08:45 CASE 7 - Galassi - 01. A Likely “Simple” Reverse CART
- 1. Alfredo R. Galassi MD, FESC, FACC, FSCAI Director of Cardiac Catheterization and Interventional Cardiology Unit Department of Medical Sciences and Pediatrics Division of Cardiology, Cannizzaro Hospital, University of Catania, Italy A Likely “Simple” Reverse CART
- 2. CASE SUMMARY Clinical Presentation Exertional angina (CCSC III) and dyspnea (NYHA II) Patient: Z-M, male, 59 yrs Risk Factors Hypertension Diabetes type I Ex-smoker Coronary Angiography Proximal RCA CTO Non-invasive Testing 2D Echo: mild hypokinesia of inferior wall , EF 55%
- 4. First Septal Sion Asahi Intecc Corsair Asahi Intecc 00:42
- 5. First Septal (different branch) Sion Asahi Intecc Corsair Asahi Intecc 00:22
- 6. Progression of Corsair Sion Asahi Intecc Corsair Asahi Intecc Laborious progression of Corsair (calcifications) 01:11
- 7. Exchanging retrograde wire Fielder XT-R Asahi Intecc Corsair Asahi Intecc 00:18
- 8. Exchanging retrograde wire Retrograde wire: Gaia 1 st Asahi Intecc Antegrade wire: Fielder XT-R Asahi Intecc 00:17
- 9. Exchanging retrograde wire Retrograde wire: Gaia 2 nd Asahi Intecc Antegrade wire: Fielder XT-R Asahi Intecc Advancement of Finecross over Fielder XT-R 01:26
- 10. Retrograde wire: Gaia 2 nd Asahi Intecc Antegrade wire: Fielder XT-A Asahi Intecc Removal of Finecross (Nanto technique) Balloon advancement/inflation Exchanging antegrade wire 00:38
- 11. Exchanging retrograde wire Retrograde wire: Miracle 6 Asahi Intecc Antegrade wire: Fielder XT-A Asahi Intecc 00:44
- 12. Exchanging microcatheter Retrograde wire: RG 3 Asahi Intecc Antegrade wire: Fielder XT-A Asahi Intecc Corsair fatigue 00:32
- 13. Retrograde wire: Fielder FC Asahi Intec Antegrade wire: Fielder XT-A Asahi Intec Reverse Knuckle Technique? 00:26
- 14. Balloon advancement Retrograde wire: Fielder FC Asahi Intec Antegrade wire: Fielder XT-A Asahi Intec 00:42
- 15. Exchanging retrograde wire Retrograde wire: Pilot 150 Abbott Vascular Antegrade wire: Fielder XT-A Asahi Intecc 01:50
- 16. Antegrade wire: Fielder XT-A Asahi Intecc Two different subintimal plans Retrograde wire: Pilot 150 Abbott Vascular 01:18
- 17. Two different subintimal plans Antegrade wire: Fielder XT-A Asahi Intec Retrograde wire: Pilot 150 Abbott Vascular Antegrade IVUS ? 00:34
- 18. Reverse CART Attempt Antegrade wire: Fielder XT-A Asahi Intecc Retrograde wire: Pilot 150 Abbott Vascular Advancement of the balloon distally 00:14
- 19. Reverse CART Attempt Antegrade wire: Fielder XT-A Asahi Intecc Retrograde wire: Pilot 150 Abbott Vascular Better back up with AL1 guiding catheter Distal balloon inflations 01:36
- 20. More Distal Reverse CART Attempt Antegrade wire: Fielder XT-A Asahi Intecc Retrograde wire: Pilot 150 Abbott Vascular 01:51
- 22. 4 everolimus eluting stents of 3.0 x 28 mm Stents Implantation
- 23. Final Result
- 24. Take Home Messages - Reverse CART is a reliable retrograde technique to achieve CTO revascularization success - Antegrade IVUS might be a useful and helpful tool - A Crossboss and stingray approach might be a useful tool - A more distal reverse CART using stiff polymeric wires to dissect antegradely, might be an alternative option in case of two different subintimal plans very apart from each other, especially when occurring in a tortuous segment of the artery
Editor's Notes
- #2: 0