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

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Mar 10, 2024 239 likes •665 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)

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Dr P.L.N.Kapardhi Director Cath Lab Services Apollo Hospital, Hyderguda, Hyderabad.

WCC & IVUS 2015

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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

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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

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Contd..,

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

WCC & IVUS 2015

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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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CrossBoss and StingRay

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Algorithm for crossing a Balloon Uncrossable CTO

WCC & IVUS 2015

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Techniques for Treatment of Balloon Uncrossable CTO

WCC & IVUS 2015

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Techniques for Treatment of Balloon Uncrossable CTO

WCC & IVUS 2015

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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

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WCC & IVUS 2015