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.

Heinz Joachim Buttner - RCA Recanalization in a post CABG patient

4th European Live Summit on Retrograde CTO Revascularization - May 8–9, 2015, in Zurich, Switzerland

  • Identifiez-vous pour voir les commentaires

Heinz Joachim Buttner - RCA Recanalization in a post CABG patient

  1. 1. RCA Recanalization in a post CABG patient Achim Büttner Universitäts-Herzzentrum Freiburg - Bad Krozingen, Germany 4th European Live Summit on Retrograde CTO Revascularization
  2. 2. Complex CTOs: Patients after CABG CTOs single operator Bad Krozingen 01/2011 – 09/2013 (n=583) P<0.001 P<0.001 P<0.001 (n=434) (n=145) 62.7 19% 34% 51 95% 69.3 37% 41% 66 82% Age (years) Angina CCS 3+4 Retrograde approach Fluoroscopy time (min) Success rate No CABG Previous CABG P<0.001P=0.118
  3. 3. Complex CTOs: Patients after CABG CTOs single operator Bad Krozingen 01/2011 – 09/2013 (n=583) P<0.001 P<0.001 (n=434) (n=145) P<0.001 27% 23 18% 1.4% 10% 32 43% 4.1% LAD-CTO CTO length (mm) Calcium °3 Rotablation No CABG Previous CABG P=0.053
  4. 4. • Male, 77 years • Risk factors: Hypertension, hypercholesterolemia • 1993 Angio: 3VD (LAD 75%, 1st Diag 60%, LCX 100%, RCA 100%) • 1993 CABG: LIMA on LAD, SVGs on 1st Diag and distal RCA • 2003, 2007, 2008: Stent implantations both SVGs • 03/2015: Angina pectoris CCS 3, dyspnoea NYHA III Echo: Normal LV function Stress test: Positive 150 watts CTO of RCA 22 years post CABG #220921
  5. 5. Left coronary artery
  6. 6. Right coronary artery (RCA) LAO
  7. 7. RCA RAO
  8. 8. SVG to 1st Diag
  9. 9. SVG to RCA
  10. 10. LIMA to LAD
  11. 11. Recanalization of RCA Antegrade Fielder XT ConfianzaPro 12 Finecross
  12. 12. Retrograde strategy Collaterals from LAD via LIMA-Graft ? Via occluded SVG ?
  13. 13. Passage SVG - Wire Ulimate 3g - Corsair Microcatheter
  14. 14. Retrograde wire Fielder XTR
  15. 15. From retrograde no entry ! ConfianzaPro12
  16. 16. Knuckle technique
  17. 17. Reverse CART 2.5mm Balloon Ultimate (Ø) Pilot 200 (!)
  18. 18. Strategy Externalization ? Tip-in ?
  19. 19. „Tip-in“ manoeuver in guiding catheter Antegrade Wire Meeting point in outer curve Retrograde Corsair in antegrade guide
  20. 20. Antegrade BMW Extra Support Finecross
  21. 21. Extra support floppy wire → Fielder XTR (Alternative: Modified CART)
  22. 22. Balloon 1.5mm
  23. 23. Balloons 2.25mm 3.0mm HP
  24. 24. Stent 2.75 x 38mm Everolimus
  25. 25. Stent 3.0 x 38mm Everolimus
  26. 26. Stent 3.5 x 8mm Everolimus
  27. 27. Final LAO
  28. 28. Final RAO
  29. 29. CTOs after CABG have worse lesion characteristics (calcium) and are technically demanding Typical „recanalization modules“ in CTOs post CABG • Occluded bypass graft as conduit for retrograde guidewires → CART, retrograde stent implantation • Knuckle technique • Reverse CART • Tip-in versus externalization (distal anatomy, back-up) Take home message
  30. 30. Complete* (n=750) Incomplete 1 region (n=444) Incomplete ≥ 2 regions*(n=191) Prognosis after PCI late post CABG *Adjusted HR 1.94 (1.36 – 2.77); p<0.001 Adjusted cumulative mortality and degree of revascularisation 0 1 2 3 4 5 Years

×