Masahisa Yamane - 45New Devices for CTO PCI

Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
14:30-14:45
New Devices for CTO PCI
Masahisa Yamane , MD, FACC
St Luke‘s International Hospital ,Tokyo, Japan
Saitama Sekishinkai Hospital, Saitama, Japan

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.

RCA CTO c Left Coronary Anomaly

IVUS (VOLCANO) for Proximal Cap AmbiguityGaia 2RAO

LAORAO

FineDuo ( Dual Lumen catheter ) for Parallel WiringConfianza Pro 12g

FineDuo: Product Specification
OTW lumen to deliver (2nd
guidewire, contrast media,
drugs)
RX lumen for the 1st
guidewire
Usages:
o Any complex PCI whenever stronger GW control & support are
required
o Drug diffusion

Double markers facilitate an accurate placement to
access
• Any side branch or collaterals
• The most distal stent strut
0.5
mm
1.0
mm0.5
mm
5 mm
Double radiopaque markers are
located specifically for better
visualization
 OTW lumen exit port in
between both markers
 1 mm Distal marker on RX
lumen part
 Distal marker on RX lumen
part is located at 0.5 mm
FineDuo: Double radiopaque markers

 GW advances
obliquely thanks
to the “bump”:
5 degree
 This angle
enables to
expand the
rotation range
of the GW
Angle and position of distal part of GW GW rotatable
range
RX
lumen
OTW
lume
n
RX
lumen
OTW
lume
n
5 degree
GW
RX
lumen
OTW
lume
n
RX
lumen
OTW
lume
n
GW
Better GW Manipulation for maneuvrability
Standard dual lumen microcatheter
FineDuo*
FineDuo: Rotatable range of Guidewire

Reverse Wire Technique - Steps• Insert the FineDuo microcatheter along the main
vessel GW with 2nd GW (for side branch) inside the
OTW lumen
• Protrude the tip of 2nd GW from the distal side hole
• Pull back the FineDuo microcatheter toward the
proximal side and orient the 2nd GW tip to face the
side branch by torque force
• Pull back the 2nd GW toward the side branch (pre-
shaping of GW tip enables easy access into the side
branch)
• After capturing the appropriate stent strut, advance
the 2nd GW distally to the side branch. Appropriate
stent strut position; most distal part at carina for
open cell stent, and central part of ostial for closed
cell stent

LAD Ca CTO

MDCT/LAD Ca CTO

LAD Ca CTO
Gaia 1 >> 2 >> 3Step down to XT-RRotablator 1.5 mm

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”

LCX CTO

LCX CTO
Suoh 03

EPI DIASTOLE EPI SYSTOLE

Tipping bend in Epicardial
“ Under steer “

“ Over steer “
1. Soft tip deflection
2. Bend opening angle
3. Hydrophilic tip favoring over-
steering
4. Conformable tip with torque
transmission
5. Adequate “space” for flip-
flopping the tip for next turn

Suoh-03

LAD CTO with Ca++

Prior PCI

Re-Attempt
Suoh 03 on Caravel

Re-Attempt
Retrograde Gaia 2XCART attemptGuide liner Assisted XCARTRG3 Externalization

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.

ASAHI Gaia next
CTO guide wire
• New generation of Gaia Family
• More torquable and penetrating power
• 3 different stiffness
Gaia Next 1 st
Gaia Next 2 nd
Gaia Next 3 rd
• Specifications finalized

The Plasma wire system
• Novel device for CTO PCI
• FIM performed successfully in 7

New devices for CTO PCI from Japan
• New technologies has changes our approaches to
CTO.
• Wires, micro-catheters, Guide-catheter(system), and
Imaging (IVUS, CT scan) are backbone
• As the technologies has developed, the operators
can adopt very fast, worldwide
• However advanced, there are always “ remaining”
challenges, as we push further
• We select the technology “wisely” and “we” use
them in appropriate context

CCT 2016 Oct 20-22, Kobe, Japan

Post CABG RCA CTO
IVUS Navigated PuncturingGaia 2SionCorsair ProRetro: XT to Sion Black KnuckleGuide liner assisted XCART

ASAHI CORSAIR PRO
Microcatheter
Hydrophilic Coating:
60cm
Usable Length
More slender distal tip and more trackability
More torque resistance to go through complex collaterals and CTOs

現行Corsairでは回転操作を加えても超えることができない
屈曲モデルを用いて通過性能の比較評価を行った
現行Corsairでは回転操作を加えても超えることができない
屈曲モデルを用いて通過性能の比較評価を行った
ASAHI Corsair ASAHI Corsair Pro
動画
結果
回転操作を加えても、挿入不可押し操作のみで挿入可
剛性徐変の最適化②
39

Masahisa Yamane - 45New Devices for CTO PCI

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Masahisa Yamane - 45New Devices for CTO PCI