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Walking through a through a chronic total occlusion

Coronary artery chronic total occlusion. Coronary artery chronic total occlusion (CTO) is complete or almost complete blockage of a coronary artery for 30 or more days. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery

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Walking through a through a chronic total occlusion

  1. 1. WALKING THROUGH ATHROUGH A CHRONICTOTAL OCCLUSION Dr Ramachandra
  2. 2. A wire can be advanced in the occlusion 1. Sliding technique 2. DrillingTechnique 3. PenetratingTechnique 4. Push andTorqueTechnique
  3. 3. CTO approaches ■ Antegrade ■ Retrograde
  4. 4. Anterograde ■ Antegrade loose tissue tracking ■ Antegrade intimal plaque tracking ■ Antegrade sub-intimal tracking
  5. 5. Retrograde 1. Antegrade KissingTechnique 2. RetrogradeTrue Lumen Puncture 3. Controlled Antegrade and Retrograde Sub-IntimalTracking (CART) 4. Reverse CART 5. Knuckle wire technique (KWT)
  6. 6. Antegrade KissingTechnique 1. This is the shortest possible technique 2. Both the antegrade and retrograde wire are in true lumen and the CTO segment 3. Crossed antregradely using the tip of retrograde wire as a marker
  7. 7. RetrogradeTrue Lumen Puncture ■ Crossed retrograde BUT the tip of antegrade wire as a marker
  8. 8. Controlled Antegrade and Retrograde Sub-IntimalTracking (CART) ■ Antegrade wire is intimal but retrograde wire is sub-intimal ■ Least favourable of all techniques ■ Dilatation of retrograde sub-intimal space with a balloon ■ Antegrade wire is then used to pierce this retrograde sub-intimal space guided by inflated retrograde balloon to enter into true distal lumen
  9. 9. Reverse CART ■ The most utilized technique ■ Retrograde wire is then used to pierce the occluded segment in sub-intimal space guided by inflated anterograde balloon to enter into true proximal lumen
  10. 10. Complications during CTO PCI 1. Thrombosis and dissection of donor artery 2. Perforation of the Collateral Channel 3. Collateral Ventricular fistula 4. Septal Hematoma 5. Entrapment of PCI equipment in septal collaterals 6. Sub-intimal stenting 7. Radiation skin injury 8. Contrast Induced Nephropathy
  11. 11. Other than me is a teacher

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