1105 lefevre - how to perform
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How to Perform and Interpret Coronary Angiography for CTO RecanalisationThierry lefvreICPS, Massy, France
Angiography / imagingFefer P et al. J Am Coll Cardiol. 2012;59:991-997
20-25%
Lesion morphologyPatient characteristicsLearning curve The Success Rate of CTO Carefull reading of diagnostic angiography !Take extra time to evaluate both the collateral donor vessel and the occluded vessel even if the initial intervention is done on an other lesion
Guidewire Crossing < 30 min.
Morino et al. JACC Interv 2011; 4: 213-221
Guidewire Crossing < 30 min.Morino et al. JACC Interv 2011; 4: 213-221
Calcium, tortuosity (including donor)Previous stentEvaluate graft for possible retrograde accessLeft ventriculographyChronic kidney disease Coronary Angiogramm
CTO Success
No ad Hoc PCI !
Good AngiogramPowerfull and selective injectionLong injectionLarge fieldNo paning
Good CTO AngiographyOptimal view of the distal run offOptimal view of the donor vesselGood views of the collateralsSeveral views of the occluded vesselAt least 1 same view for both vesselsEducate the referring physicians
What are the Questions ?Is it really a CTO ?Proximal and distal ambiguity ?Lesion length ?Vessel course, Island ?Lesion calcification and tortuosity ?Distal run off ?Collaterals ?Good and safe support ?
Is it a CTO ?Clinical historyVigorous and selective injectionCarefull frame-by frame analysisDifferent views
What about the support ?
What about the support ?
What about the support ?
What about the support ?
What about the support ?
What about the support ?
What about the support ?
Fielder XT + Finecross
What about the support ?
3D right
Miracle 12 + Finecross
What about the support ?
Anchoring balloon
What about the support ?
What about the support ?
Antegrade or Retrograde ?
Ostial and calcified lesionGC Support, Stability ?Risk of ostial dissection ?
Antegrade or Retrograde ?
Antegrade or Retrograde ?
What about the support ?
Antegrade or Retrograde ?
Antegrade or Retrograde ?
Antegrade or Retrograde ?
Antegrade or Retrograde ?
Mother and Child TechniqueAntegrade or Retrograde ?
Antegrade or Retrograde ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Vessel Course ?
Proximal Ambiguity ?
No CalcificationLesion length < 20 mmProximal ambiguity ?
Proximal Ambiguity
Proximal ambiguity ?Proximal Ambiguity ?
Proximal Ambiguity ?
What about the support ?
Proximal Ambiguity ?
Proximal Ambiguity ?
Proximal Ambiguity ?
Finecross + Fielder XT
Proximal Ambiguity ?
Proximal Ambiguity ?
Distal Run-off
Distal Run-off
Proximal ambiguity
Distal ambiguitySpace for good supportGood distal Run-offTortuosity
Distal Run-off
Distal Run-off
Distal Run-off
Good candidate for Crossboss-Stingray
Distal Run-off
Distal Run-off
Collaterals
Collaterals
Collaterals
Collaterals
Collaterals
Collaterals
Collaterals
Collaterals
Collaterals
LAD Occlusion
Cranial for entryCaudal for Exit
Cranial for entryLao or lateral for ExitCranial view
RCA Occlusion
Caudal view
LCx Occlusion
Caudal view
Collaterals
ConclusionTake extra time during the diagnostic angiogram to obtain specific anatomic information that will guide strategy (ies) for the subsequent CTO PCI.
Study the film in detail during coronary angiography in order to check that you have all the informations needed.
Educate refering physicians
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