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2nd Edition ML CTO 2017

The 2nd Edition of the international Multi-level CTO Course was held in Nice (France) from June 29th to July 1st, 2017 at Palais de la Méditerranée, and brought together over 450 participants from 40 countries. Following the success of the 2016 first Edition, the main goal of this event was to bring together all passionate operators in one place: from beginners to experts in a climate of openness and congeniality. This conference, with simultaneous translation in English and French, was organized on 3 days modules:

  • Module 1 - Module dedicated to operators willing to learn and/or reinforce their CTO knowledge on: antegrade basic techniques and strategies - first steps in retrograde.
  • Module 2 - Module dedicated to regular operators willing to master more advanced techniques: complex antegrade - first steps in antegrade dissection re-entry.
  • Module 3 - Module dedicated to experienced operators mastering all CTO techniques and strategies: complex retrograde - complex ADR - complications. Module based on interactivity and exchanges about personal and practical experiences.

Each module included live cases performed by national and international experienced operators, with associated didactic lectures and interactive discussions, related to the topics covered during sessions.

Couldn't you attend the ML CTO?
Did you wish to participate to the ML CTO but you couldn't come to Nice? Don't worry!
Now you can discover and watch the live cases that were performed during the ML CTO for only 70 € (excl. VAT) on incahtlab.

For more information about the Scientific Program and the Faculty Guests, we invite you to navigate through the ML CTO website.

THURSDAY JUNE 29th (Level 1: Discover CTO PCI)

Session 1: CTO PCI basics

Provoker: Alexandre Avran
Chairman: James Spratt
Panelists: Emmanouil Brilakis – Nicolaus Reifart – Mike Wyman
 

08:00 Introduction
Alexandre Avran and Stéphane Rinfret
08:10 Why should we treat CTOs: impact on ischemia and LV function
Christopher Buller
08:20 Recent trials on CTO PCI: should it change practice?
Stéphane Rinfret
08:30 Coronary angiography in planning for CTO PCI
Laurent Quilliet
08:40 CTO angiographic analysis: scoring systems and algorithms
Marouane Boukhris
08:50 Requirements for initiation of CTO PCI program: Tools and set up
Thomas Hovasse

Live case #1

Long proximal LCx CTO with ipsilateral and controlateral visualization
ACROSTAK - MEDTRONIC
Operators : William Nicholson, MD – Khalid Tammam, MD
IVUS commentator : Stéphane Carlier, MD
 

09:00 Live case Clinical presentation
09:10 Starting procedure


Parallel session : Case-in-box presentations
Wake up or close: tips & tricks for complications – Risto Jussila
 

10:10 Vascular access and guide selection for CTO PCI
Khaldoon Alaswad
10:20 Essential basic maneuvers for CTO PCI
Colm Hanratty
10:30 How to prevent common complications?
Javier Escaned
10:40 Radioprotection and contrast management
Nicolaus Reifart


10:50 : Coffee break

Session 2: Antegrade CTO PCI basics

Provoker: Christopher Buller
Chairman: Colm Hanratty
Panelists: Khaldoon Alaswad – Jo Dens – Javier Escaned
 

11:15 Antegrade strategy with sequential wire escalation
James Spratt
11:30 Modern parallel wire technique
Daniel Weilenmann

Live case #2

Dominant LCx CTO with septal collateral channels
ASAHI-BIOSENSORS
Operators : Satoru Sumitsuji, MD – Nicolas Boudou, MD
IVUS commentator : Stéphane Carlier, MD
 

11:45 Live case Clinical presentation
12:00 Starting procedure


Parallel session : Case-in-box presentations
Dangerous curves - Lorenzo Azzalini
 

13:00 How and when to use dual-lumen catheters
Nicolas Lhoest
13:10 How to improve guide catheter support
Benjamin Faurie


13:20 : Lunch on Hyatt Terrace

Session 3: Retrograde CTO PCI basics

Provoker: Alaswad Khaldoon
Chairman: Benjamin Faurie
Panelists: Alexander Bufe – Artis Kalnins – Khalid Tammam
 

14:30 Retrograde approach: step-by-step instructions
William Nicholson

Live case #3

Long mid RCA CTO with a good landing zone
HEXACATH – VASCULAR SOLUTIONS/TELEFLEX
Operators : Emmanouil Brilakis, MD – Mike Wyman, MD
IVUS commentator : Stéphane Carlier, MD
 

14:45 Live case Clinical presentation
15:00 Starting procedure


Parallel session : Case-in-box presentations
Ipsilateral epicardial retrograde CTO PCI over single radial access - Gregor Leibundgut
 

16:00 Reverse-CART technique
Masahisa Yamane
16:15 Dissection technique using knuckled wires: use and indication
Elliot Smith
16:25 Externalization and snaring techniques
Satoru Sumitsuji

      
16:40 : Coffee Break

Provoker: Benjamin Faurie
Chairman: Stéphane Rinfret
Panelists: Sébastien Levesque – Sudhir Rathore – Masahisa Yamane
 

17:10 Industry session
17:30 How would you approach that CTO? An interactive session
Presenters : Sébastien Levesque and Masahisa Yamane
17:50 Debate: Tip injection should always be used to guide septal collateral crossing?
Pro : Sudhir Rathore
Con : Stéphane Rinfret
18:05 MLCTO career achievement interview with Dr Heinz Joachim Büttner
18:15 Closing remarks


Exclusive on Incathlab.com: Digital Extra of the Day 
Lecture of Dr Antonio Serra: BVS implantation in chronically occluded vessels

 

FRIDAY JUNE 30th (Level 2: Progress in CTO PCI)

Session 1: Advanced Antegrade Techniques

Provoker: Christopher Buller
Chairman: Elliot smith
Panelists: Marouane Boukhris – Omer Goktekin – Daniel Weilenmann
 

08:30 Microcatheter overview: how to choose and use
Paul Knaapen
08:45 When you cannot cross the proximal cap with a microcatheter
Jonathan Hill

Live case #4

Dominant LCx CTO with ipsilateral collateral channels
ABBOTT
Operators : Kambis Mashayekhi, MD – Alexander Bufe, MD

IVUS commentator : Stéphane Carlier, MD
 

09:00 Live case Clinical presentation
09:10 Starting procedure


Parallel session : Case-in-box presentations
Tips & Tricks -Thierry Lefèvre

10:30 : Coffee break
 

Session 2: Advanced procedural guidance and complications management

Provoker: Stéphane Rinfret
Chairman: Christopher Buller
Panelists: Heinz Joachim Büttner – Nicolas Lhoest – Khalid Tammam
 

11:00 IVUS during CTO PCI
Roberto Garbo
11:15 Principles of contrast modulation techniques
Mauro Carlino

Live case #5

Ostial LAD CTO with short left main and ipsilateral and contralateral collateral channels
TERUMO
Operators : Masahisa Yamane, MD – Alexandre Avran, MD
IVUS commentator : Stéphane Carlier, MD
 

11:30 Live case Clinical presentation
11:40 Starting procedure


Parallel session : Case-in-box presentations
RCA ostial CTO and snaring – Andrea Gagnor
 

13:00 How to manage ambiguous proximal cap without a retrograde option  
Alexander Bufe
13:15 How to manage CTO PCI complications
Emmanouil Brilakis
13:30 Perforations: the complete toolbox and how to use it
Kambis Mashayekhi


13:45 : Lunch on Hyatt Terrace


Session 3: Basics in Antegrade Dissection Re-entry

Provoker: Kambis Mashayekhi
Chairman: Max Amor
Panelists: Yangsoo Jang – Sanjog Kalra – Nicolaus Reifart
 

14:45 Toolbox for effective dissection re-entry techniques
Jonathan Hill


Live case #6

LCx CTO with ambiguous proximal cap
ALVIMEDICA – VOLCANO/PHILIPS
Operators : Roberto Garbo, MD – Andrea Gagnor, MD
IVUS commentator : Stéphane Carlier, MD
 

15:00 Live case Clinical presentation
15:10 Starting procedure


Parallel session : Case-in-box presentations
Heavily calcified distal RCA CTO uncrossable with device neither retrogradely nor anterogradely - Meruzhan Saghatelyan

16:30 : Coffee break

Provoker: Thierry Lefèvre
Chairman: Alexander Bufe
Panelists: Georges Sianos – Mauro Carlino – Paul Knaapen
 

17:00 Industry-supported session
17:15 Device-based ADR: step-by-step instructions
Mike Wyman
17:30 Wire-based ADR: bailout indications and Mini-Star technique
Alfredo Galassi
17:45 How would you approach that CTO? An interactive session
Presenters: Lorenzo Azzalini and Mauro Carlino

Session 4: CTO PCI for Fellows

Chairman: Alexandre Avran
Panelists: Nicolas Boudou - Emmanouil Brilakis – Stéphane Rinfret
 

18:00 The hybrid algorithm: choosing the right approach
Emmanouil Brilakis
18:15 Case presentations
18:45 The new Jedi meets Yoda: Q&A session
All Faculty members
19:00 Closing remarks


Exclusive on Incathlab.com: Digital Extra of the Day
Lecture of Dr Daniel Weilenmann: Management of septal complications

SATURDAY JULY 1st (Level 3: Master CTO PCI)

Session 1: Retrograde advanced strategies

Provoker: Elliot Smith
Chairman: Alfredo Galassi
Panelists: Philippe Durand – Andrea Gagnor – William Nicholson
 

08:30 Solution for difficult retrograde re-entry
Yangsoo Jang

Live case #7

Blunt mid RCA CTO
BIOTRONIK
Operators : Georges Sianos, MD – Jonathan Hill, MD
IVUS commentator : Stéphane Carlier, MD
 

08:45 Live case Clinical presentation
09:00 Starting procedure


Parallel session : Case-in-box presentations
Late acquired malapposition and sub-occlusive restenosis after reverse CART for ostially occluded LAD - Erion Xhepa
 

10:15 Wire crosses septal channel but microcatheter doesn’t follow: what to do?
Gerald Werner
10:30 Retrograde approach through epicardial collateral channels
Kambis Mashayekhi
10:45 Ping-pong technique for retrograde approach
Nicolas Boudou


10:55 : Coffee break
 

Session 2: Antegrade Dissection Re-entry Advanced Strategies

Provoker: Alexandre Avran
Chairman: Jonathan Hill
Panelists: Kambis Mashayekhi – Satoru Sumitsuji – Mike Wyman
 

11:25 How would you approach that CTO? An interactive session
Presenters: Kambis Mashayekhi and Alexandre Avran
11:45 Difficult ADR situations: how to handle?
Colm Hanratty
12:00 How to deal with ostial RCA CTOs
Alexandre Avran

Live case #8

RCA CTO with good landing zone
BOSTON – GUERBET 
Operators : Christopher Buller, MD – James Spratt, MD
IVUS commentator : Stéphane Carlier, MD
 

12:15 Live case Clinical presentation
12:30 Starting procedure


Parallel session : Case-in-box presentations
Multivessel Disease with double CTO - Eugenio La Scala

13:45 : Lunch on Hyatt Terrace
 

Session 3: Difficult CTO PCI, Costs and outcomes

Provoker: Jonathan Hill
Chairman: Masahisa Yamane
Panelists: Max Amor – Laurent Drogoul – Risto Jussila
 

14:50 The RECHARGE registry: what have we learned?
Jo Dens
15:00 Specific issues with post-CABG CTOs
Heinz Joachim Büttner


Parallel session : Case-in-box presentations
Previous CABG  alter the native coronary disease nature - Albert Alahmar, MD
 

16:25 Industry session


16:45 : Coffee break

Chairman: Omer Goktekin
Panelists: Colm Hanratty - Thomas Hovasse – Daniel Weilenmann

17:15 Supported CTO PCI using percutaneous left ventricular assist devices
Sanjog Kalra
17:30 Cost of CTO PCI: the cathlab manager perspective
Aurélie Fresselinat
17:40 How are they doing? Angiographic follow-up of last year cases
Laurent Drogoul
18:00 Take home messages and conclusion
Alexandre Avran and Stéphane Rinfret


 

PARAMEDICS SESSION - THURSDAY JUNE 29th
This session will be in French, without English translation


Modérateurs : Dr Nicolas Lhoest – Hervé Faltot

08:30 Ouverture de la journée
08:40 Pourquoi et comment démarrer un programme CTO ?
Hervé Faltot
08:50 Présentation clinique du live case
09:00 Live case n°1

Session 1: La désobstruction: Enjeux et Outils

Modérateurs : Dr Nicolas Lhoest – Hervé Faltot

10:00 Désobstruction des occlusions coronaires chroniques : Pourquoi ? Pour qui ?
Fanny Villanova
10:15 Les outils incontournables
Gilles Wilhelm
10:30 Techniques antérogrades de désobstruction
Dr Nicolas Lhoest


10:45 : Pause café

Modérateurs : Dr Alexandre Avran – Hervé Faltot

11:30 Techniques rétrogrades de désobstruction
Dr Alexandre Avran
11:45 Présentation clinique du live case
12:00 Live case n°2


13:15 : Déjeuner

Modérateurs : Dr Max Amor – Hervé Faltot

14:15 Présentation clinique du live case
14:30 Live case n°3 (inclus 30mn de préparation paramédicale)

Session 2: Management et sécurité du patient

Modérateurs : Dr Max Amor – Hervé Faltot

15:45 Préparation en amont de la procédure
Nathalie Lattarico
16:00 Assistance per CTO : le méthode McGill
Nathalie Ferlatte
16:15 Surveillance per-procédure
Rafik Lamari
16:30 Gestion post désobstruction
Sabrina Benmesbah
16:45 Take Home Messages

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