Intracoronary Imaging: When to use, how to use and how to interpret the images
- 1. Intracoronary imaging: when to use, how to use and how to interpret the images Roberto Garbo Maria Pia Hospital GVM Care & Research Turin, Italy
- 2. I, Roberto Garbo, 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 the context of the subject of this presentation Disclosure Statement of Financial Interest
- 3. • Entry point evaluation and wire penetration in ambiguous proximal cap, Ostial LAD CTO • IVUS for ADR strategy from subintimal space • IVUS for Reverse CART: correct position, balloon sizing, wires connection • Difficult Re-entry in Retrograde approach: True Ostial CTO’s .. • IVUS for Vessel size evaluation and stent implantation during CTO PCI avoiding antegrade injection IVUS UTILITY IN CTO
- 4. IVUS FOR ENTRY POINT EVALUATION
- 7. GAIA 2nd WRONG PUNCTURE TOO ECCENTRIC
- 8. mid-LAD CTO with blunt stump, NO retrogade collaterals May 2014
- 9. IVUS-GUIDED PENETRATION LAD wire (Gaia 2nd) WRONG Puncture (eccentric)
- 11. Unsuccessful LAD penetration attempt through dual lumen Nhancer Rx™ Successful Left Circunflex crossing with Gaia 3
- 12. SUBINTIMAL PUNCTURE OF GAIA 3 rd AT THE LEVEL OF DISTAL LEFT MAIN VISUALIZED BY IVUS
- 13. Finecross™ 130 cm + Gaia 2nd + IVUS guidance PERFECT CENTRAL PUNCTURE WITH GAIA 2 nd AT OSTIAL LAD
- 15. FINAL RESULT
- 16. Pre CTO PCI Post CTO PCI (5 months) EF 10% EF 50%
- 17. 55y male, mid RCA CTO, blunt stump with retrograde collaterals . Failure antegrade attempt Second attempt
- 18. IVUS guided good puncture for Entry point with Hornet 14 and Failure : subintimal in distal RCA
- 19. IVUS FOR ADR
- 20. mid-LAD CTO with blunt stump, NO retrogade collaterals May 2014
- 21. Conquest pro 12 re-entry from subintimal space Conquest pro 12 In the intimal space 8F: CORSAIR + IVUS
- 22. Conquest pro 12 in the distal vessel (all true lumen)
- 23. FINAL RESULT after 3 BVS
- 24. GAIA 3 rd retrograde crossing
- 25. Conquest Pro 9 sub-intimal – IVUS PULL BACK confirmation
- 26. Finecross + HORNET 14: IVUS-guided re-entry from subintimal space (Pullback)
- 27. Hornet 14 exchanged with Sion on Finecross
- 28. IVUS Pullback on Sion wire: all intraluminal !!!
- 29. FINAL RESULT
- 30. IVUS FOR ENTRY POINT FAILURE DUAL LUMEN FAILURE
- 32. IVUS ADR FAILURE IN CALCIFIED SEGMENT
- 33. IVUS-ADR WITH CP12 SUCCESS IN SEGMENT WITHOUT CALCIFICATION
- 34. FINAL RESULT
- 36. OSTIAL LAD CTO
- 37. Ultimate 3 re-entry into LM and then in Aorta…
- 39. Reverse CART
- 40. OSTIAL RCA CTO
- 41. HORNET 14 retrograde crossing failure with IVUS confirmation (wire in the wall)
- 42. HORNET 14 retrograde crossing successful with IVUS confirmation (wire free in Aorta)
- 43. IVUS WHEN REVERSE CART DOESN’T WORK
- 46. Type 4 situation
- 47. Subintimal connection after retrograde Knuckle with CP12
- 48. IVUS guided good puncture for Entry point with Hornet 14 and Failure : subintimal in distal RCA
- 49. RETROGRADE APPROACH: Reverse CART with 2.5mm balloon distal and Failure in distal re-entry with Guidezilla 6f
- 50. DISTAL RCA NO CONNECTION: IVUS subintimal, Retrograde wire intimal Type 4 situation
- 51. MID RCA GOOD CONNECTION: BOTH WIRE IN THE INTIMAL SPACE Type 1 situation
- 53. FIRST INJECTION AFTER RE-ENTRY AND STENTING
- 54. THANKS FOR YOUR ATTENTION
- 55. THANKS FOR YOUR ATTENTION