Video : Live case #5 from Swiss CTO Summit 2019

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.

Cardiology / Coronary / Cto / Conference

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

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

1. Galassi AR, Sumitsuji S, Boukhris M, Brilakis ES, Di Mario C, Garbo R, et al. Utility of Intravascular Ultrasound in Percutaneous Revascularization of Chronic Total Occlusions. JACC Cardiovasc Interv. Oct 2016;9(19):1979‑91.

2. Matsuno S, Tsuchikane E, Harding SA, Wu EB, Kao H-L, Brilakis ES, et al. Overview and proposed terminology for the reverse controlled antegrade and retrograde tracking (reverse CART) techniques. EuroIntervention. Mai 2018;14(1):94‑101.

3. Galassi AR, Werner GS, Boukhris M, Azzalini L, Mashayekhi K, Carlino M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the EuroCTO Club. EuroIntervention. Juin 2019;15(2):198‑208.

Shooting date : 2019-11-08
Last update : 2021-05-11

6 comments

Join the Discussion

See previous comments (2)

Al fazir O. beautiful case

2020-05-17, 17h35
Join files

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.

1 - Add file(s) upload
Arun K. Nicely executed!

2020-07-05, 20h38
Join files

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.

1 - Add file(s) upload
Yasser H. Great job team

2020-11-14, 13h53
Join files

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.

1 - Add file(s) upload
Benjamin F. Thank you for your feed-back!

2020-11-14, 21h55
Join files

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.

1 - Add file(s) upload
ahmed B. Nice duoet

2021-09-07, 20h38
Join files

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.

1 - Add file(s) upload
Eli P. Very interesting!

2023-06-19, 16h38
Join files

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.

1 - Add file(s) upload

Live case #5 from Swiss CTO Summit 2019 - Dr Avran & Dr Faurie

Case of the month: February 2020

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