×
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
22137 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

Shooting date : 2019-01-18
Last update : 2019-05-28
Dr. 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

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

                Heartpump support for High Risk PCI and Cardiogenic Shock

                Share
                Wednesday, September 14th 2022 from 06pm to 07pm (GMT+2)
                Honolulu : Wednesday, September 14th 2022 from 06am to 07am (GMT+2)
                San Francisco : Wednesday, September 14th 2022 from 09am to 10am (GMT+2)
                New York : Wednesday, September 14th 2022 from 12pm to 01pm (GMT+2)
                Buenos Aires : Wednesday, September 14th 2022 from 01pm to 02pm (GMT+2)
                Reykjavik : Wednesday, September 14th 2022 from 04pm to 05pm (GMT+2)
                London / Dublin : Wednesday, September 14th 2022 from 05pm to 06pm (GMT+2)
                Paris / Berlin : Wednesday, September 14th 2022 from 06pm to 07pm (GMT+2)
                Istanbul : Wednesday, September 14th 2022 from 07pm to 08pm (GMT+2)
                Moscou / Dubaï : Wednesday, September 14th 2022 from 08pm to 09pm (GMT+2)
                Bangkok : Wednesday, September 14th 2022 from 11pm to 12am (GMT+2)
                Shanghai : Thursday, September 15th 2022 from 12am to 01am (GMT+2)
                Tokyo : Thursday, September 15th 2022 from 01am to 02am (GMT+2)
                Sydney : Thursday, September 15th 2022 from 03am to 04am (GMT+2)
                Wellington : Thursday, September 15th 2022 from 05am to 06am (GMT+2)

                Protected PCI: Clinical Evidence and Best Practices Improvement

                Impella Case Club

                Share
                Thursday, October 6th 2022 from 12:30pm to 02pm (GMT+2)
                Honolulu : Thursday, October 6th 2022 from 12:30am to 02am (GMT+2)
                San Francisco : Thursday, October 6th 2022 from 03:30am to 05am (GMT+2)
                New York : Thursday, October 6th 2022 from 06:30am to 08am (GMT+2)
                Buenos Aires : Thursday, October 6th 2022 from 07:30am to 09am (GMT+2)
                Reykjavik : Thursday, October 6th 2022 from 10:30am to 12pm (GMT+2)
                London / Dublin : Thursday, October 6th 2022 from 11:30am to 01pm (GMT+2)
                Paris / Berlin : Thursday, October 6th 2022 from 12:30pm to 02pm (GMT+2)
                Istanbul : Thursday, October 6th 2022 from 01:30pm to 03pm (GMT+2)
                Moscou / Dubaï : Thursday, October 6th 2022 from 02:30pm to 04pm (GMT+2)
                Bangkok : Thursday, October 6th 2022 from 05:30pm to 07pm (GMT+2)
                Shanghai : Thursday, October 6th 2022 from 06:30pm to 08pm (GMT+2)
                Tokyo : Thursday, October 6th 2022 from 07:30pm to 09pm (GMT+2)
                Sydney : Thursday, October 6th 2022 from 09:30pm to 11pm (GMT+2)
                Wellington : Thursday, October 6th 2022 from 11:30pm to 01am (GMT+2)

                Ballon actif ou stent actif

                Quand le passé rencontre le futur

                Share
                Thursday, January 19th 2023 from 05pm to 06pm (GMT+1)
                Honolulu : Thursday, January 19th 2023 from 05am to 06am (GMT+1)
                San Francisco : Thursday, January 19th 2023 from 07am to 08am (GMT+1)
                New York : Thursday, January 19th 2023 from 10am to 11am (GMT+1)
                Buenos Aires : Thursday, January 19th 2023 from 12pm to 01pm (GMT+1)
                London / Dublin : Thursday, January 19th 2023 from 03pm to 04pm (GMT+1)
                Paris / Berlin : Thursday, January 19th 2023 from 04pm to 05pm (GMT+1)
                Istanbul : Thursday, January 19th 2023 from 05pm to 06pm (GMT+1)
                Moscou / Dubaï : Thursday, January 19th 2023 from 07pm to 08pm (GMT+1)
                Bangkok : Thursday, January 19th 2023 from 10pm to 11pm (GMT+1)
                Shanghai : Thursday, January 19th 2023 from 11pm to 12am (GMT+1)
                Tokyo : Friday, January 20th 2023 from 12am to 01am (GMT+1)
                Sydney : Friday, January 20th 2023 from 01am to 02am (GMT+1)
                Wellington : Friday, January 20th 2023 from 03am to 04am (GMT+1)

                Left Main Bifurcation from data to clinical practice

                Share
                Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                Honolulu : Thursday, March 16th 2023 from 05am to 07:30am (GMT+1)
                San Francisco : Thursday, March 16th 2023 from 07am to 09:30am (GMT+1)
                New York : Thursday, March 16th 2023 from 10am to 12:30pm (GMT+1)
                Buenos Aires : Thursday, March 16th 2023 from 12pm to 02:30pm (GMT+1)
                London / Dublin : Thursday, March 16th 2023 from 03pm to 05:30pm (GMT+1)
                Paris / Berlin : Thursday, March 16th 2023 from 04pm to 06:30pm (GMT+1)
                Istanbul : Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                Moscou / Dubaï : Thursday, March 16th 2023 from 07pm to 09:30pm (GMT+1)
                Bangkok : Thursday, March 16th 2023 from 10pm to 12:30am (GMT+1)
                Shanghai : Thursday, March 16th 2023 from 11pm to 01:30am (GMT+1)
                Tokyo : Friday, March 17th 2023 from 12am to 02:30am (GMT+1)
                Sydney : Friday, March 17th 2023 from 01am to 03:30am (GMT+1)
                Wellington : Friday, March 17th 2023 from 03am to 05:30am (GMT+1)

                Bifurcation PCI - Insights from the Visible Heart® Lab 

                Share
                Scroll Up