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CTO PCI What’s New in 2011

Toyohashi Heart Center Yasushi Asakura M.D.

Toyohashi Heart Center

Antegrade Approach with Single Wire

↓ Parallel Wire Technique

↓

Retrograde Approach ↓

IVUS Guided Wiring

Step by Step Approach

Antegrade Approach with Single Wire

Toyohashi Heart Center

Wire Selection

1. Miracle 3, 6, 12g

2. Confienza Family

0%

20%

40%

60%

80%

100%

2004 2009

Spring coil floppy wire

Plastic jacket wire

Spring coil CTO wire67.5%

15.0%

17.5%

52.0%

47.3%

7.0%

Crossing Guide Wire in THC

(n=120) (n=114)

Toyohashi Heart Center

Crossing Guide Wire in THC

Miracle33%

Confienza11%

Pilot4%

Wizard4%

FielderFC15%

X-treme27%

Others3%

Failure3%

Toyohashi Heart Center

Toyohashi Heart Center

Microchannels in CTO

Toyohashi Heart Center

Structure of Fielder-XT

0.009 Tapered Tip Hydrophilic Coating & Polymer Sleeve Tip Load: 0.8g

Toyohashi Heart Center

Soldering Length at Wire Tip

Toyohashi Heart Center

Case

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Fielder XT

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CTO Wire Manipulation

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Tapered Wire Manipulation

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Fielder XT

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Final

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Microchannels and Wire Tip

0.010”

32mm O.D: 0.014” / 12.5cm

0.6g O.D: 0.010” / 4cm O.D: 0.014” / 12.5cm

0.0078”

8mm

Wizard78 Structural Image

Toyohashi Heart Center

Toyohashi Heart Center

Tapered Wires 2011

Fielder-XT (ASAHI)

Fielder-XTA, XTR (ASAHI)

Abbyss (NIPRO)

Wizard (Life Line)

Progress (Abbott)

Equation (JJ)

Toyohashi Heart Center

Antegrade Approach with Single Wire

↓ Parallel Wire Technique

↓

Retrograde Approach ↓

IVUS Guided Wiring

Step by Step Approach

Retrograde Approach

ASAHI Corsair was originally developed as a septal channel dilator,

to ease retrograde approaches for CTO-PCI. This is a unique device

that can be used both as a microcatheter and as a support catheter.

Toyohashi Heart Center

2. Retrograde Wiring

3. Kissing Wire Technique

4. IVUS Guided Wiring

5. Subintimal Tracking

1. Channel Crossing

Standardized Retrograde Technique

Toyohashi Heart Center

What’s New?

1. Wire Selection

Toyohashi Heart Center

Wire Selection 2011

Fielder FC Fielder XT

SION

SION BLUE Fielder XTR

Toyohashi Heart Center

Case

Toyohashi Heart Center

Retrograde Approach

Toyohashi Heart Center

SION

Toyohashi Heart Center

SION

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Case Fielder XTR

Toyohashi Heart Center

Channel Selection (Septal / Epicardial )

Trends in a Retrograde Technique

Wire Selection (SION, Fielder XTR)

Subintimal Tracking (R-CART >>CART)

Corsair Support Procedure

Toyohashi Heart Center

What’s New?

1. Wire Selection

2. IVUS Guided R-CART

Toyohashi Heart Center

IVUS Tells Us

1. Vessel Size

2. Position of Wires

Toyohashi Heart Center

IVUS Findings

Toyohashi Heart Center

Both Wires in Intima

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Both Wires in Sub-Intima

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Antegrade Wire in Intima Retrograde Wire in Sub-Intima

Toyohashi Heart Center

IVUS

Toyohashi Heart Center

Antegrade Wire in Intima Retrograde Wire in Sub-Intima

Toyohashi Heart Center

IVUS

Toyohashi Heart Center

Antegrade Wire in Sub-Intima Retrograde Wire in Intima

Toyohashi Heart Center

Case RAO

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Retrograde Approach

Toyohashi Heart Center

IVUS

Toyohashi Heart Center

4.0mm Balloon

Toyohashi Heart Center

IVUS Guided Wiring

Toyohashi Heart Center

IVUS

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Retrograde Wiring

Toyohashi Heart Center

How to Make Connection?

1. R-CART

2. CART

Antegrade Wire in Sub-Intima Retrograde Wire in Intima

Toyohashi Heart Center

How to Make Connection?

1. R-CART

2. CART

3. Knuckle Wire

4. Wire Penetration

Toyohashi Heart Center

Case

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Reverse CART

Toyohashi Heart Center

Penetration Using Conquest Pro 12

Toyohashi Heart Center

Final

Toyohashi Heart Center

Summary

1. In an antegrade approach, we often start with tapered soft wire in order to do micro-channel tracking.

3. In a retrograde approach, we more often use epicardial channel owing to Corsair and new wires.

4. R-CART is common procedure and IVUS guidance is sometimes helpful.

2. Retrograde technique has been established and standardized.

Toyohashi Heart Center

TOPIC 2012 July 26-28, 2012

Toyohashi Heart Center

Toyohashi Heart Center

Toyohashi Heart Center

Toyohashi Heart Center

Toyohashi Heart Center

Toyohashi Heart Center