×
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
Registration Login
Educational objectives
- What to do when usual antegrade and retrograde approach failed? Consider the use of « knuckle » technique with « REVERSE CART » technique (by experienced operators)
- Do we have to carry out a CTO when the distal branch appears poorly developed?
- Which guiding catheter to choose when you have pressure damping? Consider the use of side holes guiding catheter
- How to choose the right microcatheter
- « Knuckle » technique: which guidewire? Consider the use of a soft polymer wire
- How to facilitate « REVERSE CART » technique? Consider the use of a catheter extension
- Perform an IVUS: is this determining?
Step-by-step procedure
-
New try of RCA CTO recanalisation with REVERSE CART technique by circumflex epicardial channel after standard antegrade and standard retrograde failure (no other possibilty: septal from LIMA are not connected with PDA)
-
Antegrade approach with AL 1, 7F (side holes guiding catheter due to ostial lesion),
-
Retrograde approach with EBU 4, 7F
1) Retrograde approach (epicardial channel from circumflex)
- Microcathter: MAMBA FLEX
- First wire: SION BLUE, second wire : SION
- MAMBA FLEX microcatheter and SION wire are in front of the distal cap after antegrade injection
2) Antegrade approach (RCA)
- Microcathter: MAMBA FLEX
- First wire: GAIA 3rd to perform the proximal cap puncture
- Second wire: FIELDER XTA with small bend to perform « knuckle technique »
- Stop just before the distal cap
3) « Knuckle », retrograde approach
- « Knuckle technique » with GAIA 3rd
4) REVERSE CART
- Remove the anterograde MAMBA FLEX
- Catheter extension GUIDEZILLA 7F
- Use 2.5 balloon to carry out the REVERSE CART
- Retrograde fresh Gaia 3rd wire to perform REVERSE CART
- Externalise the wire
- Pull back the retrograde MAMBA FLEX to perform an IVUS
5) IVUS
- RCA distal branch sizing
6) Angioplasty
- Predilatation with 2mm balloon
- 2.5*24 mm DES in the PDA
- Two DES in the RCA (3*48mm, 3*38mm) up to the ostium
- 1.5 balloon in the crux to PL branch
Bibliography
Shooting date : 2019-11-08
Last update : 2021-05-11
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
Join the Discussion
Suggestions
Stenting of obstructive right femoro-iliac post-thrombotic lesions
Case of the month: January 2020
Share
Occluded instent left SFA stenosis | Fractured stents treated - Eluvia stenting
Case of the month: June 2022
Share
Long Femoral Occlusion (35 cm) - Subintimal crossing and extra long stenting
Case of the month: July 2017
Share
Al fazir O. beautiful case
Arun K. Nicely executed!
Yasser H. Great job team
Benjamin F. Thank you for your feed-back!
ahmed B. Nice duoet
Eli P. Very interesting!