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Apollo Hospital, Hyderguda, Hyderabad. WCC & IVUS 2015 - PowerPoint PPT Presentation

Mar 10, 2024 •239 likes •664 views

Dr P.L.N.Kapardhi Director Cath Lab Services Apollo Hospital, Hyderguda, Hyderabad. WCC & IVUS 2015 Introduction: Inability to cross CTO with first balloon after successful wiring. Prevalence: 6.4% to 10% (Operator experience)

  1. Dr P.L.N.Kapardhi Director Cath Lab Services Apollo Hospital, Hyderguda, Hyderabad. WCC & IVUS 2015

  2. Introduction:  Inability to cross CTO with first balloon after successful wiring.  Prevalence: 6.4% to 10% (Operator experience)  No specific clinical and angiographic predictors.  ? Heavy calcium. WCC & IVUS 2015

  3. Techniques Techniques increasing guide catheter support: Long sheaths (35 cms) 8F extra support guide, eg: EBU, XB,AL. Deep throttling Guideliner (mother and child technique) Anchor Balloons Hydrophilic embodiment of the wires. WCC & IVUS 2015

  4. Contd.., Techniques modifying the CTO lesion: Grenadoplasty Wedgies (Balloon Assisted Micro Dissections) low profile Hydrophylic balloons Micro catheter advancing Recrossing with 2 nd wire wire cutting technique seasaw Balloon wire cutting subintimal distal anchor wire subintimal space plaque modification – Antegrade knuckle, stringray balloon WCC & IVUS 2015

  5. Contd.., Retrograde approach – Distal anchor by retrograde balloon, reverse CART, retrograde knuckle(hybrid approach) Rotational atherectomy X 80 Excimer Laser ( Ablative and Acoustic energy) WCC & IVUS 2015

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  17. WCC & IVUS 2015

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  31. CrossBoss and StingRay WCC & IVUS 2015

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  38. Algorithm for crossing a Balloon Uncrossable CTO WCC & IVUS 2015

  39. Techniques for Treatment of Balloon Uncrossable CTO WCC & IVUS 2015

  40. Techniques for Treatment of Balloon Uncrossable CTO WCC & IVUS 2015

  41. Summary  Most commonly used – Multiple low profile balloons  Second most commonly used – Micro catheter advancement with – Corsair , Tornus , Fine cross  Miscellaneous – Anchor Balloon ( Side branch , Co axial) Antegrade Sub intimal distal anchor Distal Anchor with retrograde balloon SeaSaw Balloon wire cutting technique Double wire cutting technique  Rotablation  Laser Atherectomy WCC & IVUS 2015

  42. WCC & IVUS 2015

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