Andrew Ladwiniec: Perforations within the subintimal space
- 1. Perforations in the Sub-intimal Space Dr Andrew Ladwiniec Consultant Cardiologist Glenfield Hospital, Leicester, United Kingdom Friday 2nd September 2022
- 2. Honoraria/Speaketr Fees from Boston Scientific Teleflex Disclosure Statement of Financial Interest
- 3. How common is it? Why is it important? What is different about managing (and avoiding) sub-intimal perforations? Sub-intimal perforation
- 4. How common is it? Hirai et al. J Am Coll Cardiol Intv. 2019; 12:1902-12. Mean J-CTO score: 3.0 Significant calcification: 47% AWE = 2.8% (18 of 639) ADR = 7.8% (31 of 400) RWE = 7.2% (19 of 263) RDR = 5.9% (21 of 353) Smith et al. Heart. 2013; 99: 1471-74.
- 5. Kinnaird et al. Circ Cardiovasc Interv. 2017; 10:e004642. Why does it matter? 9 in-hospital deaths in Open CTO due to perforation 1% of cases 10% of perforations Hirai et al. J Am Coll Cardiol Intv. 2019; 12:1902-12..
- 6. The use of sub-intimal techniques is safe and efficient
- 7. Where can it go wrong? Getting into the sub-intimal space Traversing the sub-intimal space Connecting spaces Ballooning/stenting the sub-intimal space
- 9. Sealing perforations behind a tissue plane Spratt JC et al. A guide to mastering antegrade CTO PCI Part 02. Optima. 2019.
- 12. Culprit occluded SVG-RCA Native CTO RCA Spratt JC et al. A guide to mastering antegrade CTO PCI Part 02. Optima. 2019. Caution when stenting sub-intimally
- 13. You can find out late
- 14. Perforations happen to us all The principles of management are well established Avoidance and treatment can differ slightly if in the sub-intimal space In Summary
- 15. Perforations happen to us all The principles of management are well established Avoidance and treatment can differ slightly if in the sub-intimal space In Summary