CTO PCI What’s New in 2011
Toyohashi Heart Center Yasushi Asakura M.D.
Toyohashi Heart Center
Antegrade Approach with Single Wire
↓ Parallel Wire Technique
↓
Retrograde Approach ↓
IVUS Guided Wiring
Step by Step Approach
Antegrade Approach with Single Wire
Toyohashi Heart Center
Wire Selection
1. Miracle 3, 6, 12g
2. Confienza Family
0%
20%
40%
60%
80%
100%
2004 2009
Spring coil floppy wire
Plastic jacket wire
Spring coil CTO wire67.5%
15.0%
17.5%
52.0%
47.3%
7.0%
Crossing Guide Wire in THC
(n=120) (n=114)
Toyohashi Heart Center
Crossing Guide Wire in THC
Miracle33%
Confienza11%
Pilot4%
Wizard4%
FielderFC15%
X-treme27%
Others3%
Failure3%
Toyohashi Heart Center
Toyohashi Heart Center
Microchannels in CTO
Toyohashi Heart Center
Structure of Fielder-XT
0.009 Tapered Tip Hydrophilic Coating & Polymer Sleeve Tip Load: 0.8g
Toyohashi Heart Center
Soldering Length at Wire Tip
Toyohashi Heart Center
Case
Toyohashi Heart Center
Fielder XT
Toyohashi Heart Center
CTO Wire Manipulation
Toyohashi Heart Center
Tapered Wire Manipulation
Toyohashi Heart Center
Fielder XT
Toyohashi Heart Center
Final
Toyohashi Heart Center
Microchannels and Wire Tip
0.010”
32mm O.D: 0.014” / 12.5cm
0.6g O.D: 0.010” / 4cm O.D: 0.014” / 12.5cm
0.0078”
8mm
Wizard78 Structural Image
Toyohashi Heart Center
Toyohashi Heart Center
Tapered Wires 2011
Fielder-XT (ASAHI)
Fielder-XTA, XTR (ASAHI)
Abbyss (NIPRO)
Wizard (Life Line)
Progress (Abbott)
Equation (JJ)
Toyohashi Heart Center
Antegrade Approach with Single Wire
↓ Parallel Wire Technique
↓
Retrograde Approach ↓
IVUS Guided Wiring
Step by Step Approach
Retrograde Approach
ASAHI Corsair was originally developed as a septal channel dilator,
to ease retrograde approaches for CTO-PCI. This is a unique device
that can be used both as a microcatheter and as a support catheter.
Toyohashi Heart Center
2. Retrograde Wiring
3. Kissing Wire Technique
4. IVUS Guided Wiring
5. Subintimal Tracking
1. Channel Crossing
Standardized Retrograde Technique
Toyohashi Heart Center
What’s New?
1. Wire Selection
Toyohashi Heart Center
Wire Selection 2011
Fielder FC Fielder XT
SION
SION BLUE Fielder XTR
Toyohashi Heart Center
Case
Toyohashi Heart Center
Retrograde Approach
Toyohashi Heart Center
SION
Toyohashi Heart Center
SION
Toyohashi Heart Center
Case Fielder XTR
Toyohashi Heart Center
Channel Selection (Septal / Epicardial )
Trends in a Retrograde Technique
Wire Selection (SION, Fielder XTR)
Subintimal Tracking (R-CART >>CART)
Corsair Support Procedure
Toyohashi Heart Center
What’s New?
1. Wire Selection
2. IVUS Guided R-CART
Toyohashi Heart Center
IVUS Tells Us
1. Vessel Size
2. Position of Wires
Toyohashi Heart Center
IVUS Findings
Toyohashi Heart Center
Both Wires in Intima
Toyohashi Heart Center
Both Wires in Sub-Intima
Toyohashi Heart Center
Antegrade Wire in Intima Retrograde Wire in Sub-Intima
Toyohashi Heart Center
IVUS
Toyohashi Heart Center
Antegrade Wire in Intima Retrograde Wire in Sub-Intima
Toyohashi Heart Center
IVUS
Toyohashi Heart Center
Antegrade Wire in Sub-Intima Retrograde Wire in Intima
Toyohashi Heart Center
Case RAO
Toyohashi Heart Center
Retrograde Approach
Toyohashi Heart Center
IVUS
Toyohashi Heart Center
4.0mm Balloon
Toyohashi Heart Center
IVUS Guided Wiring
Toyohashi Heart Center
IVUS
Toyohashi Heart Center
Retrograde Wiring
Toyohashi Heart Center
How to Make Connection?
1. R-CART
2. CART
Antegrade Wire in Sub-Intima Retrograde Wire in Intima
Toyohashi Heart Center
How to Make Connection?
1. R-CART
2. CART
3. Knuckle Wire
4. Wire Penetration
Toyohashi Heart Center
Case
Toyohashi Heart Center
Reverse CART
Toyohashi Heart Center
Penetration Using Conquest Pro 12
Toyohashi Heart Center
Final
Toyohashi Heart Center
Summary
1. In an antegrade approach, we often start with tapered soft wire in order to do micro-channel tracking.
3. In a retrograde approach, we more often use epicardial channel owing to Corsair and new wires.
4. R-CART is common procedure and IVUS guidance is sometimes helpful.
2. Retrograde technique has been established and standardized.
Toyohashi Heart Center
TOPIC 2012 July 26-28, 2012
Toyohashi Heart Center
Toyohashi Heart Center
Toyohashi Heart Center
Toyohashi Heart Center
Toyohashi Heart Center
Toyohashi Heart Center