Experts "Live" CTO Workshop 2014 26th Septemper 2014 in Madrid, Spain

1. How to Perform and Interpret Coronary
Angiography for CTO Recanalisation
Thierry lefèvre
ICPS, Massy, France

2. Angiography / imaging
0
2000
4000
6000
8000
10000
12000
14000
16000
CABG STEMI Coronary angio
CTO
No CTO
Fefer P et al. J Am Coll Cardiol. 2012;59:991-997
20-25%

3. Lesion morphology
Patient characteristics
Learning curve
The Success Rate of CTO

4. Guidewire Crossing < 30 min.
Morino et al. JACC Interv 2011; 4: 213-221

5. CTO Success
No ad Hoc PCI !

6. Good Angiogram
 Powerfull and selective injection
 Long injection
 Large field
 No paning

7. Good CTO Angiography
 Optimal view of the distal run off
 Optimal view of the donor vessel
 Good views of the collaterals
 Several views of the occluded vessel
 At least 1 same view for both vessels
 Educate the referring physicians

8. What are the Questions ?
 Is it really a CTO ?
 Proximal and distal ambiguity ?
 Lesion length ?
 Vessel course, Island ?
 Lesion calcification and tortuosity ?
 Distal run off ?
 Collaterals ?
 Good and safe support ?

9. What about the support ?

10. What about the support ?
Fielder XT + Finecross

11. What about the support ?
3D right
Miracle 12 +
Finecross

12. What about the support ?
Anchoring balloon

13. What about the support ?

14. What about the support ?

15. Antegrade or Retrograde ?
Ostial and calcified lesion
GC Support, Stability ?
Risk of ostial dissection ?

16. Antegrade or Retrograde ?

17. Antegrade or Retrograde ?

18. Antegrade or Retrograde ?

19. Antegrade or Retrograde ?

20. Antegrade or Retrograde ?

21. Antegrade or Retrograde ?

22. « Mother and Child Technique »
Antegrade or Retrograde ?

23. Antegrade or Retrograde ?

24. Vessel Course ?

25. Vessel Course ?

26. Vessel Course ?

27. Vessel Course ?

28. Vessel Course ?

29. Vessel Course ?

30. Vessel Course ?

31. Vessel Course ?

32. Vessel Course ?

33. Vessel Course ?

34. Vessel Course ?

35. Vessel Course ?

36. Proximal Ambiguity ?
No Calcification
Lesion length < 20 mm
Proximal ambiguity ?

37. Proximal Ambiguity

38. Proximal ambiguity ?
Proximal Ambiguity ?

39. Proximal Ambiguity ?

40. What about the support ?

41. Proximal Ambiguity ?

42. Proximal Ambiguity ?

43. Proximal Ambiguity ?
Finecross + Fielder XT

44. Proximal Ambiguity ?

45. Proximal Ambiguity ?

46. Distal Run-off

47. Distal Run-off
Proximal ambiguity
Distal ambiguity
Space for good support
Good distal Run-off
Tortuosity

48. Distal Run-off

49. Distal Run-off

50. Distal Run-off
Good candidate for Crossboss-Stingray

51. Distal Run-off

52. Distal Run-off

53. Collaterals

54. Collaterals

55. Collaterals

56. Collaterals

57. Collaterals

58. Collaterals

59. Collaterals

60. Collaterals

61. Conclusion
 Take extra time during the diagnostic
angiogram to obtain specific anatomic
information that will guide strategy (ies) for the
subsequent CTO PCI.
 Study the film in detail during coronary
angiography in order to check that you have all
the informations needed.
 Educate refering physicians