CTO: Technique and Tools
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1 CTO: Technique and Tools S. Hinan Ahmed, MD Associate Professor: Cardiology and Cardiothoracic Surgery Program Director: Interventional Fellowship Program Associate Editor: Cath Cardiov Interventions UT Health Science Center San Antonio NCVH, 2015
2 Conflicts of Interest Advisory Board: Abbott Vascular, GE Medical Consultant: St. Jude Medical, Sanofi-Aventis, GORE Medical Speaker: Astra Zeneca
3 CTO: Prevalence CTOs in particular are present in as many as 40% of patients presenting with CLI. The anatomical challenges associated with CTO treatment include the frequent presence of heavy calcification, no distinct cap, collaterals.
4 CTO: Challenges Lower procedural success Failure to cross is the primary method of failure Wire coupled with a support catheter works in 40-60% of cases Subintimal passage and re-entry works in 80% -(Data above the knee) These factors are the rationale for developing novel peripheral CTO crossing catheters.
5 Know the anatomy CTO: Tips Have a plan A and B Access (Contralateral, Antegrade, Retrograde, Dual) Equipment Available Wires Catheters Crossing devices Reentry
6 Case
7 Angiography left leg
8 Reverse CART
9 Results
10 CTO Cap Analysis
11 CTO Analysis
12 Courtesy of Metro Heart & Vascular
13 CTO CAPS DYNAMICS: CTOP II Central Lumen guidewire navigation can be difficult Distal G62123 v Best Strategy: Follow Concavity Proximal Cap: RETROGRADE APPROACH ANTEGRADE CONVEX Distal Cap: RETROGRADE CONCAVE Courtesy of Metro Heart & Vascular
14 CTO CAPS DYNAMICS: CTOP IIIa Proximal Cap: ANTEGRADE CONCAVE Micro CT scan of a CTO Proximal v Best Strategy: Follow Concavity ANTEGRADE - RETROGRADE Distal Cap: RETROGRADE CONCAVE Courtesy of Metro Heart & Vascular
15 CTO CAPS DYNAMICS: CTOP IIIb1 Proximal Cap: ANTEGRADE CONCAVE Micro CT scan of a CTO Proximal v Best Strategy: ANTEGRADE RETROGRADE The distal cap will be challenging given its FLAT configuration. Distal Cap: RETROGRADE CONVEX FLAT Courtesy of Metro Heart & Vascular
16 CTO CAPS DYNAMICS: CTOP IIIb2 Distal G62123 Proximal Cap: ANTEGRADE CONVEX FLAT Central Lumen guidewire navigation can be difficult v Best Strategy: ANTEGRADE RETROGRADE The proximal cap will be challenging given its FLAT configuration. Distal Cap: RETROGRADE CONCAVE Courtesy of Metro Heart & Vascular
17 CTO CAPS DYNAMICS: CTOP IV Proximal Cap: ANTEGRADE CONVEX Micro CT scan of a CTO Proximal v Best Strategy: ANTEGRADE RETROGRADE Both caps will be challenging given FLAT configuration. Most complex CTO. Distal Cap: RETROGRADE CONVEX Courtesy of Metro Heart & Vascular
18 Pedal Approach CTO PT
19 Pedal Approach: AT
20 Crossing Devices
21 Crosser catheter Uses high-frequency vibration to facilitate navigation of guidewires beyond chronic total occlusions (CTOs). Complementary to alternate between CROSSER Catheter activation and guidewire probing. System set up. Quick pass/fail assessment and shorter CTO crossing times.*
22 Frontrunner XP catheter Features a profile of.039" with 2.3 mm jaws. Hydrophilic coating to facilitate crossing. Catheter steerability. Integrated system. Variable support from advancing and retracting the 4.5F Micro Guide Catheter.
23 Wildcat catheter Rotatable tip equipped with distal spiral wedges that can be used to bore a track into the CTO Crossing Profile: 2 mm (.080") Sheath Compatibility: 6 French Guidewire Compatibility:.035"
24 Ocelot catheter Similar mechanism as Wildcat catheter but added imaging with real time OCT Crossing Profile: 2 mm (.080") Inner Diameter:.41 mm (.016") Working Length: 110 cm (43.3") Sheath Compatibility: 6 French Guidewire Compatibility:.014
25 Safe-Cross system Safe-Cross system combines an optical coherence reflectometer with radiofrequency energy delivered from the wire tip to help the operator remain intraluminal
26 TruePath Rotating diamond-coated tip designed to break through plaque in peripheral lesions Size (OD): 0.018" Length: 165 cm Sheath Compatibility: compatible catheters 135cm Tip Profile: 0.017"
27 Viance Catheter Over the wire guidewire compatible, 150 cm long multi-wire coiled shaft that has a inch atraumatic distal tip. Hydrophilic stainless steel distal coating and is compatible through 5Fr sheath
28 Cross and confirm
29 Planter Loop Cases
30
31
32
33
34 Before and After
35 Plantar Loop Case 2
36
37 Before and After
38 Other Tools
39 ReEntry Tools
40 Quick Capture
41 Acknowledgements Thank You
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