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Chapters (9)
Description
Shooting date : 2018-01-11
Last update : 2018-06-16
Language(s) : English

This didactic procedure concerns a 63 y.o male, with  medical history of CAD (Lcx already treated few months before, LAD CTO JCTO Scor...

This didactic procedure concerns a 63 y.o male, with  medical history of CAD (Lcx already treated few months before, LAD CTO JCTO Score:4).

First attempt of LAD recanalization  has failed, the patient is still symptomatic  despite OMT.

The second attempt was a success with retrograde approach using IVUS guided retrograde puncture.

Educational objectives

  • How to approach patients with Symptomatic coronary  chronic total occlusions.
  • Optimal Application of the Hybrid algorithm in treatment of coronary CTO.
  • Evaluation of the anatomical complexity of coronary CTO with combined angiography and IVUS.
  • IVUS usefulness to decide strategy in coronary CTO procedures.
  • Step by step retrograde approach in coronary CTO procedures.
  • IVUS guidance for safe retrograde and antegrade punctures.
  • How to optimize sizing and stent implantation in Coronary CTO procedures.

Step-by-Step procedure

  • Double Femoral approach 7F introducers.
  • EBU 3.5 7F to the Left system and AL0.75 7F to the right system with two Sion blue wires for stabilization.
  • IVUS assessment of the LAD Poximal CAP.
  • Retrograde approach with Corsair microcatheter and surfing technique via PDA-septal connections using a Sion black guidewire.
  • IVUS evaluation of the  retrograde wire position.
  • Retrograde puncture of the proximal CAP using a Confianza Pro 12 guidewire.
  • IVUS evaluation of t the Confianza Pro12 wire confirming subintimal position in the Proximal LAD.
  • Antegrade puncture using a Confianza Pro12 and Finecross microcatheter.
  • Progession antergradelly using Finecross microcatheter and Sion black wire.
  • Confirming the distal position with safe Tip injection.
  • IVUS evaluation of the antegrade wire and LAD sizing.
  • Retrograde material remove.
  • Predilatation and stenting of Ostio-proximal LAD with Promus 3.0x32mm DES.
  • Stenting of the Mid-LAD with Promus 2.5x24mm.
  • Final angiographic and IVUS control and Optimization.

Biobliography

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  • Mohamed M. Good job

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    • Rohit M. Good discuss so far

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      • Hatem E. Very nice

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        • Leonid G. Excellent and rational

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          • Tameka C. Very informative. New to CTO procedures..

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            • Denis Nikolov D. Good job ;)

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              • Mohamed M. Good

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                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)

                Complex CTO: Ostial LAD CTO with ambiguous Proximal CAP

                Case of the month: May 2019

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