当前治疗CTO的逆向疗法课件

1、Current strategy of retrograde wire for CTOToshiya Muramatsu MDDivision of Cardiology, Saiseikai Yokohama-City Eastern HospitalStrategic ChangesRetrograde approach 25.1%Seesaw wiring 33.2%GW 4.0 2.4(max 10)Total 46.4 %Seesaw wiring 43.1%Conquest trialN=116July, 2003 - March, 2004J-CTON=378April, 200

2、6 - December, 20072 years laterApproach site (Overall)femoral80.8%97.4%radial5.1%1.8%brachial14.2 %0.9%Single site puncture35.4%49.5%Dual site puncture64.6%50.5%GC size 6.9 0.5 Fr7.1 FrGC size (contralateral)6.0 1.0 FrContrast amount (cc)312 155365 146Fluoro scopic time (min)52.9 37.850.9 35.7Total

3、procedural time (min)123.3 65.7Emergent procedure1.8%Basic Procedural CharacteristicsJ-CTOConquestN= 451N=337Procedural Success90.0 %89.8 %90.5%（initial success87.9%)88.8%Conquest trialSingle wire94.0%277 13343.2 31.5(54.6%)Seesaw82.1%339 15350.2 29.3(20.3 %)Retrograde93.3 %436 203.76.4 45.6(11.9 %)

4、 Seesaw + Retrograde66.0 %423 15097.9 9.0(12.7%)N=378Proc. success (%DS 3 times)4.2%Stent thrombosis 0%Stroke0%In-hospital outcomesN=451Perforation4.4% (18/408)tanponade0.5%(2/408)Treatmentballoon compression2.7% (11/408)drainage0.2% (1/408)coil embolization0.5% (2/408)covered stent0% (0/408)surgery

5、0% (0/408)Emergent PCI0.9% (4/451)Emergent CABG0% (0/451)Blood transfusion2.0% (9/451)Access site surgery0.4% (2/451)GI bleeding0.2% (1/451)ComplicationsSystems of retrograde techniqueRetrograde guiding catheter short GC(85-90cm), 7 or 8F, good back-upRetrograde guidewire floppy type GW( fielder, wh

6、isper, runthrough etc)Retrograde balloon long and small balloon(150cm,1.25mm), 23atmGW StructureX-tremeFielder FCFielder16cm Radio-opaque spring coil0.009”0.014”PTFE CoatingStainless Steel Core16cm Polymer Sleeve & Hydrophilic Coating11cm Spring Coil3cm Radio-opaque Coil0.014”PTFE CoatingStainless S

7、teel Core20cm Polymer Sleeve & Hydrophilic Coating12cm Spring Coil3cm Radio-opaque Coil0.014”PTFE Coating22cm Polymer Sleeve & Hydrophilic CoatingStainless Steel Core3cm1cmRetro GW StructureFielder FCFielderX-tremeStandrad type wire using retrogradeGood support in the channelStraightened the collate

8、ral channelSmall guidewire tipApproach for thinner collateral channelLess supportCareful manipulate making dissection1.Retrograde GW crossing through collateral channel2.Retro GW enter into subintima space from distal fibrous cap3.Antegrade GW also enter in the subintima space from proximal site4. R

9、etro balloon deliver into subintima sapce and dilate5.Dilating subintima space makes a channel connection between ante and retro GW 6. Ante GW cross through subintimal to true distal lumenCART techniqueCART techniqueCARTtecqnique PseudolumenTruelumenRetrograde dilatation of the pseudo lumen Antegrad

10、e punctureCARTtecqnique for LAD CTO Reverse CART tecqnique PseudolumenTruelumenAntegrade dilatation of the pseudo lumen Retrograde puncture Easy insert balloon from ante CTO siteNo need of retro balloon through the collateral channel to CTO vessel no chance of complication related collateral - disse

11、ction, spasm, perforation- exhaust time during balloon crossing collateral Possible using IVUSAnchoring retro GW by ante ballooning anchor balloon makes a easy crossingmicrocatheterBallooning into big vessel of reverse CART means safer than that in smaller vessel of retro ballooningBenefit of Revers

12、e CART techniqueComplication Donor artery ischmia, spasm or thrombosisChannel dissectionChannel ruptureEntrapment of retrograde guidewireGuidewire, balloon kink through collateral channelDonor vessel dissectionDonor vessel dissectionstPCI forLADstPCI forLAD2nd PCI-Riverse CART2nd PCI-Riverse CARTLMT

13、 thrombus during RetroNumber of CTO lesion Success rate and retrograde approach for CTO （）Strategy of retrograde approach for CTO Complication of retrograde approach for CTO （）Conclusion1. CTO has complicated multivariate structure in terms of pathology.2. Reading angiogram is most important point, especially forcus to collateral pathway in diagnostic angiogram.3. Collateral channel is important not only suppling diatal part of CTO vessel , but also using retrograde approach.4. Retrograde approach is useful in the case of failed penetration of fir