×
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.
My Player placeholder

Become an Incathlab member and receive full access to its content!

You must be an Incathlab member to access videos without any restrictions. Register for free in one minute and access all services provided by Incathlab.You will also be able to log into Incathlab from your Facebook or twitter account by clicking on login on the top-right corner of Incathlab website.

Registration Login


Worldwide schedules comment Share
22053 views
This complete didactic procedure concerns a 41 yo male, with multiple cardiovascular risk factors, presenting severe excertional angina related to ostial LAD chronic total occlusion.
The LAD CTO was successfully recanalized antegradly using IVUS guided-puncture Technique & Bifurcation Stenting LAD-D1 with DK-Crush Technique.

Educational objectives

  • How to manage diabetic patients with one vessel disease (Proximal LAD CTO): CABG vs PCI.
  • Step-by-Step setup & Access-guiding catheters choice.
  • Application of the Hybrid algorithm in CTO PCI procedures.
  • IVUS guided proximal  CAP puncture technique.
  • Tips & Tricks to gain support and safely advance microcatheters, balloons...in uncrossable lesions.
  • How to Stent bifurcations in CTO lesions.
  • How to perform double Stent Technique: DK-Crush.
  • How to prevent complications during every Step CTO PCI procedure.

Step-by-Step procedure

  • Dual Femoral Access : 8F introducer in Right CFA & 7F introducer in Left CFA.
  • JR 7F  guiding catheter for the RCA & 8F EBU3.0 for the Left main.
  • Proximal CAP engagment using Workhorse guidewire Sionblue (Asahi) then Fielder XT-A (Asahi) & Low profile microcatheter Caravel (Asahi).
  • Advancement of the Filder XT-R into the first diagonal.
  • Trapping the microcather with Trapping dedicated Device: Trapper (Boston Scientific).
  • Predilation toward the Diagonal with small balloon 1.5x20mm.
  • Exchange of the Fielder XT-A (Asahi) with a workhorse guidewire Sionblue (Asahi).
  • IVUS evaluation of the proximal CAP.
  • Echo-guided puncture using a Fielder XT-A Guidewire & Caravel microcatheter (Asahi).
  • Exchange Fielder XT-A guidewire to Gaia Second (Asahi) to cross the occlusion & angiographic control in two orthogonal views.
  • Anchoring balloon technique in the diagonal to advance the Caravel into the LAD.
  • After failing the Anchoring balloon technique, a dilatation of the proximal Cap using a small balloon 1.5x20mm was performed.
  • Exchange  to the microcatheter & Crossing into the true lumen using a workhorse guidewire Runthrough guidewire (Terumo).
  • Predilatation of the Diagonal & the LAD with  2.5x15mm.
  • Angiographic control.
  • Bifurcation two stents technique: LAD-1st Diagonal with DK-Crush Technique.

Biobliography

CTO technics

Shooting date : 2019-01-18
Last update : 2019-05-28
Dr. Khaldoon Alaswad
Detroit, United States
Owayed Al Shammeri
Riyadh, Saudi Arabia, Saudi Arabia

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
7 comments
Join the Discussion
See previous comments (3)
  • Amir ali M. nice 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.


    • Naga ganesh K. Great

        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.


      • Mochamad Faishal R. Excellent technique

          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.


        • Pierre D. very educational 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.


          • hazem E. excellent comprehensive presentation to the point clear steps

              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.


            • Venkatesa R. very 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.


              • Tekten T. thanks

                  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.


                Suggestions

                Tuesday, March 29th 2022 from 06pm to 07pm (GMT+2)
                Honolulu : Tuesday, March 29th 2022 from 07am to 08am (GMT+2)
                San Francisco : Tuesday, March 29th 2022 from 10am to 11am (GMT+2)
                New York : Tuesday, March 29th 2022 from 01pm to 02pm (GMT+2)
                Buenos Aires : Tuesday, March 29th 2022 from 02pm to 03pm (GMT+2)
                Reykjavik : Tuesday, March 29th 2022 from 05pm to 06pm (GMT+2)
                London / Dublin : Tuesday, March 29th 2022 from 06pm to 07pm (GMT+2)
                Paris / Berlin : Tuesday, March 29th 2022 from 07pm to 08pm (GMT+2)
                Istanbul : Tuesday, March 29th 2022 from 08pm to 09pm (GMT+2)
                Moscou / Dubaï : Tuesday, March 29th 2022 from 09pm to 10pm (GMT+2)
                Bangkok : Wednesday, March 30th 2022 from 12am to 01am (GMT+2)
                Shanghai : Wednesday, March 30th 2022 from 01am to 02am (GMT+2)
                Tokyo : Wednesday, March 30th 2022 from 02am to 03am (GMT+2)
                Sydney : Wednesday, March 30th 2022 from 04am to 05am (GMT+2)
                Wellington : Wednesday, March 30th 2022 from 06am to 07am (GMT+2)

                The Role of Mechanical Circulatory Support in Complex VT Cases

                Share
                With Masahisa Yamane
                Honolulu : Tuesday, June 6th 2023 from 01pm to 01pm (GMT+2)
                San Francisco : Tuesday, June 6th 2023 from 04pm to 04pm (GMT+2)
                New York : Tuesday, June 6th 2023 from 07pm to 07pm (GMT+2)
                Buenos Aires : Tuesday, June 6th 2023 from 08pm to 08pm (GMT+2)
                Reykjavik : Tuesday, June 6th 2023 from 11pm to 11pm (GMT+2)
                London / Dublin : Wednesday, June 7th 2023 from 12am to 12am (GMT+2)
                Paris / Berlin : Wednesday, June 7th 2023 from 01am to 01am (GMT+2)
                Istanbul : Wednesday, June 7th 2023 from 02am to 02am (GMT+2)
                Moscou / Dubaï : Wednesday, June 7th 2023 from 03am to 03am (GMT+2)
                Bangkok : Wednesday, June 7th 2023 from 06am to 06am (GMT+2)
                Shanghai : Wednesday, June 7th 2023 from 07am to 07am (GMT+2)
                Tokyo : Wednesday, June 7th 2023 from 08am to 08am (GMT+2)
                Sydney : Wednesday, June 7th 2023 from 10am to 10am (GMT+2)
                Wellington : Wednesday, June 7th 2023 from 12pm to 12pm (GMT+2)

                A complex ostial LAD occlusion in a 67 years old man

                Alex & Friends - Ep.5

                Share
                Tuesday, July 12th 2022 from 06pm to 07:30pm (GMT+2)
                Honolulu : Tuesday, July 12th 2022 from 07am to 08:30am (GMT+2)
                San Francisco : Tuesday, July 12th 2022 from 10am to 11:30am (GMT+2)
                New York : Tuesday, July 12th 2022 from 01pm to 02:30pm (GMT+2)
                Buenos Aires : Tuesday, July 12th 2022 from 02pm to 03:30pm (GMT+2)
                Reykjavik : Tuesday, July 12th 2022 from 05pm to 06:30pm (GMT+2)
                London / Dublin : Tuesday, July 12th 2022 from 06pm to 07:30pm (GMT+2)
                Paris / Berlin : Tuesday, July 12th 2022 from 07pm to 08:30pm (GMT+2)
                Istanbul : Tuesday, July 12th 2022 from 08pm to 09:30pm (GMT+2)
                Moscou / Dubaï : Tuesday, July 12th 2022 from 09pm to 10:30pm (GMT+2)
                Bangkok : Wednesday, July 13th 2022 from 12am to 01:30am (GMT+2)
                Shanghai : Wednesday, July 13th 2022 from 01am to 02:30am (GMT+2)
                Tokyo : Wednesday, July 13th 2022 from 02am to 03:30am (GMT+2)
                Sydney : Wednesday, July 13th 2022 from 04am to 05:30am (GMT+2)
                Wellington : Wednesday, July 13th 2022 from 06am to 07:30am (GMT+2)

                Mechanical circulatory support with CP Axillary access and surgical 5.5

                Impella Case Club

                Share
                Wednesday, November 24th 2021 from 12:30pm to 01:30pm (GMT+1)
                Honolulu : Wednesday, November 24th 2021 from 01:30am to 02:30am (GMT+1)
                San Francisco : Wednesday, November 24th 2021 from 03:30am to 04:30am (GMT+1)
                New York : Wednesday, November 24th 2021 from 06:30am to 07:30am (GMT+1)
                Buenos Aires : Wednesday, November 24th 2021 from 08:30am to 09:30am (GMT+1)
                London / Dublin : Wednesday, November 24th 2021 from 11:30am to 12:30pm (GMT+1)
                Paris / Berlin : Wednesday, November 24th 2021 from 12:30pm to 01:30pm (GMT+1)
                Istanbul : Wednesday, November 24th 2021 from 01:30pm to 02:30pm (GMT+1)
                Moscou / Dubaï : Wednesday, November 24th 2021 from 03:30pm to 04:30pm (GMT+1)
                Bangkok : Wednesday, November 24th 2021 from 06:30pm to 07:30pm (GMT+1)
                Shanghai : Wednesday, November 24th 2021 from 07:30pm to 08:30pm (GMT+1)
                Tokyo : Wednesday, November 24th 2021 from 08:30pm to 09:30pm (GMT+1)
                Sydney : Wednesday, November 24th 2021 from 09:30pm to 10:30pm (GMT+1)
                Wellington : Wednesday, November 24th 2021 from 11:30pm to 12:30am (GMT+1)

                The Fabulous Complex PCI Tournament

                A search for rare, challenging and complicated PCI Cases

                Share
                Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                Honolulu : Thursday, March 16th 2023 from 06am to 08:30am (GMT+1)
                San Francisco : Thursday, March 16th 2023 from 08am to 10:30am (GMT+1)
                New York : Thursday, March 16th 2023 from 11am to 01:30pm (GMT+1)
                Buenos Aires : Thursday, March 16th 2023 from 01pm to 03:30pm (GMT+1)
                London / Dublin : Thursday, March 16th 2023 from 04pm to 06:30pm (GMT+1)
                Paris / Berlin : Thursday, March 16th 2023 from 05pm to 07:30pm (GMT+1)
                Istanbul : Thursday, March 16th 2023 from 06pm to 08:30pm (GMT+1)
                Moscou / Dubaï : Thursday, March 16th 2023 from 08pm to 10:30pm (GMT+1)
                Bangkok : Thursday, March 16th 2023 from 11pm to 01:30am (GMT+1)
                Shanghai : Friday, March 17th 2023 from 12am to 02:30am (GMT+1)
                Tokyo : Friday, March 17th 2023 from 01am to 03:30am (GMT+1)
                Sydney : Friday, March 17th 2023 from 02am to 04:30am (GMT+1)
                Wellington : Friday, March 17th 2023 from 04am to 06:30am (GMT+1)

                Bifurcation PCI - Insights from the Visible Heart® Lab 

                Share
                Tuesday, November 30th 2021 from 07pm to 08pm (GMT+1)
                Honolulu : Tuesday, November 30th 2021 from 08am to 09am (GMT+1)
                San Francisco : Tuesday, November 30th 2021 from 10am to 11am (GMT+1)
                New York : Tuesday, November 30th 2021 from 01pm to 02pm (GMT+1)
                Buenos Aires : Tuesday, November 30th 2021 from 03pm to 04pm (GMT+1)
                London / Dublin : Tuesday, November 30th 2021 from 06pm to 07pm (GMT+1)
                Paris / Berlin : Tuesday, November 30th 2021 from 07pm to 08pm (GMT+1)
                Istanbul : Tuesday, November 30th 2021 from 08pm to 09pm (GMT+1)
                Moscou / Dubaï : Tuesday, November 30th 2021 from 10pm to 11pm (GMT+1)
                Bangkok : Wednesday, December 1st 2021 from 01am to 02am (GMT+1)
                Shanghai : Wednesday, December 1st 2021 from 02am to 03am (GMT+1)
                Tokyo : Wednesday, December 1st 2021 from 03am to 04am (GMT+1)
                Sydney : Wednesday, December 1st 2021 from 04am to 05am (GMT+1)
                Wellington : Wednesday, December 1st 2021 from 06am to 07am (GMT+1)

                The Role of Mechanical Circulatory Support in High-Risk PCI & in CTO PCI

                Impella Case Club

                Share
                Monday, November 29th 2021 from 06pm to 07pm (GMT+1)
                Honolulu : Monday, November 29th 2021 from 07am to 08am (GMT+1)
                San Francisco : Monday, November 29th 2021 from 09am to 10am (GMT+1)
                New York : Monday, November 29th 2021 from 12pm to 01pm (GMT+1)
                Buenos Aires : Monday, November 29th 2021 from 02pm to 03pm (GMT+1)
                London / Dublin : Monday, November 29th 2021 from 05pm to 06pm (GMT+1)
                Paris / Berlin : Monday, November 29th 2021 from 06pm to 07pm (GMT+1)
                Istanbul : Monday, November 29th 2021 from 07pm to 08pm (GMT+1)
                Moscou / Dubaï : Monday, November 29th 2021 from 09pm to 10pm (GMT+1)
                Bangkok : Tuesday, November 30th 2021 from 12am to 01am (GMT+1)
                Shanghai : Tuesday, November 30th 2021 from 01am to 02am (GMT+1)
                Tokyo : Tuesday, November 30th 2021 from 02am to 03am (GMT+1)
                Sydney : Tuesday, November 30th 2021 from 03am to 04am (GMT+1)
                Wellington : Tuesday, November 30th 2021 from 05am to 06am (GMT+1)

                DAPT meets its MASTER webinar

                Part 1 : The unknown HBR patient

                Share
                Scroll Up