Advanced d Techniques and Tools to Treat Below the Knee CTO
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1 TCTAP 2013, Apr , 2013, Seoul, Korea Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan Crossing Strategy t for Complex & CTO Lesion - Cross with Confidence - Supported by Educational Grant from Johnson & Johnson Medical Korea Advanced d Techniques and Tools to Treat Below the Knee CTO Kazushi Urasawa, MD, PhD, FJCC Katsuhiko Sato, MD, PhD, Ryoji Koshida, MD, PhD Michinao Tan, MD,, Yuya Nakagawa, MD Cardiovascular Center, Tokeidai Memorial Hospital Sapporo, Japan
2 Standard setup for BTK intervention 1. Puncture site ipsi-lateral antegrade 2. Sheath Sheathless guiding cathe. ex. 4.5F Parent-Plus (Medikit) 3. Guidewire guidewire Various products 4. Guidewire buck-up compatible micro-cathe. Prominent (Tokai Medical Products) Corsair-PV (Asahi Intec)
3 Wiring techniques for BTK-CTO 1. Antegrade wiring 2. Bi-directional wiring with distal puncture Dorsalis Pedis distal ATA distal dsa PTA distal PA Plantar artery Digital arteries 3. Bi-directional wiring using collateral channel Trans-collateral angioplasty (TCA)
4 TCA for BTK-CTO: Case 1 Case: 83yo Male Diagnosis: CLI (Rutherford 5) Risk factors: Hypertension Diabetes Mellitus
5 Control angiography
6 Tip injection from a Prominent at peroneal trunk
7 Selective angiography of a collateral channel
8 Angiogram of a channel connecting to PTA
9 Prominent was successfully advanced to PTA
10 Balloon dilatation of PTA
11 Balloon dilatation of distal PTA and plantar A.
12 Angiography after balloon angioplasty
13 TCA for BTK-CTO: Case 2 Case: 71yo Male Diagnosis: CLI (Rutherford 5) Risk factors: Hypertension Diabetes Mellitus Chronic renal failure (HD)
14 Control angiography
15 Wiring to the ATA (Micro Knuckle Method) Cruise (Neos) Prominent (Tokai Medical Products)
16 Angioplasty for the diffuse stenosis of ATA
17 Angiography after balloon angioplasty
18 Tip injection at DP
19 Cruise was advanced to lateral plantar artery
20 Prominent was advanced through the channel
21 Tip injection at lateral plantar A.
22 Retrograde wire was advanced to the proximal end of CTO Chevalier floppy (JJ Cordis)
23 Advance an antegrade wire to the PTA Astato XS9-12 (Asahi Intec) Corsair-PV (Asahi Intec)
24 Wire Rendez-vous at distal PTA
25 Advance antegrade wire to the plantar A.
26 Balloon angioplasty of PTA-CTO
27 Balloon angioplasty of plantar A.
28 Antegrade wiring to the PA
29 Balloon angioplasty of PA
30 Final angiography
31 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan Two Key Issues which are essential for successful TCA 1. Technique for safe and secure guidewire navigation within collateral l channels. 2. Guidewire i and micro-catheter t selection
32 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan TCA : Tips - 1 Channel selection Pick up collateral channels suitable for TCA on control angiogram / MDCT not too long not too tortuous not too fine
33 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan TCA : Tips - 2 Guidewire selection Cruise (= Fielder / Regalia) soft tip wire (Tip weight = 1 g) Plastic jacket / Hydrophilic coating Poor tip-shape memory As far as we tested, Cruise seems to be the only one guidewire suitable for TCA. Tapered type guidewires i are dangerous, and easily result in wire-induced channel perforation.
34 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan TCA : Tips - 3 Microcatheter selection for backup support Prominent (Tokai Medical Products: TMP) Prominent-TCA (TMP) Prominent-BTK (TMP) Corsair-PV (Asahi Intec)
35 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan TCA : Tips - 4 How to pass a guidewire (Cruise) through a collateral channel 1. Shaping of guidewire tip Create 45 degree angle at the 1mm from the tip 2. Step by step technique Advance guidewire, then advance micro-catheter to straighten the segment. 3. Re-create load-map frequently Three dimensional shape of the collateral channel may change dramatically after the passage of guidewire and micro-catheter.
36 Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan Summary Trans-collateral approach is extremely useful to set-up bi-directional wiring, and greatly enhances the initial success rate of BTK intervention. Although TCA is a little bit difficult compared with distal punctures, it is worthwhile to learn the skill of trans-collateral wiring if you want to expand your EVT activity.
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My idea on intimal tracking guide wire selection for Pop-BTK treatment
LINC 2017 Leipzig January 24-27, 2017 My idea on intimal tracking guide wire selection for Pop-BTK treatment Jos C. van den Berg, MD PhD Ospedale Regionale di Lugano, sede Civico Lugano University of Bern
Catheters and Wires. Dr. Vaibhav Jain MD,DNB,MNAMS Senior Consultant, IR Medanta, the Medicity, Gurgaon
Catheters and Wires Dr. Vaibhav Jain MD,DNB,MNAMS Senior Consultant, IR Medanta, the Medicity, Gurgaon Guidewires: Guidewires (solid wires navigated within the vascular system / extravascular tract) act
Re-entry into the true lumen from the subintimal space
VASCULAR AND ENDOVASCULAR TECHNIQUES Peter F. Lawrence, MD, Section Editor Re-entry into the true lumen from the subintimal space Peter A. Schneider, MD, Michael T. Caps, MD, MPH, and Nicolas Nelken, MD,
Is there still any space left for DES in the BTK area??? (Angiolite BTK trial, 6 month Data)
Is there still any space left for DES in the BTK area??? (Angiolite BTK trial, 6 month Data) (Angiolite BTK DES, IVascular) P. Goverde MD, K. Taeymans MD, K. Lauwers MD Vascular Clinic ZNA Antwerp,Belgium
WHEN, HOW AND WHERE?
CORONARY CHRONIC TOTAL OCCLUSION RETROGRADE APPROACH WHEN, HOW AND WHERE? Ferdinando Varbella Rivoli (Torino) OSPEDALI RIUNITI DI RIVOLI DEFINITION OF CTO 1. DEGREE OF STENOSIS 100% 2. ANTEGRADE FLOW:
6/6/2016. Pedal Loop Reconstruction: A Crash Course in 60 minutes. Pedal-Plantar Anatomy. Anand Prasad, MD, FACC, FSCAI, RPVI.
6/6/2016 Pedal Loop Reconstruction: A Crash Course in 60 minutes Pedal-Plantar Anatomy Anand Prasad, MD, FACC, FSCAI, RPVI Associate Professor of Medicine Freeman Heart Association Endowed Professor in
PCI for Chronic Total Occlusions
PCI for Chronic Total Occlusions Chronic Total Occlusions Why not Medical Treatment? Medical Treatment CTO in 891 pts over 24 years High 10% Mortality Low 2 % 1 year 10 years Puma JA, et al. JACC 1994;23:390A
Access (Antegrade, Retrograde, Pedal)
Access (Antegrade, Retrograde, Pedal) ARCH St. Louis Craig M. Walker, MD, FACC, FACP Clinical Professor of Medicine Tulane University School of Medicine New Orleans, LA Clinical Professor of Medicine LSU