Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.

1105 Lefevre - How to perform

Experts "Live" CTO Workshop 2014
26th Septemper 2014 in Madrid, Spain

  • Identifiez-vous pour voir les commentaires

1105 Lefevre - How to perform

  1. 1. How to Perform and Interpret Coronary Angiography for CTO Recanalisation Thierry lefèvre ICPS, Massy, France
  2. 2. Angiography / imaging 0 2000 4000 6000 8000 10000 12000 14000 16000 CABG STEMI Coronary angio CTO No CTO Fefer P et al. J Am Coll Cardiol. 2012;59:991-997 20-25%
  3. 3. Lesion morphology Patient characteristics Learning curve The Success Rate of CTO
  4. 4. Guidewire Crossing < 30 min. Morino et al. JACC Interv 2011; 4: 213-221
  5. 5. CTO Success No ad Hoc PCI !
  6. 6. Good Angiogram  Powerfull and selective injection  Long injection  Large field  No paning
  7. 7. Good CTO Angiography  Optimal view of the distal run off  Optimal view of the donor vessel  Good views of the collaterals  Several views of the occluded vessel  At least 1 same view for both vessels  Educate the referring physicians
  8. 8. What are the Questions ?  Is it really a CTO ?  Proximal and distal ambiguity ?  Lesion length ?  Vessel course, Island ?  Lesion calcification and tortuosity ?  Distal run off ?  Collaterals ?  Good and safe support ?
  9. 9. What about the support ?
  10. 10. What about the support ? Fielder XT + Finecross
  11. 11. What about the support ? 3D right Miracle 12 + Finecross
  12. 12. What about the support ? Anchoring balloon
  13. 13. What about the support ?
  14. 14. What about the support ?
  15. 15. Antegrade or Retrograde ? Ostial and calcified lesion GC Support, Stability ? Risk of ostial dissection ?
  16. 16. Antegrade or Retrograde ?
  17. 17. Antegrade or Retrograde ?
  18. 18. Antegrade or Retrograde ?
  19. 19. Antegrade or Retrograde ?
  20. 20. Antegrade or Retrograde ?
  21. 21. Antegrade or Retrograde ?
  22. 22. « Mother and Child Technique » Antegrade or Retrograde ?
  23. 23. Antegrade or Retrograde ?
  24. 24. Vessel Course ?
  25. 25. Vessel Course ?
  26. 26. Vessel Course ?
  27. 27. Vessel Course ?
  28. 28. Vessel Course ?
  29. 29. Vessel Course ?
  30. 30. Vessel Course ?
  31. 31. Vessel Course ?
  32. 32. Vessel Course ?
  33. 33. Vessel Course ?
  34. 34. Vessel Course ?
  35. 35. Vessel Course ?
  36. 36. Proximal Ambiguity ? No Calcification Lesion length < 20 mm Proximal ambiguity ?
  37. 37. Proximal Ambiguity
  38. 38. Proximal ambiguity ? Proximal Ambiguity ?
  39. 39. Proximal Ambiguity ?
  40. 40. What about the support ?
  41. 41. Proximal Ambiguity ?
  42. 42. Proximal Ambiguity ?
  43. 43. Proximal Ambiguity ? Finecross + Fielder XT
  44. 44. Proximal Ambiguity ?
  45. 45. Proximal Ambiguity ?
  46. 46. Distal Run-off
  47. 47. Distal Run-off Proximal ambiguity Distal ambiguity Space for good support Good distal Run-off Tortuosity
  48. 48. Distal Run-off
  49. 49. Distal Run-off
  50. 50. Distal Run-off Good candidate for Crossboss-Stingray
  51. 51. Distal Run-off
  52. 52. Distal Run-off
  53. 53. Collaterals
  54. 54. Collaterals
  55. 55. Collaterals
  56. 56. Collaterals
  57. 57. Collaterals
  58. 58. Collaterals
  59. 59. Collaterals
  60. 60. Collaterals
  61. 61. Conclusion  Take extra time during the diagnostic angiogram to obtain specific anatomic information that will guide strategy (ies) for the subsequent CTO PCI.  Study the film in detail during coronary angiography in order to check that you have all the informations needed.  Educate refering physicians

×