当前治疗CTO的逆向疗法.ppt
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1、Current strategy of retrograde wire for CTO,Toshiya Muramatsu MD Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital,Strategic Changes,GW 4.0 2.4 (max 10),Total 46.4 %,2 years later,Approach site (Overall) femoral 80.8% 97.4% radial 5.1% 1.8% brachial 14.2 % 0.9% Single site puncture 35
2、.4% 49.5% Dual site puncture 64.6% 50.5% GC size 6.9 0.5 Fr 7.1 Fr GC size (contralateral) 6.0 1.0 Fr Contrast amount (cc) 312 155 365 146 Fluoro scopic time (min) 52.9 37.8 50.9 35.7 Total procedural time (min) 123.3 65.7 Emergent procedure 1.8%,Basic Procedural Characteristics,J-CTO Conquest,N= 45
3、1,N=337,Procedural Success,90.0 %,89.8 %,90.5% (initial success 87.9%),88.8%,Conquest trial,Single wire 94.0% 277 133 43.2 31.5 (54.6%) Seesaw 82.1% 339 153 50.2 29.3 (20.3 %) Retrograde 93.3 % 436 203. 76.4 45.6 (11.9 %) Seesaw + Retrograde66.0 % 423 150 97.9 9.0 (12.7%),N=378,Proc. success (%DS 50
4、%),Contributions of Supplemental Strategies,Procedural Time (min),Contrast (cc),All cause death 0.4% (causes: sepsis(n=1), pneumonia/ARDS (n=1) Cardiac death 0% Myocardial infarction 4.4% Q wave MI 0.2% non Q wave MI (CPK 3 times) 4.2% Stent thrombosis 0% Stroke 0%,In-hospital outcomes,N=451,Perfora
5、tion 4.4% (18/408) tanponade 0.5%(2/408) Treatment balloon compression 2.7% (11/408) drainage 0.2% (1/408) coil embolization 0.5% (2/408) covered stent 0% (0/408) surgery 0% (0/408) Emergent PCI 0.9% (4/451) Emergent CABG 0% (0/451) Blood transfusion 2.0% (9/451) Access site surgery 0.4% (2/451) GI
6、bleeding 0.2% (1/451),Complications,Retrograde Wire Technique,Guidewire cross from CTO distal site through collaterals channels supplied from contrallateral vessel.,Indication of Retrograde Approach,Failed Antegrade Approach Hopeless Antegrade Approach Unknown Entry Point Long CTO(40mm) Heavy Calciu
7、m RCA Bent Point CTO Ante GW into Subintimal Space Good Collaterals Straight, Big, Visible,Systems of retrograde technique,Retrograde guiding catheter short GC(85-90cm), 7 or 8F, good back-up Retrograde guidewire floppy type GW( fielder, whisper, runthrough etc) Retrograde balloon long and small bal
8、loon(150cm,1.25mm), 23atm,GW Structure,X-treme,Fielder FC,Fielder,16cm Radio-opaque spring coil,0.009”,0.014”,PTFE Coating,Stainless Steel Core,16cm Polymer Sleeve & Hydrophilic Coating,11cm Spring Coil,3cm Radio-opaque Coil,0.014”,PTFE Coating,Stainless Steel Core,20cm Polymer Sleeve & Hydrophilic
9、Coating,12cm Spring Coil,3cm Radio-opaque Coil,0.014”,PTFE Coating,22cm Polymer Sleeve & Hydrophilic Coating,Stainless Steel Core,3cm,1cm,Retro GW Structure,Fielder FC,Fielder X-treme,Standrad type wire using retrograde Good support in the channel Straightened the collateral channel,Small guidewire
10、tip Approach for thinner collateral channel Less support Careful manipulate making dissection,My strategy of Retrograde Technique,Good support F Guiding Catheter Straight collateral is good root for navigate GW If possible, GW introduce to true lumen retrogradly If impossible、change to CART techniqu
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