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15:20 CASE 12 - Wojcik

Experts "Live" CTO Workshop 2014
25th Septemper 2014 in Madrid, Spain

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15:20 CASE 12 - Wojcik

  1. 1. Successful recanalization of RCA chronic total occlusion with multiple BVS implantation
  2. 2. Case Summary Demographics / CVRFs / Clinical presentation 74 years old male stable angina CCS III Inferior wall inf. 2003 PCI LAD 2009 Unseccessful recanalization MB 2012 Unseccessful recanalization RCA May 2014 - antegrade appr. EKG / Non-invasive Testing Small Q waves II, III, aVF Hypokinesia of inferior wall EF 46%
  3. 3. Angiography / imaging
  4. 4. Initial Strategy ? Antegrade appr. ? Retrograde appr. ? Others ?
  5. 5. A priori Retrograde approach Step 1: Retro guidewire passage by III septal collaterals to occluded part RCA Step 2: Direct retrograde crossing or kissing wire crossing, externalization Step 3: IVUS/OCT guided BVS Implantation Case strategy
  6. 6. Case Summary Duration of the procedure: 190 min: Retro - > 2 h Ante – 30 min Fluoroscopy time: 106 min Total amount of contrast: 550 ml Xr dose: 11510 mGy
  7. 7. Key learning points Retro: LCA: 7F EBU 4,0 Sion Sion blue Fielder XT, FC Corsair 150 cm
  8. 8. Key learning points Ante: RCA: 6F JR 4,0 Sion + Corsair Confianza Pro 12 + Corsair Mini Trek 1,20/12 mm-> Mini Track 2,0/30mm-> Sprinter NC 3,5/27 mm 3 x Absorb 3,5/28 mm + 1 x Absorb 3,0/18 mm
  9. 9. Key learning points Learning point 1: not everything visible is crossable Learning point 2: switch for antegrade procedure should be after 30 min unsuccessful guidewire penetrating ? Learning point 3: antegrade wire-based strategy of CTO-PCI is associated with high success rates after retrograde access failure…

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