Masashi Kimura, MD Etsuo Tsuchikane, MD Osamu Katoh, MD Toyohashi Heart Center, Japan

Transcription

1 Masashi Kimura, MD Etsuo Tsuchikane, MD Osamu Katoh, MD, Japan

2 Retrograde Approach for Coronary CTO Collateral channels A. bypass graft B. epicardial collateral C. septal perforator Retrograde wiring techniques Retrograde wire crossing Kissing wire technique Knuckle wire technique CART technique (Reverse CART technique)

3 Retrograde Channel (in the last successful 100 retrograde cases) 8% 13% Bypass graft Epicardial Septal 79%

4 Retrograde Approach for Coronary CTO Collateral channels Retrograde wiring techniques A. bypass graft Single or bilateral B. epicardial wiring technique collateral C. septal perforator Wiring technique = with balloon dilatation Retrograde wire crossing Kissing wire technique Knuckle wire technique CART technique (Reverse CART technique)

5 Concept of CART technique Standard CART Reverse CART Antegrade Antegrade Retrograde Retrograde (J Invasive Cardiol 2006;18:334-8)

6 Retrograde Wiring Techniques 13% 19% Retrograde wire crossing 2% 11% Kissing wire technique Knuckle wire technique CART Reverse CART 55% 68%

7 Retrograde Approach for Coronary CTO Collateral channels A. bypass graft B. epicardial collateral C. septal perforator Retrograde wiring techniques Retrograde wire crossing Kissing wire technique Knuckle wire technique CART technique (Reverse CART technique)

8 Limitations of Septal Channel Tracking with CART Dilatation of septal channel is mandatory to advance balloons through septal channel. These procedure carry the risk of septal channel perforation and septal hematoma. CART requires retrograde balloon access into the occlusion, however, it s sometimes difficult because of complex anatomy even after dilatation of the septal channel. Long procedure time always carries the risk of donor artery trouble (thrombus formation, etc).

9 Channel Dilator Corsair

10 Basic structure is same as Tornus device.

11 Corsair Marker coil 10.86mm (2.6Fr) 20.82mm (2.5Fr) 30.86mm (2.6Fr) Tapered Soft Tip 20cm Screw Head Structure Hydrophilic Polymer Coating PTFE Inner Layer

12 RCA-CTO, Re-attempted case Septal channels

13 Reverse CART using Corsair Cosair Corsair Retrograde wiring with Miracle 3

14 Reverse CART using Corsair Corsair Retrograde wiring with Corsair

15 Reverse CART using Corsair Balloon Miracle 3 Corsair Antegrade wiring Antegrade 3.0mm ballooning

16 Reverse CART using Corsair Successful reverse CART Retrograde wire in GC

17 Rt. Groin Lt. Groin Corsair in GC under trapped wire Externalization of 300cm Wire

18 Use of 300 cm Wire 2.5mm balloon Antegrade ballooning Antegrade wiring after removal of 300cm wire

19 No injury in the septal channel

20 Final

21 The Advantage of Corsair For Channel Tracking Excellent cross-ability through collateral channel No need of channel dilatation Less channel injury Expanded indication for epicardial channel

22 LCx-CTO, 2 nd Attempt Channel from Dx

23 Tip injection

24 Fielder FC

25 Corsair Reverse CART

26 No channel damage

27 The Advantage of Corsair For Channel Tracking Excellent cross-ability through collateral channel No need of channel dilatation Less channel injury Expanded indication for epicardial channel For Retrograde Wiring of CTO Excellent support for wire manipulation Good cross-ability into/through the occlusion Enabled usage of 300cm wire or snare wire

28 Mid LAD-CTO, 1 st Attempt

29 Epicardial Channel Tracking Microcatheter Corsair

30 Reverse CART

31 Antegrade wiring success Final Result

32 RCA-CTO, 2 nd Attempt Retrograde wiring

33 FielderXT Corsair

34 Corsair beyond the bend Reverse CART

35 Registry Data of Corsair 2Drs (Katoh 2007/9~, Tsuchikane 2008/5~) 180 CTO attempted, 176 procedural success (97.8%) 124 CTO attempted by retrograde approach 114 CTO with successful channel crossing (91.9%) Corsair was used in 93 CTO with successful channel crossing

36 Registry Data of Corsair N=93 Reattempt 61 (65.6%) RCA 74 (79.6%), LMT 1, LAD 15, LCx 3 SVG 2, epicardial 14, septal 77 Channel crossing success: 90 (96.8%) Retrograde procedural success: 92 (98.9%) Successful access into CTO with Corsair: 85/90 (94.4%) Successful crossing CTO with Corsair after retrograde wire crossing or reverse CART: 63/75 (84.0%)

37 Registry Data of Corsair Matched Case Controlled Study Control: 93CTO with successful channel crossing just before introduction of Corsair Control Corsair P value Male Age (y.o.) Prior MI Prior CABG Multivessel HT DM HL H/O smoking 84.9% 62±9 57.0% 9.7% 67.7% 60.2% 38.7% 54.8% 44.1% 86.0% 63±9 59.1% 10.8% 69.9% 59.1% 37.6% 57.0% 47.3% n.s. n.s. n.s. n.s. n.s. n.s. n.s. n.s. n.s.

38 Registry Data of Corsair Matched Case Controlled Study Control: 93CTO with successful channel crossing just before introduction of Corsair Control Corsair P value De novo Calcified Vessel tortuousity Occlusion bend Reference (mm) Occlusion length (mm) Unknown or >1yr occlusive duration 96.8% 55.9% 31.2% 25.8% 3.02± ± % 97.8% 60.2% 32.3% 29.0% 3.00± ± % n.s. n.s. n.s. n.s. n.s. n.s. n.s. n.s. n.s.

39 Registry Data of Corsair 8% 11% 2% 15% Control P=0.18 Corsair 81% 83% SVG epicardial septal

40 Registry Data of Corsair Matched Case Controlled Study Procedural success rate P=0.03 (86/93) (92/93) Without Corsair With Carsair

41 Registry Data of Corsair Matched Case Controlled Study Reasons for failure Catheter not crossed through channel Retro-wire not advanced into CTO Control 4 3 Corsair 0 1

42 Registry Data of Corsair 3% 24% 21% P< % 65% Control 8% 60% Corsair 11% Retrograde wire crossing CART Bilateral wire (kissing, knuckle) Reverse CART

43 Registry Data of Corsair Matched Case Controlled Study Procedure Control Corsair P value Contrast dose (ml) Fluoroscopy time (min) Procedure time (min) 283.6± ± ± ± ± ±

44 Registry Data of Corsair Matched Case Controlled Study Complication MACE Septal hematoma Cardiac tamponade Fracture of Corsair Control Corsair * (* Distal tip of Corsair was cut in severe calcification. Both were successfully retrieved.)

45 Registry Data of Corsair Cautions! Be careful when using Corsair in cases with severe calcified occlusions. Never accumulate the torque power for one direction. Braided tip; visual exam and X-ray

46 Registry Data of Corsair Cautions! Be careful when using Corsair in cases with severe calcified occlusions. Never accumulate the torque power for one direction.

47 In conclusions, In this FIM study, the CORSAIR can provide a high success rate with PCI in retrograde approach for CTO without major complications. These results indicate that this novel device is feasible and safe. Additional clinical trials should be considered to confirm these promising results.

48 13 th CTO Club June 10-11, 2011, Toyohashi, Japan