using a deflectable tipped catheter to treat previously inaccessible lesions
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Using a deflectable tipped Catheter to treat previously inaccessible lesions. Helen Routledge Interventional Fellow Institut Cardiovasculaire Paris Sud SpR Cardiology, University Hospital Birmingham. Multiple PCI procedures LCA. Failed PCI to CTO RCA - PowerPoint PPT PresentationTRANSCRIPT
Using a deflectable tipped Catheter to Using a deflectable tipped Catheter to treat previously inaccessible lesionstreat previously inaccessible lesions
Helen Routledge Interventional Fellow
Institut Cardiovasculaire Paris SudSpR Cardiology, University Hospital Birmingham
Multiple PCI procedures LCA. Failed PCI to CTO RCA
CABG Feb 2006 - RIMA to proximal PDA + SVG to distal RCA
May 2006 - Unstable angina
51 year old male
Occluded SVG to RCA
Patent RIMA to PDA
Lesion at ostium of PLA
1st Attempt at PCI : Guiding Catheter dissection ostium of RIMA
Recurrent Angina CCS 3 in Nov 06
Treated for ISR in LCA and DES in proximal RIMA
Recurrent angina
Intractable Angina
Extreme angulationLesion tortuosityAccess 6f RRA, IMAMinimal support
BMW (Guidant Corp.)PT2 (Boston Scientific)Whisper (Guidant Corp.)Cross-it (Terumo)Steer-It (Cordis)
Impossible to Wire?
Re-do bypass graftingMedical therapyTry and get round the bend…..!Venture Catheter
Solutions?
Venture Venture TMTM Catheter Catheter
Over the wire or Monorail low profile, 3.5F catheter Steerable radiopaque tip
Venture catheter advanced over Whisper
Whisper advanced into PLA
Venture Catheter advanced further into PLA
Whisper exchanged for BHW (Guidant Corp.)
Predilatation, Cypher 2.5 x 18mm Stent, Wire Exchange, Kissing
Final result – free of Angina
SVG to LCx
Venture BHW guidewire Cypher 2.5 x 13mm
SVG to LCx
Lesion compromising large PLA
Venture Catheter deflected towards PLA
SVG to PDA
Pre-dilated
Unable to stent
Buddy wire
Endeavour
Post-dilated, final result
Difficult Side Branch Access
Before
and after Main Branch Stenting
62 year old female - ACS
Failure to Wire SB
BMW (Boston Scientific)Whisper (Guidant Corp.)Choice PT(Terumo)Venture Monorail + BMW
Taxus 3 x 20 12 ATM
PTS strategy
PTS strategy
Taxus 3 x 20 12 ATM
Final Kissing, Final Result
Failure to Re-wire SB
Subocclusion, Occlusion
Venture Monorail, kissing
Result
Side Branch Access - Trifurcation
Side Branch Access - Trifurcation
Difficult to wire Septal.. Venture and Whisper
Angulation & Tortuous AnatomyAngulation & Tortuous Anatomy
Difficult side branchesDifficult side branches
LMS PCI – recrossing to LCx
Side Branch Access - Trifurcation
MB StentPre-dilatation septal
Side Branch Access - Trifurcation
Tortuosity, double bend, angulation
SVG to LAD
Venture?
Retrograde?Wire advanced to native vessel
Angulated and tortuous lesions beyond Grafts 4