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

1. Successful recanalization of RCA chronic
total occlusion with multiple BVS implantation

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. Angiography / imaging

4. Initial Strategy ?
Antegrade appr. ?
Retrograde appr. ?
Others ?

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. 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. Key learning points
Retro:
LCA: 7F EBU 4,0
Sion
Sion blue
Fielder XT, FC
Corsair 150 cm

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. 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…