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Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
12:15 – 12:30
An update on specific advan...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Disclosure Statement of Financial Interes...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
RCA Calcified CTO
Proximal Ambiguity, Ben...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Pre PCI CTA
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
RCA Calcified CTO
Gaia 1 to 2 ndGaia 3
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Pre PCI CTA
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
RCA Calcified CTO
Sion BlueDifficulty in ...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
RCA Calcified CTO
• Every Calcified CTO d...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Post Bypass LCX CTO
No Proximal Cap Ambig...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Post Bypass LCX CTO
Retrograde Gaia 2Ante...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Suoh-03
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Wiring for Tortuous AC channel
Gaia 2 on ...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
New Generation Wire for collaterals
Rever...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Suoh-03
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Caravel® structure (135 cm and 150 cm)
Hy...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Finecross GT 130 and 150cm
コード
番号
マーカー
部外...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
LAD CTO Re-attempt
No R to L collateralsA...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Pre-PCI CPR
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
LAD CTO Re-attempt
SionSelective Injectio...
4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich, Swiss
RCA CTO @ distal bifur (ISR)
Su...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Suoh 03
• Tip load 0.3g, coreless , so fr...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
LAD disease and LX CTO
Gaia 1 to 2 ndSion...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Retrograde Gaia 2, Confianza Pro12, and S...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
LAD disease and LX CTO
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
LAD disease and LX CTO
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
After IVUS guided Wiring of a new Sion bl...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Promus PREMIER™ 2.5 mmXIENCE Xpedition™ 2...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Lesson
• Suoh 03 can negotiate the channe...
Retrograde procedure outcome (3)
75%
73%
65%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Attempt Channel
Guidewire cross
Channel
...
56,1%
31,0%
12,9%
0%
40%
80%
Single wire Parallel wire IVUS guided
re-entry
Successful CTO crossing strategy
by antegrade ...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
Wire / Strategy selection for CTO 2015
Fi...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
An update on new guide wires in 2015
• In...
Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
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Friday 1215 – yamane

Experts "Live" CTO Workshop 2015 Septemper, 18th – 19th , 2014 in Istanbul, Turkey

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Friday 1215 – yamane

  1. 1. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey 12:15 – 12:30 An update on specific advantages of different new guide wires for both antegrade and retrograde approach Masahisa Yamane , MD, FACC St Luke‘s International Hospital ,Tokyo, Japan Saitama Sekishinkai Hospital, Saitama, Japan
  2. 2. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey 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.
  3. 3. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey RCA Calcified CTO Proximal Ambiguity, Bending, Length < 20 mm, and CalcificationPoor distal landing prior to bifurcation“Interventional “Collateral
  4. 4. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Pre PCI CTA
  5. 5. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey RCA Calcified CTO Gaia 1 to 2 ndGaia 3
  6. 6. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Pre PCI CTA
  7. 7. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey RCA Calcified CTO Sion BlueDifficulty in Crossing over GuidelinerRotablator 1.5 to 2.0mm
  8. 8. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey RCA Calcified CTO • Every Calcified CTO different, needs “tailored” approach • CTA has a limitation to elucidate CTO details, variable information for “CTO” operators • Wire drives expeditiously on “Navi” map
  9. 9. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Post Bypass LCX CTO No Proximal Cap Ambiguity, length < 20mm, No Calcification, but poor “Landing” zone“ Interventional” Collaterals ?Gaia 1Selective Injection through Finecross GT in RIMA Graft to PD to collateralRAO 50 ⁰Suoh 03
  10. 10. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Post Bypass LCX CTO Retrograde Gaia 2Antegrade 1.5 mm ballooning for XCARTAfter wire externalization, balloon dilation on RG3
  11. 11. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Suoh-03
  12. 12. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Wiring for Tortuous AC channel Gaia 2 on CorsairSuoh 03 on CaravelProximal Ambiguity, Length>20mm, bend inside, poor “landing” zone or another CTO or a disease beyond Interventional Collaterals? Selective Injection through Caravel
  13. 13. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey New Generation Wire for collaterals Reverse CART with Retrograde XT-R
  14. 14. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Suoh-03
  15. 15. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Caravel® structure (135 cm and 150 cm) Hydrophilic coating: 75cm Caravel Prox. 0.55mm 0.85mm PTFE 0.62mm Caravel Dis. 0.43mm PTFE Products O.D. I.D. Length Coating Entry Distal Proximal Entry Distal Proximal Length ASAHI Caravel ASAHI Corsair Finecross MG Not publicly available Finecross GT m m Ⓒ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.
  16. 16. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Finecross GT 130 and 150cm コード 番号 マーカー 部外径 (Fr./mm ) 先端部 外径 (Fr./m m) 基部外 径 (Fr./m m) 先端部内 径 (inch/mm ) 基部内 径 (inch/m m) マーカー長 (mm) カテーテル 有効長 (cm) 最大適用 GW径 (inch/mm ) 共通 コー (JA NC- F863B 1.7/0.57 1.8/0.6 0 2.6/0.8 7 0.018/0.45 0.021/0. 55 1.0 130 0.014/0.36 498 57 NC- F865B 150 498 17 • 中 • 大
  17. 17. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey LAD CTO Re-attempt No R to L collateralsAmbiguous proximal cap, no bend, length> 20mm and poor distal “landing”No substantial L to L collaterals, either
  18. 18. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Pre-PCI CPR
  19. 19. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey LAD CTO Re-attempt SionSelective Injection through Finecross GTSion BlackRetrograde Gaia 2Antegrade Gaia 3Proximal Stent deliverySuoh 03
  20. 20. 4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich, Swiss RCA CTO @ distal bifur (ISR) Suoh 03 over Finecross GT
  21. 21. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey 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”
  22. 22. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey LAD disease and LX CTO Gaia 1 to 2 ndSionSion blackSuoh 03Suoh 03 with some resistanceClear proximal cap, length >20mm, poor distal “landing” and no calcificationProxi LAD disease and Collateral to LCX present, if any ?RAO 50 ⁰
  23. 23. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Retrograde Gaia 2, Confianza Pro12, and Sion blackAfter Wire externalization, IVUS on RG3 LAD disease and LX CTO
  24. 24. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey LAD disease and LX CTO
  25. 25. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey LAD disease and LX CTO
  26. 26. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey After IVUS guided Wiring of a new Sion black LAD disease and LX CTO
  27. 27. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Promus PREMIER™ 2.5 mmXIENCE Xpedition™ 2.75 mmXIENCE Xpedition™ x 2 LAD disease and LX CTO
  28. 28. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Lesson • Suoh 03 can negotiate the channel, which does not equal intimal tracking throughout
  29. 29. Retrograde procedure outcome (3) 75% 73% 65% 60% 65% 70% 75% 80% 85% 90% 95% 100% Attempt Channel Guidewire cross Channel Catheter cross Procedure Success 2012 2013 2014 -25%
  30. 30. 56,1% 31,0% 12,9% 0% 40% 80% Single wire Parallel wire IVUS guided re-entry Successful CTO crossing strategy by antegrade approach Failure reason N=145 Couldn’t cross CTO by guidewire 85.1% (120) Couldn’t cross CTO by any catheter 9.2% (12) Procedure discontinuation due to complication 5.7% (8) Not identify 2.8% (4) Retrograde Procedure Outcome (2) In case switched to antegrade after retrograde (n=382) Total 2012 2013 2014 P Antegrade procedure success switched after retrograde failure 62.0% (237/382) 64.8% (81/125) 57.9% (99/171) 66.3% (57/86) 0.3153 Overall procedure success in retrograde cases 81.5% (1067/1309) 83.1% (407/490) 80.1% (431/538) 80.1% (229/281) 0.4770
  31. 31. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey Wire / Strategy selection for CTO 2015 Fielder XT/ FC Confianza Pro 9g Miracle bross 12 g Progress 200T Parallel wire method Miracle bross 3g Ultimate 3g Progress 40 Retro grade approach IVUS navigated Gaia 1,2, 3 Sion Sion black XT-R on Corsair Finecross Caravel Suoh 03
  32. 32. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey An update on new guide wires in 2015 • Integration of Imaging  CTO wiring • New generation wires and ( micro-catheters) simplify and streamline the flow of the PCI steps • Suoh 03 can change the “ most” challeging part of collateral crossing in Retrograde • Wider application of technique and tecknology can further expand the success rate
  33. 33. Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey

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