Retrograde microcather cannot pass the lesion Roberto Garbo, Turin, Italy 10th Experts „Live“ CTO Workshop - Day2

1. Retrograde microcatheter cannot
cross the lesion: tips & tricks
Roberto Garbo, MD
San Giovanni Bosco Hospital, Turin, Italy

2. Background
• Retrograde approach improved recanalization success rate
in CTO interventions.
• In principle retrograde CTO crossing could be “easier” than
antegrade because the distal cap is usually softer than the
proximal.
• However, in some cases, CTO recanalization still remain
difficult even with retrograde approach.
• Even in presence of a “good” retrograde collateral channel,
difficulties may be encountered in crossing the channel
and then the CTO.

3. Before retrograde crossing
of the CTO…
Reach it !!!

4. ANCHORING BALLOON
EFFECTIVE
Corsair and Finecross™
NOT CROSSING septal

5. 57 y male, previous primary PCI on prox-mid LAD
Prox RCA CTO (2nd attempt)
septal branch surfing…

6. CORSAIR NOT CROSSING SEPTAL

7. 2nd septal branch dilatation (1.25 mm balloon)
at the ostium
(through LAD stent) distally

8. … to facilitate Corsair™ advancement

9. 65 years-old male, previous
mid LAD PCI
OM CTO with several CTO
PCI antegrade attempts
and residual
RETROGRADE option

10. Turnpike LP™ 150 cm

11. Collateral navigation: Sion Regular™

12. Failed crossing with Turnpike LP™
Anchoring
balloon
Deep
intubation

13. Exchange with
Finecross™ 150 cm
and advancement
Retrograde crossing with
Ultimate3™ wire

14. FINAL RESULT

15. When the distal cap of the
CTO is reached…
Cross it !!!

16. 68y woman, anterior
ischemia (SPECT).
Previous primary PCI
on mid RCA + PCI prox
LAD /Dg1

17. Corsair™ doesn’t cross
septal branch
Finecross™ successful
Finecross™ in front of CTO
distal CAP (heavy calcific
LAD…)

18. REVERSE CART
Ultimatebros 3™ wire
retrograde crossing

19. Sapphire II PRO™
1.0 mm
CORSAIR & FINECROSS™ FAILURE IN RETROGRADE
CROSSING (DESPITE RETROGRADE WIRE TRAPPING)

20. Successful Corsair™
retrograde crossing
Sapphire II PRO™
dilatation

21. FINAL RESULT

22. J-CTO SCORE: 4
56y man, previous PCI on LAD and prox LCx + distal
LCx PCI failure. Persistent effort angina CCS III

23. Dual arterial access with 8 Fr right femoral and
6 Fr right radial artery EBU 8 French 90 cm
2nd Antegrade attempt failure
Fielder XT-A, Gaia 2 and Conquest Pro unsuccessful
CorsairFinecross

24. Retrograde approach via ipsilateral
epicardial channel from distal LAD
DES 2.5/12 mm

25. Collateral channel crossing

26. Collateral channel crossing

27. Retrograde CTO
crossing
(Fielder XT-A)
Retrograde approach via ipsilateral
epicardial channel from distal LAD

28. Corsair and FineCross 150 unable to retrograde
crossing despite retrograde wire trapping and
Guideliner (severe calcified lesion).
Guideliner
Ping pong technique
XT-A

29. “Tip-in" technique
Switch from XT-A to RG3 but
RG3 stucked into the 6 Fr
catheter
Finecross 130 antegrade
(bare)
Finecross advanced through
Retrograde RG3 guidewire
(then carried in front of
calcified stenosis)

30. Antegrade Finecross 130
unable to cross CTO
Antegrade rotawire into retrograde
Finecross 150
“Rendez-vous” technique

31. Rotational atherectomy
(1.25 and 1.50 mm burr)
Retrograde
Finecross
Retrograde
Finecross

32. FINAL RESULT

33. Conclusions / Take Home message
• Retrograde approach in CTO recanalization still
represent a challenge in interventional cardiology.
• Even in presence of a “good” retrograde collateral
channel, difficulties may be encountered in crossing
the channel and then the CTO.
• Dedicated materials and operators’ experience are the
Key to overcome this difficulties and reach CTO-PCI
success.