10:50 ochiai - 10 key points to avoid major complications during cto pci

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10 Key Points to Avoid Major Complications

during CTO PCI

Masahiko Ochiai MD FACC FESC FSCAI

Division of Cardiology and Cardiac Catheterization LaboratoriesShowa University Northern Yokohama Hospital Kanagawa JAPAN

September 26 (Fri)Madrid Spain

1 Definite progress for final success should be accomplished

within fluoroscopy time of 60mim (or skin dose of 5 Gy)

Antegrade approach successful antegrade wire cross

Retrograde approach successful delivery of a retrograde Corsair through collateral channels

What is the Definite Progress

Even after the definite progress more radiation exposure is mandatory for ballooning and stenting etc

Early transient erythema 2 Gy HoursMain erythema 6 ~ 10 dLate erythema 15 ~ 6 ndash 10 wkTemporary epilation 3 ~ 3 wkPermanent epilation 7 ~ 3 wkDry desquamation 14 ~ 4 wkMoist desquamation 18 ~ 4 wkSecondary ulceration 24 gt 6 wkIschemic dermal necrosis 18 gt 10 wkDermal atrophy (1st phase) 10 gt 14 wkDermal atrophy (2nd phase) 10 gt 1 yrTelangiectasia 10 gt 1 yrLate dermal necrosis gt12 gt 1yrSkin cancer Not known 5 yr

Threshold Skin Entrance Dose for Radiation Dermatitis

King SB Yeung AC Interventional Cardiology 2007 The McGraw-Hill Companies

Distribution of the Skin Dose in CTO PCI

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

1 Definite progress for final success should be accomplished

within fluoroscopy time of 60mim (or skin dose of 5 Gy)

Antegrade approach successful antegrade wire cross

Retrograde approach successful delivery of a retrograde Corsair through collateral channels

What is the Definite Progress

Even after the definite progress more radiation exposure is mandatory for ballooning and stenting etc

Early transient erythema 2 Gy HoursMain erythema 6 ~ 10 dLate erythema 15 ~ 6 ndash 10 wkTemporary epilation 3 ~ 3 wkPermanent epilation 7 ~ 3 wkDry desquamation 14 ~ 4 wkMoist desquamation 18 ~ 4 wkSecondary ulceration 24 gt 6 wkIschemic dermal necrosis 18 gt 10 wkDermal atrophy (1st phase) 10 gt 14 wkDermal atrophy (2nd phase) 10 gt 1 yrTelangiectasia 10 gt 1 yrLate dermal necrosis gt12 gt 1yrSkin cancer Not known 5 yr

Threshold Skin Entrance Dose for Radiation Dermatitis

King SB Yeung AC Interventional Cardiology 2007 The McGraw-Hill Companies

Distribution of the Skin Dose in CTO PCI

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Antegrade approach successful antegrade wire cross

Retrograde approach successful delivery of a retrograde Corsair through collateral channels

What is the Definite Progress

Even after the definite progress more radiation exposure is mandatory for ballooning and stenting etc

Early transient erythema 2 Gy HoursMain erythema 6 ~ 10 dLate erythema 15 ~ 6 ndash 10 wkTemporary epilation 3 ~ 3 wkPermanent epilation 7 ~ 3 wkDry desquamation 14 ~ 4 wkMoist desquamation 18 ~ 4 wkSecondary ulceration 24 gt 6 wkIschemic dermal necrosis 18 gt 10 wkDermal atrophy (1st phase) 10 gt 14 wkDermal atrophy (2nd phase) 10 gt 1 yrTelangiectasia 10 gt 1 yrLate dermal necrosis gt12 gt 1yrSkin cancer Not known 5 yr

Threshold Skin Entrance Dose for Radiation Dermatitis

King SB Yeung AC Interventional Cardiology 2007 The McGraw-Hill Companies

Distribution of the Skin Dose in CTO PCI

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Early transient erythema 2 Gy HoursMain erythema 6 ~ 10 dLate erythema 15 ~ 6 ndash 10 wkTemporary epilation 3 ~ 3 wkPermanent epilation 7 ~ 3 wkDry desquamation 14 ~ 4 wkMoist desquamation 18 ~ 4 wkSecondary ulceration 24 gt 6 wkIschemic dermal necrosis 18 gt 10 wkDermal atrophy (1st phase) 10 gt 14 wkDermal atrophy (2nd phase) 10 gt 1 yrTelangiectasia 10 gt 1 yrLate dermal necrosis gt12 gt 1yrSkin cancer Not known 5 yr

Threshold Skin Entrance Dose for Radiation Dermatitis

King SB Yeung AC Interventional Cardiology 2007 The McGraw-Hill Companies

Distribution of the Skin Dose in CTO PCI

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Distribution of the Skin Dose in CTO PCI

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Back of a Referred Patient after 2nd Attempt of RCA CTO

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Back of a Referred Patient after 2nd Attempt of LCx CTO

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

2 Prepare detailed PCI strategies based on high quality angiogram without panning

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP DM HL Obesity 57 years male

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP DM HL Obesity 57 years male

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Difference between II System and FPD

Comparison of the effect of circumference distortion ( Left II Right FPD)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

The Benefits of FPD System

Example of Image Processing on FPD system ( Left Before processing Right After processing )

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

middot Panning was essential in the era of image intensifiers However current FPD provides clear images of whole coronary arteries in 6 or 7 inch without panning If magnified image is required modern dicom viewer easily provides it

middot Detailed information regarding collateral channels or CTO structure are lost by panning Panning does more harm than good   Itrsquos so called masturbation in coronary angiogram

middot In my institution panning is strictly prohibited

Panning

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

middot 5Fr JL for LCA and 5Fr JR or IM for RCA

middot LCA 35mlsec total 55ml (Assist TM)RAO 30 caudal 20 RAO 30 RAO 30 cranial 20AP cranial 25 AP caudal 25LAO 45 caudal 25 LAO 45 LAO 45 cranial 15

middot RCA 25mllsec total 5ml (Assist TM)LAO 45 AP cranial 25 RAO 30

middot Moderate magnification (6inch) without any panning and collimation

Protocol of Diagnostic CAG at SUNYH

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

3 Measure ACT and keep it within your target range

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Arterial Access in Retrograde Approachmiddot Antegrade 8Fr 45cm long sheath from rt groin amp 8Fr

guiding catheters with side holes

middot Retrograde 8Fr 45cm long sheath from lt groin amp 7Fr guiding catheters with side holes

Blood sample for ACT measurement is taken from the side arm of the 8Fr sheath every 30min It should be 300 sec

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

4 Everything (guiding catheters and wires) should be on the same screen

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt Sinus of Valsalva

8Fr Mach 1CLS35-SH

7Fr Mach1JL40-SH

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

5 Use guiding catheters 7Fr without a stiff and tapered tip

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

< A① >

 < E① >  < E② >Distal tip area 0603mm2

Distal tip area 0320mm2

  < C >Distal tip area 0957mm2 Distal tip area 0730mm2

< B >Distal tip area 0717mm2

< A② >Distal tip area 0672mm2

 < D >Distal tip area 0766mm2

200 Times Microscopic Examinationof Various Guiding Catheters

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

6 Do your best to identify the entry point into CTO

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 71 years male Mid LCx CTO

8Fr Brite-tipXB40-SH

6Fr diagnosticIM

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from the LA Branch

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from the LA Branch

>

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from the LA Branch

larr

larr

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 1st with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS

larr

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS was Replaced by Crusade with Trapping Technique

Leaving Gaia 1st as a Landmark on Fluoroscopy

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 2nd with Crusade

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS with Trapping Technique

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS with Trapping Technique

>

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Crusade was Replaced by IVUS with Trapping Technique

larr

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS was Replaced by Corsair with Trapping Technique

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS was Replaced by Corsair with Trapping Technique

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 2nd was Stepped Down to Gaia 1st

Gaia 2nd Gaia 1st

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 1st was Advanced Little by Little

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 1st was Advanced Little by Little

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 1st Reached Distal True Lumen

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 1st Reached Distal True Lumen

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Corsair Passed through the Occlusion

Sion

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 3 Xience Xpedition Stents

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 3 Xience Xpedition Stents

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

7 IVUS examination should be done when an antegrade wire passes the occlusion

into a distal side branch

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

>
>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

>

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 74 years male Mid LAD CTO

7Fr HyperionSPB40

5Fr diagnosticIM

>

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Stenting to the Proximal LAD

7Fr HyperionSPB40

5Fr diagnosticIM

Emerge 225mm

Xience Prime25-23mm

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

After Implantation of Xience Prime 25-23mm

>

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Gaia 2nd with Crusade

>

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Parallel Wire Technique with Conquest Pro and Crusade

>

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Parallel Wire Technique with Conquest Pro 12 after Re-mounting of Crusade over Conquest Pro

>

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

If an antegrade wire passes into the side branch of the distal vessel IVUS examination should be done

immediately after pre-dilatation with a small balloon

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Wire Exchange from Conquest Pro into Sion Blue

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination after Pre-dilatation with Emerge 15mm

TerumoNavifocus

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination after Pre-dilatation with Emerge 15mm

>

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination after Pre-dilatation with Emerge 15mm

LAD

Septal

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Guided Wiring with Conquest Pro 12

>

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from Diagonal Branch

>

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from Diagonal Branch

LAD

Conquest Pro 12

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Wire Exchange from Conquest Pro 12 into Sion

Conquest Pro 12

Sion

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from Distal LAD

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from Distal LAD

>

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 2 Promus Element Stents

>

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 2 Promus Element Stents

>

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

8 Use spring coil wires as your 1st choice of collateral channel tracking Donrsquot forget to prepare embolic coils in advance

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 77 years female Proximal RCA CTO Re-try

8Fr Mach1IM-SH

7Fr Mach1VL35-SH

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Tip Injection from 150cm Corsair

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Tip Injection from 150cm Corsair

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Fielder FC and Corsair were Advanced Alternatively

The patient suddenly complainedof severe chest pain

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Perforation of the Epicardial Collateral Channels

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Perforation of the Epicardial Collateral Channels

To achieve hemostasis at 2 different sites2 guiding catheter will be required

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

7Fr IM-SH was Replaced by Another 7Fr VL35-SH

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Apex 30-20 mm was Inflated at 3 atm

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Corsair was Replaced by Excelsior using Trapping Technique

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Tip Injection from Excelsior

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Excelsior was Advanced Further Down to the Site of Perforation

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Delivery of the 1st Coil

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after the Delivery of the 1st Coil

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Delivery of the 2nd Coil

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Ten Minutes after the Delivery of the 2nd Coil

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Ten Minutes after the Delivery of the 2nd Coil

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

9 Knuckle wiring is the safest when vessel course is not clear at all

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 65 years male Distal RCA CTO

5Fr diagnosticIM

5Fr diagnosticJL50

>

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

MSCT

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

MSCT

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Repeated Tip Injection from Corsair

7Fr HyperionSAL15-SH

7Fr HyperionSPB40-SH

>

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Channel Tracking with Sion (Cranial 40ordm)

>

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Bilateral Injection with Corsair

>

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Puncture of the Distal Cap with Conquest Pro

>

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Knuckle Wire Technique with Gaia 2nd

larr

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Knuckle Wire Technique with Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Corsair Followed the Knuckled Gaia 2nd

>

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from the 2nd RV Branch (Navifocus)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Antegrade Wiring with Gaia 3rd and Crusade

larr

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Antegrade Knuckle Wiring with Gaia 3rd and Corsair

>

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Antegrade Wiring with Gaia 3rd and Crusade

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Pre-dilatation with Kamuui 20mm14atm

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Successful Reverse CART with Sion

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 2 Xience Xpedition Stents

>

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results after Implantation of 2 Xience Xpedition Stents

>

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

10 Ostial LAD CTO has the highest risk of serious complications Stent delivery into LCx should be

guaranteed just in case

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 69 years male LAD Ostial CTO

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 69 years male LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Failed Ad-hoc PCI for LAD Ostial CTO

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Failed Ad-hoc PCI for LAD Ostial CTO

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Ad-hoc PCI for Proximal RCA Lesion

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Effort AP 67 years male LAD Ostial CTO Re-try

7Fr Mach1FL35

(lt radial)7Fr Mach1

IM-SH(rt femoral)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

I Had Reviewed the Previous Angiogram Frame by Frame

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Fiedler FC and Corsair were Easily Advancedthrough the Septal Channel

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Tip Injection from Corsair

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Fielder FC could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Corsair could be Advanced towards Proximal LAD

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Corsair could be Advanced towards Proximal LAD

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Wire Crossing with Ultimate 30

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Retrograde Wire Crossing with Ultimate 30

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Examination from LCx

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Ultimate 30

Retrograde Lesion Crossing with Corsair

Fielder FC

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Retrograde Wire Externalization with RG3

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Wiring at Septal Bifurcation

Voyager 20mm14atm

Fiedler FCwith Crusade

Fiedler FC

Finecross

Rinato

Voyager 25mm14atm

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Findings at LAD Orifice

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Positioning of Xience V 30-28mm

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Positioning of Xience V 30-28mm

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

After Post Dilatation with NC Voyager 35mm 24atm

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

After Post Dilatation with NC Voyager 35mm 24atm

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Findings at LAD Orifice

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Withdrawal of Both Guide Wires from LAD and LCx

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

We should not Loose LCx

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

IVUS Findings at LCx Orifice

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Confianza Pro 12gr with Finecross

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Wire Exchange with Finecross

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Dilatation with NC Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immedeiately after Dilatation with Voyager 25mm 12atm

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immedeiately after Dilatation with Voyager 25mm 12atm

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

What should we do next

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Kissing Inflation with NC Voyager 35mm and Hiryu 30mm

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Kissing Inflation

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Immediately after Kissing Inflation

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

Final Results

  • 10 Key Points to Avoid Major Complications during CTO PCI
  • 1 Definite progress for final success should be accomplished
  • What is the Definite Progress
  • Threshold Skin Entrance Dose for Radiation Dermatitis
  • Slide 5
  • Back of a Referred Patient after 2nd Attempt of RCA CTO
  • Back of a Referred Patient after 2nd Attempt of LCx CTO
  • 2 Prepare detailed PCI strategies based on high quality angio
  • Effort AP DM HL Obesity 57 years male
  • Effort AP DM HL Obesity 57 years male (2)
  • Difference between II System and FPD
  • The Benefits of FPD System
  • Panning
  • Protocol of Diagnostic CAG at SUNYH
  • 3 Measure ACT and keep it within your target range
  • Arterial Access in Retrograde Approach
  • 4 Everything (guiding catheters and wires) should be on the s
  • Retrograde PCI for Ostial LAD CTO from RCA Originated from Lt
  • 5 Use guiding catheters 7Fr without a stiff and tapered tip
  • Slide 20
  • 6 Do your best to identify the entry point into CTO
  • Effort AP 71 years male Mid LCx CTO
  • Effort AP 71 years male Mid LCx CTO (2)
  • IVUS Examination from the LA Branch
  • IVUS Examination from the LA Branch (2)
  • IVUS Examination from the LA Branch (3)
  • Gaia 1st with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique
  • Crusade was Replaced by IVUS with Trapping Technique (2)
  • Crusade was Replaced by IVUS
  • IVUS was Replaced by Crusade with Trapping Technique
  • Gaia 2nd with Crusade
  • Crusade was Replaced by IVUS with Trapping Technique (3)
  • Crusade was Replaced by IVUS with Trapping Technique (4)
  • Crusade was Replaced by IVUS with Trapping Technique (5)
  • IVUS was Replaced by Corsair with Trapping Technique
  • IVUS was Replaced by Corsair with Trapping Technique (2)
  • Gaia 2nd was Stepped Down to Gaia 1st
  • Gaia 1st was Advanced Little by Little
  • Gaia 1st was Advanced Little by Little (2)
  • Gaia 1st Reached Distal True Lumen
  • Gaia 1st Reached Distal True Lumen (2)
  • Corsair Passed through the Occlusion
  • Final Results after Implantation of 3 Xience Xpedition Stents
  • Final Results after Implantation of 3 Xience Xpedition Stents (2)
  • 7 IVUS examination should be done when an antegrade wire pass
  • Effort AP 74 years male Mid LAD CTO
  • Effort AP 74 years male Mid LAD CTO (2)
  • Effort AP 74 years male Mid LAD CTO (3)
  • Effort AP 74 years male Mid LAD CTO (4)
  • Effort AP 74 years male Mid LAD CTO (5)
  • Effort AP 74 years male Mid LAD CTO (6)
  • Stenting to the Proximal LAD
  • After Implantation of Xience Prime 25-23mm
  • Gaia 2nd with Crusade (2)
  • Parallel Wire Technique with Conquest Pro and Crusade
  • Parallel Wire Technique with Conquest Pro 12 after Re-mounting
  • Slide 58
  • Wire Exchange from Conquest Pro into Sion Blue
  • IVUS Examination after Pre-dilatation with Emerge 15mm
  • IVUS Examination after Pre-dilatation with Emerge 15mm (2)
  • IVUS Examination after Pre-dilatation with Emerge 15mm (3)
  • IVUS Guided Wiring with Conquest Pro 12
  • IVUS Guided Wiring with Conquest Pro 12 (2)
  • IVUS Examination from Diagonal Branch
  • IVUS Examination from Diagonal Branch (2)
  • Wire Exchange from Conquest Pro 12 into Sion
  • IVUS Examination from Distal LAD
  • IVUS Examination from Distal LAD (2)
  • Final Results after Implantation of 2 Promus Element Stents
  • Final Results after Implantation of 2 Promus Element Stents (2)
  • 8 Use spring coil wires as your 1st choice of collateral chan
  • Effort AP 77 years female Proximal RCA CTO Re-try
  • Effort AP 77 years female Proximal RCA CTO Re-try (2)
  • Effort AP 77 years female Proximal RCA CTO Re-try (3)
  • Tip Injection from 150cm Corsair
  • Tip Injection from 150cm Corsair (2)
  • Fielder FC and Corsair were Advanced Alternatively
  • Perforation of the Epicardial Collateral Channels
  • Perforation of the Epicardial Collateral Channels (2)
  • 7Fr IM-SH was Replaced by Another 7Fr VL35-SH
  • Apex 30-20 mm was Inflated at 3 atm
  • Corsair was Replaced by Excelsior using Trapping Technique
  • Tip Injection from Excelsior
  • Excelsior was Advanced Further Down to the Site of Perforation
  • Slide 86
  • Delivery of the 1st Coil
  • Immediately after the Delivery of the 1st Coil
  • Delivery of the 2nd Coil
  • Immediately after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil
  • Ten Minutes after the Delivery of the 2nd Coil (2)
  • 9 Knuckle wiring is the safest when vessel course is not clea
  • Effort AP 65 years male Distal RCA CTO
  • Effort AP 65 years male Distal RCA CTO (2)
  • Effort AP 65 years male Distal RCA CTO (3)
  • Effort AP 65 years male Distal RCA CTO (4)
  • MSCT
  • MSCT (2)
  • Tip Injection from Corsair
  • Repeated Tip Injection from Corsair
  • Retrograde Channel Tracking with Sion (Cranial 40ordm)
  • Retrograde Channel Tracking with Sion (Cranial 40ordm) (2)
  • Bilateral Injection with Corsair
  • Puncture of the Distal Cap with Conquest Pro
  • Retrograde Knuckle Wire Technique with Gaia 2nd
  • Retrograde Knuckle Wire Technique with Gaia 2nd (2)
  • Retrograde Knuckle Wire Technique with Gaia 2nd (3)
  • Retrograde Corsair Followed the Knuckled Gaia 2nd
  • Retrograde Corsair Followed the Knuckled Gaia 2nd (2)
  • IVUS Examination from the 2nd RV Branch (Navifocus)
  • Antegrade Wiring with Gaia 3rd and Crusade
  • Antegrade Wiring with Gaia 3rd and Crusade (2)
  • Antegrade Knuckle Wiring with Gaia 3rd and Corsair
  • Antegrade Wiring with Gaia 3rd and Crusade (3)
  • Pre-dilatation with Kamuui 20mm14atm
  • Successful Reverse CART with Sion
  • Final Results after Implantation of 2 Xience Xpedition Stents
  • Final Results after Implantation of 2 Xience Xpedition Stents (2)
  • 10 Ostial LAD CTO has the highest risk of serious complication
  • Effort AP 69 years male LAD Ostial CTO
  • Effort AP 69 years male LAD Ostial CTO (2)
  • Effort AP 69 years male LAD Ostial CTO (3)
  • Effort AP 69 years male LAD Ostial CTO (4)
  • Effort AP 69 years male LAD Ostial CTO (5)
  • Failed Ad-hoc PCI for LAD Ostial CTO
  • Failed Ad-hoc PCI for LAD Ostial CTO (2)
  • Ad-hoc PCI for Proximal RCA Lesion
  • Final Results
  • Effort AP 67 years male LAD Ostial CTO Re-try
  • Effort AP 67 years male LAD Ostial CTO Re-try (2)
  • I Had Reviewed the Previous Angiogram Frame by Frame
  • Fiedler FC and Corsair were Easily Advanced through the Septal
  • Tip Injection from Corsair (2)
  • Fielder FC could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD
  • Corsair could be Advanced towards Proximal LAD (2)
  • Retrograde Wire Crossing with Ultimate 30
  • Retrograde Wire Crossing with Ultimate 30 (2)
  • Retrograde Wire Crossing with Ultimate 30 (3)
  • IVUS Examination from LCx
  • Retrograde Lesion Crossing with Corsair
  • Immediately after Retrograde Wire Externalization with RG3
  • Wiring at Septal Bifurcation
  • IVUS Findings at LAD Orifice
  • Positioning of Xience V 30-28mm
  • Positioning of Xience V 30-28mm (2)
  • Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm
  • After Post Dilatation with NC Voyager 35mm 24atm (2)
  • After Post Dilatation with NC Voyager 35mm 24atm (3)
  • IVUS Findings at LAD Orifice (2)
  • Immediately after Withdrawal of Both Guide Wires from LAD and L
  • Immediately after Withdrawal of Both Guide Wires from LAD and L (2)
  • We should not Loose LCx
  • IVUS Findings at LCx Orifice
  • Confianza Pro 12gr with Finecross
  • Immediately after Wire Exchange with Finecross
  • Dilatation with NC Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm
  • Immedeiately after Dilatation with Voyager 25mm 12atm (2)
  • What should we do next
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (2)
  • V-Stenting at LMT Bifurcation (Xience V 35-18 30-18) (3)
  • Kissing Inflation with NC Voyager 35mm and Hiryu 30mm
  • Immediately after Kissing Inflation
  • Immediately after Kissing Inflation (2)
  • Final Results (2)
  • Final Results (3)
  • Final Results (4)

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