Friday 1215 – yamane

Euro CTO CLUB The Experts “Live” Workshop 2015, Sep 18-19, 2015 Istanbul, Turkey
12:15 – 12:30
An update on specific advantages of
different new guide wires for both
antegrade and retrograde approach
Masahisa Yamane , MD, FACC
St Luke‘s International Hospital ,Tokyo, Japan
Saitama Sekishinkai Hospital, Saitama, Japan

Disclosure Statement of Financial Interest
I, Masahisa Yamane MD,DO NOT have a financial
interest/arrangement or affiliation with one or
more organizations that could be perceived as a
real or apparent conflict of interest in this
presentation.

RCA Calcified CTO
Proximal Ambiguity, Bending, Length < 20 mm, and CalcificationPoor distal landing prior to bifurcation“Interventional “Collateral

Pre PCI CTA

RCA Calcified CTO
Gaia 1 to 2 ndGaia 3

RCA Calcified CTO
Sion BlueDifficulty in Crossing over GuidelinerRotablator 1.5 to 2.0mm

RCA Calcified CTO
• Every Calcified CTO different, needs “tailored”
approach
• CTA has a limitation to elucidate CTO details,
variable information for “CTO” operators
• Wire drives expeditiously on “Navi” map

Post Bypass LCX CTO
No Proximal Cap Ambiguity, length < 20mm, No Calcification, but poor “Landing” zone“ Interventional” Collaterals ?Gaia 1Selective Injection through Finecross GT in RIMA Graft to PD to collateralRAO 50 ⁰Suoh 03

Post Bypass LCX CTO
Retrograde Gaia 2Antegrade 1.5 mm ballooning for XCARTAfter wire externalization, balloon dilation on RG3

Suoh-03

Wiring for Tortuous AC channel
Gaia 2 on CorsairSuoh 03 on CaravelProximal Ambiguity, Length>20mm, bend inside, poor “landing” zone or another
CTO or a disease beyond
Interventional Collaterals? Selective Injection through Caravel

New Generation Wire for collaterals
Reverse CART with Retrograde XT-R

Caravel® structure (135 cm and 150 cm)
Hydrophilic coating： 75cm
Caravel Prox.
0.55mm 0.85mm
PTFE
0.62mm
Caravel Dis.
0.43mm
PTFE
Products
O.D. I.D.
Length
Coating
Entry Distal Proximal Entry Distal Proximal Length
ASAHI Caravel
ASAHI Corsair
Finecross MG
Not publicly
available
Finecross GT
ｍ
ｍ
ⒸASAHI INTECC CO., LTD 2014; This document is for training of staff and contains confidential or privileged information. Any
distribution, copying, forwarding or citation is strictly prohibited.

Finecross GT 130 and 150cm
コード
番号
マーカー
部外径
（Fr./mm
）
先端部
外径
（Fr./m
m）
基部外
径
（Fr./m
m）
先端部内
径
（inch/mm
）
基部内
径
（inch/m
m）
マーカー長
（mm）
カテーテル
有効長
（cm）
最大適用
GW径
（inch/mm
）
共通
コー
（JA
NC-
F863B
1.7/0.57
1.8/0.6
0
2.6/0.8
7
0.018/0.45
0.021/0.
55
1.0
130
0.014/0.36
498
57
NC-
F865B
150
498
17
• 中
• 大

LAD CTO Re-attempt
No R to L collateralsAmbiguous proximal cap, no bend, length> 20mm and poor distal “landing”No substantial L to L collaterals, either

Pre-PCI CPR

LAD CTO Re-attempt
SionSelective Injection through Finecross GTSion BlackRetrograde Gaia 2Antegrade Gaia 3Proximal Stent deliverySuoh 03

4th European Live Summit on Retrograde CTO Revascularization, May 8-9,2015 : Zurich, Swiss
RCA CTO @ distal bifur (ISR)
Suoh 03 over Finecross GT

Suoh 03
• Tip load 0.3g, coreless , so fragile, pre-shaped
• Can not predict to navigate at discretion
• Push, pull, rotate :
• Pull while rotate/Push while rotate
• Physics not applied to the tip “behavior”

LAD disease and LX CTO
Gaia 1 to 2 ndSionSion blackSuoh 03Suoh 03 with some resistanceClear proximal cap, length >20mm, poor distal “landing” and no calcificationProxi LAD disease and Collateral to LCX present, if any ?RAO 50 ⁰

Retrograde Gaia 2, Confianza Pro12, and Sion blackAfter Wire externalization, IVUS on RG3

After IVUS guided Wiring of a new Sion black

Promus PREMIER™ 2.5 mmXIENCE Xpedition™ 2.75 mmXIENCE Xpedition™ x 2

Lesson
• Suoh 03 can negotiate the channel, which
does not equal intimal tracking throughout

Retrograde procedure outcome (3)
75%
73%
65%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Attempt Channel
Guidewire cross
Channel
Catheter cross
Procedure
Success
2012 2013 2014
-25％

56,1%
31,0%
12,9%
0%
40%
80%
Single wire Parallel wire IVUS guided
re-entry
Successful CTO crossing strategy
by antegrade approach
Failure reason N=145
Couldn’t cross CTO by guidewire 85.1% (120)
Couldn’t cross CTO by any catheter 9.2% (12)
Procedure discontinuation due to
complication
5.7% (8)
Not identify 2.8% (4)
Retrograde Procedure Outcome (2)
In case switched to antegrade after retrograde (n=382)
Total 2012 2013 2014 P
Antegrade procedure success
switched after retrograde failure
62.0%
(237/382)
64.8%
(81/125)
57.9%
(99/171)
66.3%
(57/86)
0.3153
Overall procedure success in
retrograde cases
81.5%
(1067/1309)
83.1%
(407/490)
80.1%
(431/538)
80.1%
(229/281)
0.4770

Wire / Strategy selection for CTO 2015
Fielder XT/ FC Confianza Pro 9g
Miracle bross 12 g
Progress 200T
Parallel wire method
Miracle bross 3g
Ultimate 3g
Progress 40
Retro grade approach
IVUS navigated
Gaia 1,2, 3
Sion
Sion black
XT-R
on
Corsair
Finecross
Caravel
Suoh 03

An update on new guide wires in 2015
• Integration of Imaging  CTO wiring
• New generation wires and ( micro-catheters)
simplify and streamline the flow of the PCI
steps
• Suoh 03 can change the “ most” challeging
part of collateral crossing in Retrograde
• Wider application of technique and
tecknology can further expand the success
rate

Friday 1215 – yamane

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Friday 1215 – yamane