08:05 escaned - final cto training for all
TRANSCRIPT
![Page 1: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/1.jpg)
CTO training for allMore operators are required to treat
more patients better
Javier Escaned MD PhD
Hospital Clínico San Carlos
Madrid / Spain
![Page 2: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/2.jpg)
Which is the main difference?
On average, PCI willbe attempted in 99.9% of cases
On average, PCI willbe attempted in
…. ? cases
![Page 3: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/3.jpg)
PCI difficulty(skills required)
Overall PCI success rate
Technical improvement and PCI skills
Non-CTO revascularization
“The great equalizer”
• PCI has been hugely simplified by standardization and better tools.
• Success rate is today >95% after a short learning curve, even in off-label contexts.
![Page 4: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/4.jpg)
• On the contrary, CTOs constitutes a challenging PCI subset, with little adoption of proposed standardization approaches over the years.
• Success rates have remained low (50%) over decades for the non-trained operator, being a cause of frustration. Success rate in trained operators is 80-90%.
• Despite of the frequency of CTOs with a clinical indications for revascularization, patients with CTOs are largely undertreated with PCI.
• There is growing evidence that non-treated CTOs translate into worse patient outcomes.
Low CTO PCI success rates
![Page 5: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/5.jpg)
PCI difficulty(skills required)
Overall PCI success rate
(most PCI operators)
Technical improvement and PCI skills
CTO revascularization
Success rateCTO operators
(minority)
• “Expert” clubs played a key role in standardization and consolidation of knowledge (J-CTO, EuroCTO, Hybrid Community)
• Success rate with these approaches is around 80-90% in overall CTO population
![Page 6: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/6.jpg)
Technical improvement and PCI skills
CTO revascularization
1994
![Page 7: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/7.jpg)
Technical improvement and PCI skills
CTO revascularization
1994 2014
![Page 8: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/8.jpg)
Technical improvement and PCI skills
CTO revascularization
![Page 9: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/9.jpg)
• Established interventionalists less prone to adopt new approaches, follow logistic recommendations or accept that a colleague focuses in CTO PCI.
• Consolidated habits and cathlab workflow in non-CTO PCI act as obstacles.
• Perception of “CTO experts” as elite guys who speak a complex jargon among themselves may deter interventionalists to embark in CTO treatment.
• Interventionalists are less challenged by CTOs than by other PCI subsets (bifurcations) in clinical practice
Obstacles to adoption of consolidated knowledge
![Page 10: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/10.jpg)
• Success rate increases when more patients with CTOs are attempted according to consolidated knowledge.
• As success rate increases, more patients benefit from complete revascularization.
• This is followed by an increase in case volume, treatment reclassification and patient referrals.
Success rate influences CTO PCI adoption
![Page 11: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/11.jpg)
expertbeginner
CTO difficulty
50% 80%
% of success
Success rate influences adoption
95%
![Page 12: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/12.jpg)
expertbeginner
CTO difficulty
70%
% of success
More CTO
patients
treated
Success rate influences adoption
95%85%
![Page 13: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/13.jpg)
Thompson et al: JACC:CI vol 2., No. 9, 2009
0
10
20
30
40
50
60
70
80
90
100
early 05 late 05 early 06 late 06 early 07 late
07/early08
Experienced retrograde operators
Non retrograde operators
P<0.0001
Pro
ce
du
ral S
uc
ce
ss
(%
)
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6
Success rate influences adoption
![Page 14: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/14.jpg)
![Page 15: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/15.jpg)
Learn, share, be proctored
![Page 16: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/16.jpg)
Learn, share, be proctored
![Page 17: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/17.jpg)
• Understand CTO PCI developments and terminology
• Perform adequate procedural planning
• Incorporate new skills and get a proper tool kit
• Grade CTO difficulty to match cases to your level of expertise
• Build your experience in a gradual fashion
• Ensure patient and PCI team safety
• Contribute to create a CTO culture in your cathlab
• Offer your patients with CTOs better treatment options
The Expert´s Live 2014 aims to help you to:
![Page 18: 08:05 Escaned - Final cto training for all](https://reader036.vdocument.in/reader036/viewer/2022062412/58f176711a28ab07338b4567/html5/thumbnails/18.jpg)
EuroCTO Club6th Experts "Live" Workshop 2014Septemper, 25th – 26th , 2014Madrid, Spain
Thank you for your attention