8th Experts Live CTO Workshop 2016, September, 30th - October 1st, 20116 in Krakow, Poland

1. Femoral is (still) better
Andrea Gagnor
FINALPROGRAM
The Experts „ Live“
Workshop 2016
September 30th - October 1st, 2016
Krakow, Poland
ICEKrakow
Course Directors
Jaroslaw Wójcik,
Lublin, Poland
Leszek Bryniarski,
Krakow, Poland
ECC-President
Alfredo R. Galassi,
Catania, Italy
Co-Directors
Nicolas Boudou,
Toulouse, France
George Sianos,
Thessaloniki, Greece
Gerald S. Werner,
Darmstadt, Germany
FINALPROGRAM
The Experts „ Live“
Workshop 2016
September 30th - October 1st, 2016
Krakow, Poland
ICEKrakow
Course Directors
Jaroslaw Wójcik,
Lublin, Poland
Leszek Bryniarski,
Krakow, Poland
ECC-President
Alfredo R. Galassi,
Catania, Italy
Co-Directors
Nicolas Boudou,
Toulouse, France
George Sianos,
Thessaloniki, Greece
Gerald S. Werner,
Darmstadt, Germany

2. 0
2
4
6
8
10
12
14
16
18
8,6
12,2
15,7 15
17,5
2011
2012
2013
2014
2015
%
CTO: radial approach
EURO CTO data

3. Burzotta, CCI 2013
Impact of the “learning curve”

4. Double radial approach 21
Crossover to f emoral approach 3 (15%)
Guiding catheter 6 F 19 (95%)
Microcatheter to start 15 (75%)
OTW balloon to start 5 (25%)
Fielder XT to start 12 (60%)
Fielder XT successf ul to cross 9 (45%)
Anchoring balloon technique 2 (20%)
DES implantation (in case of success) 100%
CARDI AC COMPLI CATI ONS
(perf oration, dissection, pericardial
ef f usion or tamponade)
NONE
ACCESS SI TE COMPLI CATI ONS NONE
MACE I N HOSPI TAL NONE
PROCEDURAL SUCCESS 21/ 25 (67%)
PATI ENT SUCCESS 21/ 24 (70%)
Double radial approach 21
Crossover to f emoral approach 3 (15%)
Guiding catheter 6 F 19 (95%)
Microcatheter to start 15 (75%)
OTW balloon to start 5 (25%)
Fielder XT to start 12 (60%)
Fielder XT successf ul to cross 9 (45%)
Anchoring balloon technique 2 (20%)
DES implantation (in case of success) 100%
CARDI AC COMPLI CATI ONS
(perf oration, dissection, pericardial
ef f usion or tamponade)
NONE
ACCESS SI TE COMPLI CATI ONS NONE
MACE I N HOSPI TAL NONE
PROCEDURAL SUCCESS 21/ 25 (67%)
PATI ENT SUCCESS 21/ 24 (70%)
Courtesy Prof. Burzotta

5. Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons

6. 7,2
7,4
7,6
7,8
8
8,2
8,4
8,6
8,8
9
9,2
9,4
fluoro time
radial
femoral
min
Jolly, JACC Cardiovasc Interv 2013
P<0.001
None?

7. 860
880
900
920
940
960
980
1000
1020
1040
1060
Air Kerma
radial
femoral
mGy
Jolly, JACC Cardiovasc Interv 2013
p=0.05

8. Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons

9. Distribution of Radial Artery Diameter
Saito S et al. Cathet Cardiovasc Interv 1999;46:173-17
Distribution of Radial Artery Diameter
Saito S et al. Cathet Cardiovasc Interv 1999;46:173-17
Saito, CCI 1999

10. Modified from David Smith
diameter devices techniques
6F Balloon/stent anchoring
Rotablator 1.5-1.75 Trapping (2.0 and
Finecross)
Guiding catheter extension
Microcatheter/Corsair/Torns
Double lumen catheters
IVUS
7F Rotablator (larger burrs) Trapping (2.5 and
Corsair/double
lumen cath)
8F CrossBoss IVUS guided
butbut

11. 2.5 balloon
Corsair
6F
No Corsair trapping

12. Entry point
6F, 7F
No IVUS and micro
wire

14. Modified from David Smith
diameter devices techniques
6F Balloon/stent anchoring
Rotablator 1.5-1.75 Trapping (2.0 and
Finecross)
Guiding catheter extension
Microcatheter/Corsair/Torns
Double lumen catheters
IVUS
7F Rotablator (larger burrs) Trapping (2.5 and
Corsair/double
lumen cath)
8F CrossBoss IVUS guided

15. Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons

16. Radial: limitations
spasm

17. RADIAL SPASMRADIAL SPASM
Radial: limitations
RADIAL/BRACHIAL LOOPRADIAL/BRACHIAL LOOP

18. RADIAL SPASMRADIAL SPASM
Radial: limitations
RADIAL/BRACHIAL LOOPRADIAL/BRACHIAL LOOP
Subclavian kinking

19. and even tortuosity ….

20. Radial: limitations. Support

23. 2.5 balloon
Corsair
1.25 Tazuna

26. 0
0.5
1
1.5
2
2.5
2008 2009 2010 2011 2012 2013 2014
0.5 0.5
0.3
0 0.03
0.08 0.07
0.8
1.1
0.9
1
0.8
0.5
0.4
2.2
1
2.5
1.5
1.9
2.3
2.5
0.1
0.6
0.3
0.6
0.5
0.6
0.5
1
0.8
0.3
0.7
1
0.5 0.50.5
1.2
0.3
0.7
0.8
0.6
0.5
Death
Myocardial infarction Vascular complication
Donor vessel dissection
Cardiac tamponade
Coronary perforation
0
0.5
1
1.5
2
2.5
2008 2009 2010 2011 2012 2013 2014
0.5 0.5
0.3
0 0.03
0.08 0.07
0.8
1.1
0.9
1
0.8
0.5
0.4
2.2
1
2.5
1.5
1.9
2.3
2.5
0.1
0.6
0.3
0.6
0.5
0.6
0.5
1
0.8
0.3
0.7
1
0.5 0.50.5
1.2
0.3
0.7
0.8
0.6
0.5
Death
Myocardial infarction Vascular complication
Donor vessel dissection
Cardiac tamponade
Coronary perforation

27. Radial: complications

28. Conclusion
• Personal view

29. Conclusion
• Personal view
• CTO PCI is a complex procedure: efficacy AND
safety

30. Conclusion
• Personal view
• CTO PCI is a complex procedure: efficacy AND
safety
• Procedural time, RX time, contrast dye

31. (personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)

32. (personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection

33. (personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection
– “simple” retrograde

34. (personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection
– “simple” retrograde
– Retrograde with antegrade radial guiding catheter

35. (personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection
– “simple” retrograde
– Retrograde with antegrade radial guiding catheter
– aortic/iliac/femoral vasculopaty