
                Bangkok : Thursday, January 28th 2021 from 11pm to 12:30am (GMT+7)
                Shanghai : Friday, January 29th 2021 from 12am to 01:30am (GMT+8)
                Tokyo : Friday, January 29th 2021 from 01am to 02:30am (GMT+9)
                Sydney : Friday, January 29th 2021 from 02am to 03:30am (GMT+10)
                Wellington : Friday, January 29th 2021 from 04am to 05:30am (GMT+12)

                Patientenmanagement während einer „Protected PCI“: Wie reduziere ich das periprozedurale Risiko...

                COMPLEX SKILLS in Protected PCI Series - Course 2

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

                Smart Assist and Connect Function

                Game Changer in Impella Patient Treatment

                Share
                Monday, April 27th 2020 from 06pm to 07pm (GMT+2)
                Honolulu : Monday, April 27th 2020 from 06am to 07am (GMT-10)
                San Francisco : Monday, April 27th 2020 from 09am to 10am (GMT-7)
                New York : Monday, April 27th 2020 from 12pm to 01pm (GMT-4)
                Buenos Aires : Monday, April 27th 2020 from 01pm to 02pm (GMT-3)
                Reykjavik : Monday, April 27th 2020 from 04pm to 05pm (GMT)
                London / Dublin : Monday, April 27th 2020 from 05pm to 06pm (GMT+1)
                Paris / Berlin : Monday, April 27th 2020 from 06pm to 07pm (GMT+2)
                Istanbul : Monday, April 27th 2020 from 07pm to 08pm (GMT+3)
                Moscou / Dubaï : Monday, April 27th 2020 from 08pm to 09pm (GMT+4)
                Bangkok : Monday, April 27th 2020 from 11pm to 12am (GMT+7)
                Shanghai : Tuesday, April 28th 2020 from 12am to 01am (GMT+8)
                Tokyo : Tuesday, April 28th 2020 from 01am to 02am (GMT+9)
                Sydney : Tuesday, April 28th 2020 from 03am to 04am (GMT+11)
                Wellington : Tuesday, April 28th 2020 from 05am to 06am (GMT+13)

                Post 11 Mai : Questions pratiques sur la prise en charge cardiovasculaire

                Share
                Thursday, June 18th 2020 from 05pm to 06pm (GMT+2)
                Honolulu : Thursday, June 18th 2020 from 05am to 06am (GMT-10)
                San Francisco : Thursday, June 18th 2020 from 08am to 09am (GMT-7)
                New York : Thursday, June 18th 2020 from 11am to 12pm (GMT-4)
                Buenos Aires : Thursday, June 18th 2020 from 12pm to 01pm (GMT-3)
                Reykjavik : Thursday, June 18th 2020 from 03pm to 04pm (GMT)
                London / Dublin : Thursday, June 18th 2020 from 04pm to 05pm (GMT+1)
                Paris / Berlin : Thursday, June 18th 2020 from 05pm to 06pm (GMT+2)
                Istanbul : Thursday, June 18th 2020 from 06pm to 07pm (GMT+3)
                Moscou / Dubaï : Thursday, June 18th 2020 from 07pm to 08pm (GMT+4)
                Bangkok : Thursday, June 18th 2020 from 10pm to 11pm (GMT+7)
                Shanghai : Thursday, June 18th 2020 from 11pm to 12am (GMT+8)
                Tokyo : Friday, June 19th 2020 from 12am to 01am (GMT+9)
                Sydney : Friday, June 19th 2020 from 02am to 03am (GMT+11)
                Wellington : Friday, June 19th 2020 from 04am to 05am (GMT+13)

                Ein Aufruf zum Neustart

                Notwendigkeit komplexer Koronarinterventionen während der Covid-19 Pandemie

                Share
                Thursday, June 25th 2020 from 05pm to 06:30pm (GMT+2)
                Honolulu : Thursday, June 25th 2020 from 05am to 06:30am (GMT-10)
                San Francisco : Thursday, June 25th 2020 from 08am to 09:30am (GMT-7)
                New York : Thursday, June 25th 2020 from 11am to 12:30pm (GMT-4)
                Buenos Aires : Thursday, June 25th 2020 from 12pm to 01:30pm (GMT-3)
                Reykjavik : Thursday, June 25th 2020 from 03pm to 04:30pm (GMT)
                London / Dublin : Thursday, June 25th 2020 from 04pm to 05:30pm (GMT+1)
                Paris / Berlin : Thursday, June 25th 2020 from 05pm to 06:30pm (GMT+2)
                Istanbul : Thursday, June 25th 2020 from 06pm to 07:30pm (GMT+3)
                Moscou / Dubaï : Thursday, June 25th 2020 from 07pm to 08:30pm (GMT+4)
                Bangkok : Thursday, June 25th 2020 from 10pm to 11:30pm (GMT+7)
                Shanghai : Thursday, June 25th 2020 from 11pm to 12:30am (GMT+8)
                Tokyo : Friday, June 26th 2020 from 12am to 01:30am (GMT+9)
                Sydney : Friday, June 26th 2020 from 02am to 03:30am (GMT+11)
                Wellington : Friday, June 26th 2020 from 04am to 05:30am (GMT+13)

                Approaching Complex CTOs via radial access

                Day 2

                Share
                Scroll Up