×
It looks like you're using an obsolete version of internet explorer. Internet explorer is no longer supported by Microsoft since the end of 2015. We invite you to use a newer browser such as Firefox, Google Chrome or Microsoft Edge.
19340 views

This didactic procedure concerns a 63 y.o male, with  medical history of CAD (Lcx already treated few months before, LAD CTO JCTO Score:4).

First attempt of LAD recanalization  has failed, the patient is still symptomatic  despite OMT.

The second attempt was a success with retrograde approach using IVUS guided retrograde puncture.

Educational objectives

  • How to approach patients with Symptomatic coronary  chronic total occlusions.
  • Optimal Application of the Hybrid algorithm in treatment of coronary CTO.
  • Evaluation of the anatomical complexity of coronary CTO with combined angiography and IVUS.
  • IVUS usefulness to decide strategy in coronary CTO procedures.
  • Step by step retrograde approach in coronary CTO procedures.
  • IVUS guidance for safe retrograde and antegrade punctures.
  • How to optimize sizing and stent implantation in Coronary CTO procedures.

Step-by-Step procedure

  • Double Femoral approach 7F introducers.
  • EBU 3.5 7F to the Left system and AL0.75 7F to the right system with two Sion blue wires for stabilization.
  • IVUS assessment of the LAD Poximal CAP.
  • Retrograde approach with Corsair microcatheter and surfing technique via PDA-septal connections using a Sion black guidewire.
  • IVUS evaluation of the  retrograde wire position.
  • Retrograde puncture of the proximal CAP using a Confianza Pro 12 guidewire.
  • IVUS evaluation of t the Confianza Pro12 wire confirming subintimal position in the Proximal LAD.
  • Antegrade puncture using a Confianza Pro12 and Finecross microcatheter.
  • Progession antergradelly using Finecross microcatheter and Sion black wire.
  • Confirming the distal position with safe Tip injection.
  • IVUS evaluation of the antegrade wire and LAD sizing.
  • Retrograde material remove.
  • Predilatation and stenting of Ostio-proximal LAD with Promus 3.0x32mm DES.
  • Stenting of the Mid-LAD with Promus 2.5x24mm.
  • Final angiographic and IVUS control and Optimization.

Biobliography

Shooting date : 2018-01-11
Last update : 2021-05-11

Our Cases of the Month

The case of the month is a new way for our users to watch, learn, and share with incathlab. They can watch a video that highlights an innovative case and uses excellent pedagogical techniques, lear...

Share
8 comments
Join the Discussion
See previous comments (4)
  • Mohamed M. Good job

      Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
      Your browser doesn't have Flash, Silverlight or HTML5 support.


    • Rohit M. Good discuss so far

        Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
        Your browser doesn't have Flash, Silverlight or HTML5 support.


      • Hatem E. Very nice

          Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
          Your browser doesn't have Flash, Silverlight or HTML5 support.


        • Leonid G. Excellent and rational

            Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
            Your browser doesn't have Flash, Silverlight or HTML5 support.


          • Tameka C. Very informative. New to CTO procedures..

              Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
              Your browser doesn't have Flash, Silverlight or HTML5 support.


            • Denis Nikolov D. Good job ;)

                Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                Your browser doesn't have Flash, Silverlight or HTML5 support.


              • Mohamed M. Good

                  Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                  Your browser doesn't have Flash, Silverlight or HTML5 support.


                • Alexandre P. Very nice case

                    Please, select your files, click upload button, write your comment and click the send button. (allowed formats : images jpeg, gif, png, and PDF)
                    Your browser doesn't have Flash, Silverlight or HTML5 support.


                  Scroll Up