masahisa yamane - 45new devices for cto pci

Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland

14:30-14:45

New Devices for CTO PCI

Masahisa Yamane , MD, FACC

St Luke‘s International Hospital ,Tokyo, JapanSaitama Sekishinkai Hospital, Saitama, Japan

Disclosure Statement of Financial Interest

I, Masahisa Yamane MD,DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in this presentation.

RCA CTO c Left Coronary Anomaly

IVUS (VOLCANO) for Proximal Cap AmbiguityGaia 2RAO

LAORAO

FineDuo ( Dual Lumen catheter ) for Parallel WiringConfianza Pro 12g

FineDuo: Product SpecificationOTW lumen to deliver (2nd

guidewire, contrast media, drugs)

RX lumen for the 1st guidewire

Usages:

o Any complex PCI whenever stronger GW control & support are required

o Drug diffusion

Double markers facilitate an accurate placement to access

• Any side branch or collaterals

• The most distal stent strut

0.5 mm

1.0 mm0.5

Double radiopaque markers are located specifically for better visualization

OTW lumen exit port in between both markers

1 mm Distal marker on RX lumen part

Distal marker on RX lumen part is located at 0.5 mm

FineDuo: Double radiopaque markers

GW advances obliquely thanks to the “bump”: 5 degree

This angle enables to expand the rotation range of the GW

Angle and position of distal part of GW GW rotatable range

RX lumen

OTW lume

RX lumen

OTW lume

5 degree

RX lumen

OTW lume

RX lumen

OTW lume

Better GW Manipulation for maneuvrability

Standard dual lumen microcatheter

FineDuo*

FineDuo: Rotatable range of Guidewire

Reverse Wire Technique - Steps • Insert the FineDuo microcatheter along the main

vessel GW with 2nd GW (for side branch) inside the OTW lumen

• Protrude the tip of 2nd GW from the distal side hole

• Pull back the FineDuo microcatheter toward the proximal side and orient the 2nd GW tip to face the side branch by torque force

• Pull back the 2nd GW toward the side branch (pre-shaping of GW tip enables easy access into the side branch)

• After capturing the appropriate stent strut, advance the 2nd GW distally to the side branch. Appropriate stent strut position; most distal part at carina for open cell stent, and central part of ostial for closed cell stent

LAD Ca CTO

MDCT/LAD Ca CTO

LAD Ca CTO

Gaia 1 >> 2 >> 3Step down to XT-RRotablator 1.5 mm

Suoh 03

• Tip load 0.3g, coreless , so fragile, pre-shaped

• Can not predict to navigate at discretion

• Push, pull, rotate :

• Pull while rotate/Push while rotate

• Physics not applied to the tip “behavior”

LCX CTO

Suoh 03

LCX CTO

EPI DIASTOLE EPI SYSTOLE

Tipping bend in Epicardial

“ Under steer “

“ Over steer “

1. Soft tip deflection2. Bend opening angle3. Hydrophilic tip favoring over-steering4. Conformable tip with torque transmission5. Adequate “space” for flip-flopping the tip for next turn

LCX CTO

Suoh-03

LAD CTO with Ca++

Prior PCI

Re-Attempt

Suoh 03 on Caravel

Re-Attempt

Retrograde Gaia 2XCART attemptGuide liner Assisted XCARTRG3 Externalization

Caravel® structure (135 cm and 150 cm)

Hydrophilic coating： 75cm

Caravel Prox.

0.55mm 0.85mm

0.62mm

Caravel Dis.

0.43mm

ProductsO.D. I.D.

LengthCoating

Entry Distal Proximal Entry Distal Proximal Length

ASAHI Caravel

ASAHI Corsair

Finecross MGNot publicly

available

Finecross GTｍ

ⒸASAHI INTECC CO., LTD 2014; This document is for training of staff and contains confidential or privileged information. Any

distribution, copying, forwarding or citation is strictly prohibited.

ASAHI Gaia nextCTO guide wire

• New generation of Gaia Family

• More torquable and penetrating power

• 3 different stiffness

Gaia Next 1 st

Gaia Next 2 nd

Gaia Next 3 rd

• Specifications finalized

The Plasma wire system

• Novel device for CTO PCI

• FIM performed successfully in 7

New devices for CTO PCI from Japan

• New technologies has changes our approaches to CTO.

• Wires, micro-catheters, Guide-catheter(system), and Imaging (IVUS, CT scan) are backbone

• As the technologies has developed, the operators can adopt very fast, worldwide

• However advanced, there are always “ remaining” challenges, as we push further

• We select the technology “wisely” and “we” use them in appropriate context

CCT 2016 Oct 20-22, Kobe, Japan

Post CABG RCA CTO

IVUS Navigated PuncturingGaia 2SionCorsair ProRetro: XT to Sion Black KnuckleGuide liner assisted XCART

ASAHI CORSAIR PROMicrocatheter

Hydrophilic Coating:60cm

Usable Length

More slender distal tip and more trackabilityMore torque resistance to go through complex collaterals and CTOs

現行Corsairでは回転操作を加えても超えることができない屈曲モデルを用いて通過性能の比較評価を行った現行Corsairでは回転操作を加えても超えることができない屈曲モデルを用いて通過性能の比較評価を行った

ASAHI Corsair ASAHI Corsair Pro

動画

結果回転操作を加えても、挿入不可押し操作のみで挿入可

剛性徐変の最適化②

masahisa yamane - 45new devices for cto pci

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