Video : Retrograde RCA CTO PCI through epicardial collaterals

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.

Cardiology / Coronary / Pci / Case in the box

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

This complete didactic procedure concerns a 68 yo male, with history of LAD PCI. The coronary angiography has also shown proximal RCA Chronic Total Occlusion with residual proven ischemia.

This Proximal RCA Chronic Total Occlusion was recanalized retrogradely through epicardial collaterals with good final result.

Educational objectives

How to manage patients with coronary CTO.
How to apply the Hybrid algorithm during coronary CTO procedures.
How to perform antegrade Knuckle wire Technique.
How to select & approach epicardial collaterals.
How to perform Reverse CART Technique.

Step-by-Step Procedure

Double Access: Right Femoral 7F, Left Radial 6F.
Dual injection & angiographic evaluation.
Antegrade approach using Turnpike Spiral (Teleflex) & Fielder XT-A (Asahi) and then Gaia 3rd guidewire (Asahi).
Antegrade wire Knuckling to the distal RCA using Fielder XT-A.
Distal re-entry failure with Pilot 200 (Abbott).
Retrograde Approach using epicardial collaterals from Left Cx: Sion guidewire (Asahi) & Turnpike LP (Teleflex).
Revere CART technique using a 3.5x20mm balloon, guideliner V3 support (Teleflex) & Pilot 200 guidewire (Abbott).
Predilatation.
Stenting with multiple DES Supraflex (Teleflex).
Left system microcatheter removing & control.
Final result.

Protocol

Procedural time: 120min.
Contrast medium: 310ml (Ultravist)
Exposure: 1.6 Gy.
Fluoroscopic time: 65min.

Biobliography

Optimal approach to percutaneous intervention for CTO in 2017: a hybrid strategy is now the preferred choice - Editorial
Authors: Simon J. Walsh, MD, FRCP; Colm G. Hanratty, MD, FRCP; James C. Spratt, MD, FRCP
Epicardial collateral channel for retrograded recanalization of chronic total occlusion percutaneous coronary intervention: Predictors of failure and procedural outcome.- Article
Authors: Huang Z, Ma D, Zhang B, Folson AA, Lin J, Wu K, Liao H, Zhong Z.
Publication: 2018 Feb;31(1):23-30. doi: 10.1111/joic.12441. Epub 2017 Sep 19
Outcomes of the retrograde approach through epicardial versus non-epicardial collaterals in chronic total occlusion percutaneous coronary intervention. - Article
Authors: Benincasa S, Azzalini L, Carlino M, Bellini B, Giannini F, Zhao X, Colombo A.
Publication: 2017 Sep;18(6):393-398. doi: 10.1016/j.carrev.2017.03.013. Epub 2017 Mar 14.
Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral related complication. - Article
Authors: Ma JY, Qian JY, Ge L, Fan B, Wang QB, Yan Y, Zhang F, Yao K, Huang D, Ge JB.
Publication:2013 Mar;126(6):1086-91.
Intracoronary snaring of the retrograde guidewire: How to overcome extreme takeoff angles in chronic total occlusion percutaneous coronary intervention. - Article
Authors: Azzalini L, Candilio L, Carlino M, Colombo A.
Publication:2018 Feb 15;91(3):464-469. doi: 10.1002/ccd.27324. Epub 2017 Sep 25.

Shooting date : 2018-10-30
Last update : 2021-05-11

Join the Discussion

See previous comments (3)

hashemi fard O. Excellent

2018-11-23, 21h09
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.

1 - Add file(s) upload
omer S. thank you. very good job.

2019-01-20, 10h24
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.

1 - Add file(s) upload
Nihat O. Exclude final viwe good job

2019-01-20, 14h22
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.

1 - Add file(s) upload
Muhammad Asghar K. Excelent and very educational

2019-01-20, 18h25
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.

1 - Add file(s) upload
Pecheux M. Vert pedagogic

2019-01-21, 18h51
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.

1 - Add file(s) upload
Deogenes M. Amazing video

2019-01-22, 5h12
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.

1 - Add file(s) upload
albayrak S. Z

2019-01-22, 11h49
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.

1 - Add file(s) upload

Retrograde RCA CTO PCI through epicardial collaterals

Case of the month: January 2019

Become an Incathlab member and receive full access to its content!