Fielder XT: Initial and. Department of Cardiology, Asan Medical Center, Ulsan University of college of medicine
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1 Fielder XT: Initial and Professional Use for CTO Seung-Whan Lee, MD, PhD D t t f C di l A M di l C t Department of Cardiology, Asan Medical Center, Ulsan University of college of medicine
2 Plastic-Jacket Hydrophilic Guidewires Non-tapered-tip Choice-PT / PT2 (Boston) Pilot (Abbott) Fielder / Fielder-FC (ASAHI) Tapering-tip Fielder-XT (ASAHI) : tip = Fielder-XT-R (ASAHI) : tip = 0.010
3 Case I : RCA CTO
4 Which route?
5 Retrograde approach Fielder FC/Fielder XT : failed
6 Antegrade approach Fielder XT
7 Stenting
8 Final Result
9 Case II : LAD CTO
10 Which route?
11 Retrograde approach Fielder FC & Fielder XT
12 Retrograde wire advance Fielder XT
13 Retrograde wire externalization with long-wire Antegrade wiring to the distal LAD
14 Stenting
15 Final Result
16 Fielder XT Hydrophilic coated tapered tip wire Tapered tip is nice for finding microchannel or fine collateral Tip load = 0.8 g
17 16cm Polymer Sleeve & SLIP COAT 16cm Radio-opaque Coil Stainless Steel Core Fielder XT PTFE Coating 11cm Spring Coil 3cm Radio-opaque Coil Stainless Steel Core Fielder FC cm Polymer Sleeve & SLIP COAT PTFE Coating
18 Fielder XT enables precise tip shaping due to its short soldering tip. Before Shaping After Shaping 1.0mm Fielder Fielder 1.0mm Fielder FC Fielder ede FC 0.3mm~0.5mm Fielder XT Fielder XT
19 Microvessels The size is usually from to 500 μm (0.014 wire is 360 μm) Micro-CT of a 24-week old CTO (rabbit)
20 Microvessel as a Pathway CTO created by: Ruptured Plaque Thrombus Replacement of clot and cholesterol esters Deposition of collagen and calcium deposits Tissue most resistent at ends of CTO (fibrous caps) Strauss et al J Intervent Cardiol 2005
21 Big Tips Are for Waiters! Microchannels: Key for crossing tip microchannel tip microchannel
22 Microvessels : Pathways for Successful Guidewire Crossing? 16-week-old CTO that failed guidewire crossing. Few small microvessels present, dense collagen in extracellular matrix Strauss et al J Intervent Cardiol 2005
23 The Spectrum of Lumen Morphology in CTO: Clinical Challenges Proteoglycan-rich Fibrotic plaque: Negative remodelling The Bad Large recanalization channels The Good Small recanalization channels The Ugly Inflammation Necrotic core Calcification
24 CTO Pathology Micro-channels (present in up to 80%) increase success Homogenous hard plaque lower success rates J Am Coll Cardiol. 1997;29:
25 Microchannel Angiographic microchannels are visible in 30-50% CTOs
26 Suitable GideWires selection Current step-up GW strategy for Antegrade CTO-PCI DRILLING (controlled) PENETRATION SLIDING
27 Suitable GWs selectionec Guidewire e for Sliding technique SLIDING Low profile to cross microchannels or loose tissue High lubricity intra-lesion Soft tip; will not puncture hard plaque or adventitia
28 Roadmap to CTOs IVUS guided wire handling Miracle tapered CTO wires unknown factors (unexpected bend/hard tissues, vessel shrinkage, inelasticity, etc) limitations of mechanical properties of wire IVUS antegrade wire techniques kissing wire Tapered floppy polymer wire MSCT CART knuckle wire IVUS guided d reverse CART 014 snare wire Corsair/ RG-3 septal/ PL channels new CTO devices
29 Tapered Tip Soft wires They can easily enter into non-visible microchannels because of their small diameters and lower friction resistance. They can rarely damage or induce intimal dissection because of their lower tip stiffness Tapered tip soft wire is optimal first-line strategy in CTO PCI
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