How to approach ostial RCA CTO: a case based strategy ?

Learning objectives

• Learn how to treat ostial CTOs
• Put into practice the hybrid algorithm
• Learn about strategies and devices used for retrograde CTOs

Key points of the procedure

• Ostial CTOs usually needs a retrograde approach
• Snaring if often required in those cases
• Septal surfing may be challenging and needs several wires available to be successful

Step-by-step procedure

Chapter 1

• Intial dual injection angiography and procedure planning
• Material selection

Chapter 2

• Septal surfing using Turnpike LP MC
• Challenging septals with multiple attempts
• How to define the position of your wire between cavity and artery
• Different wires sued : Sion – Suho 3 and Filder XTr

Chapter 3

• How to advance your MC through the septal
• Knuckling your wire

Chapter 4 and 5

• How to snare your retrograde wire
• Where to perform your snaring
• Which wire to snare

Chapter 6

• Wire externalisation and predilatation

Bibliography

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- An algorithmic approach for the management of ostial right coronary artery chronic total occlusions.

Avran A, Boukhris M, Drogoul L, Brilakis ES.
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