The Coronary Artery Disease section of the journal Frontiers in Cardiovascular Medicine (IF 3.915) aims to publish original research of the highest quality, review articles, illustrations and editorial content on the subject of coronary artery disease. Coronary Chronic Total Occlusion (CTO) System | Boston Scientific CTO's Procedures Retrograde Approach | MedPoint.co.il. Reverse controlled antegrade and retrograde subintimal tracking is the most commonly used out of various retrograde approaches. However, a more update version is required in view of the recent technical and device advancement. CTO originating from the ostium has been one of the most difficult CTO lesions to treat with PCI for a number of reasons. In this review, the author has thrown light on a step-by-step approach of this technique, its standardization, various modications along with complications. The initial step in managing a distal target-vessel perforation is to use balloon occlusion proximal to the coronary perforation. The author proposes a step-by-step guide to the retrograde approach with alternatives to various steps for operators wishing to embark on this strategy. Retrograde recanalization of CTO represents the last frontier in interventional cardiology. If the angiographic guided antegrade wiring is failed, you should select retrograde approach, dissection reentry or IVUS guided re-wiring in this order. PitchBook: 16 new VC funds with 60%+ women decision makers have raised $4.5B from January to April 2022; women-led funds raised $3.7B in 2021 and $1.8B in 2020 For years, women-led venture capital funds were the true Silicon Valley unicorns, a rarity in a sector where the vast majority of check writers are men. The Retrograde Approach: Step-by-Step Instructions. Case-oriented and easy to read reference with illustrations and step-by-step guidance for CTO interventions. Similar Articles. You will also learn how to develop the necessary 'tool kit' to ensure you have the correct equipment in your catheter laboratory, as well as a host of techniques that are broken down and illustrated The snare technique has 3 main strengths. 6 - Step 2 - CTO crossing from the retrograde approach - Paul Knaapen Start time : 41min.4s. After advancing a small balloon (1.5 mm to 2 mm) over the retrograde wire into the subintima, the balloon should be inflated in the subintima to make a large crack. Step by Step: How I treat SFA lesions Sabine Steiner Retrograde approach in CTO Failure of guidewire-passage in CTOs Of the SFA Subintimal wire passage Failed antegrad re-entry . Retrograde approach: If interventional collaterals present. The summary of IVUS-Guided Re-Wiring in the Antegrade Approach: When-The algorithm from AP-CTO club and my experiences-1. Medications: ASA 81mg, Prasugrel 5mg, Lisinopril 10mg, Rosuvastatin 20mg, Nebivolol 5mg, ISMN 60mg. The snare technique has 3 main strengths. This session was originally presented during PCR e-Course 2020. Training room Siemens Healthineers / Level 1 Procedure step by step with cusp overlap technique, valve-in-valve, post-TAVI PCI case Add this session to my programme. Rapid-Fire Debate - Sub-Intimal CTO PCI Is Safe and Provides Durable Results. Tuesday 17 May 2022. Presenter: Paul Knaapen. The first step is to push the retrograde guidewire as far up the aorta as possible (Figure 2A), ideally passing the arch into the descending aorta. Care must be taken A method of treating vessel occlusions including chronic total occlusions (CTO) of the coronary arteries, and to generally remove tissue material, is presented that relies on remotely actuated navigation of an interventional RF-capable ablation device to the occlusion and controlled application of ablative RF energy. CTO step by step analisys. Retrograde Approach of CTO PCI. However, it is important to be aware that the retrograde approach is not a curiosity or a trick to show operative skills in The combined use of remote navigation-based precision Collaterals are basically divided into epicardial and septal pathways. As it pointed out, the majority of retrograde CTO would be crossed with r-CART, using the techniques described in the previous section. incorporated into the hybrid algorithm [14,15], and the group has published step-by-step guide [16,17]. Epicardial collaterals. Retrograde coronary angioplasty of isolated arterial segments through saphenous vein bypass grafts. Sion black polymer jacket with slip coat and rope coil structured tip is good for distal tortu- Retrograde Percutaneous Intervention of CTO Step by Step Rao 263. externalization much easy.32 Balloon angioplasty and DES Specialized centers can now achieve success rates of over 85%, which is a result of technical advancements in retrograde techniques irrespective of the CTO anatomy. Abstract The retrograde approach to chronic total occlusion (CTO) crossing differs from the antegrade approach because the occlusion is approached from the distal vessel. The retrograde approach is a cornerstone technique of the hybrid chronic total occlusion (CTO) percutaneous coronary intervention (CTO) portfolio [14].Mastering the retrograde approach substantially improves treatment options and success rates [].This chapter will provide the reader with a framework on how to select cases for the retrograde approach based on the angiographic STEP 2: Superselectiv injection J-channel score: 1 Huang Score: 1 77.8%54.3% 18. Proximal cap? 1 - 11 , 10.1016/j.jcin.2011.10.011 Article Download PDF View Record in Scopus Google Scholar Specific to retrograde CTO PCI, guide wires can become knotted after crossing into the CTO territory though this is rare and avoidable. September 28, 2019. Retrograde Wire Escalation (Direct cross) Retrograde Dissection and Re-entry . DOI: 10.1016/j.jcin.2011.10.011 Corpus ID: 374936; The retrograde technique for recanalization of chronic total occlusions: a step-by-step approach. The success rate of CTO PCI has been Topics discussed in this issue include, but are not limited to: Indications for percutaneous coronary intervention of CTO; Pre-procedure planning for CTO PCI; Toolbox for CTO PCI; Antegrade Wire Escalation Case Selection and On behalf of the Organizing Committee of the Turkish Society of Cardiology (TSC) CTO Club Istanbul - CTO 2022 Meeting, Turkey we would like to have this opportunity to invite you to our congress which will be held in Istanbul between the dates of 27-28 May, 2022. 44% of cases, with retrograde approaches serving as the successful strategy 35% of the time.3 Step-by-Step Technique There are four general steps to retrograde CTO PCI: I) Define a strategy II) Cross the retrograde collateral III) Cross the CTO IV) Treat the lesion All the essential background knowledge is provided, including with regard to procedurally relevant histopathology, assessment of chronic total occlusion by means of angiography and computed 28 This is the most widely used retrograde dissection re-entry technique with subintimal position of both antegrade and retrograde wires. }, author={Dominique Joyal and Craig A. Thompson and J Aaron Grantham and Christopher E. However, the modern era of retrograde CTO PCI began with the development of the controlled antegrade and retrograde tracking (CART) technique consisting of antegrade wiring into distal true lumen through a local subintimal space created by retrograde balloon dilatation. Despite several comprehensive and detailed descriptive papers on the retrograde techniques, retrograde CTO PCI remains difficult for many interventionists. Success arises from adequate filming of the CTO during angiography and appropriate planning of the procedure. Although successful recanalization rates of CTO have remained suboptimal in percutaneous coronary intervention, evolving techniques including retrograde approach, have raised hopes for improving the overall success. This issue of Interventional Cardiology Clinics, guest edited by Drs. Access part 1 of the session: CTO procedures - the antegrade approach. STEP 1: Analyze the angiogram Higher flow, more contrast (5/sec. 6. William L. Lombardi and Kathleen E. Kearney, will focus on Chronic Total Occlusion. This book equips readers with the knowledge required in order to successfully treat coronary chronic total occlusion by means of percutaneous coronary interventions. The Official Journal of EuroPCR and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) The Fundamentals of Retrograde CTO Technique. This step is followed by balloon trapping of the wire and by guide advancement to the RCA ostium, as described for the aortic catch-it. Planned to do PCI of CTO RCA via retrograde approach due to failed antegrade approach. Presentation CTO 2020. Along with the landmark work of Wu et al [18], most of the procedural details of retrograde CTO PCI have been described. Reverse controlled antegrade and retrograde subintimal tracking is the most commonly used out of various retrograde approaches. Diagn. Micro channel Distal cap? 17. The technique of retrograde CTO PCI was first described in 1990 by Kahn and Hartzler, who used a saphenous vein graft (SVG) to perform PCI of occluded left anterior descending artery (LAD).13 Silvestri et al14 demonstrated retrograde stenting of the left main artery in 1996 using SVG. contemporary, updated step-by-step guide for op-erators wishing to embark on retrograde recanali-zation of CTO. September 28, 2019. This is usually achieved by inflating a balloon (1:1 sizing) in the proximal portion of the leaking vessel. Your CTO Tutors will suggest you a table of video contents following an educational program from beginner to advanced level, completed by a didactic part with relevant lectures. Demonstrate snaring and externalization techniques. DOI: 10.4244/EIJ-D-17-00867 About the Author Emmanouil S. Brilakis, MD, PhD, FACC, FAHA, FESC, FSCAI Dr. Brilakis is Director of the Center for Complex Coronary Interventions at the Minneapolis Heart Institute and the Center for. Long-Term Safety and Efficacy of Bempedoic Acid in Patients With Atherosclerotic Cardiovascular Disease and/or Heterozygous Familial Hypercholesterolemia (from the CLEAR Harmony Open-Label Extension Study) Step 6. The techniques for the retrograde approach are classified into four categories: (1) the kissing-wire technique (ie, to advance an antegrade stiff wire toward a retrograde one, which is a clear landmark of distal true lumen), (2) the retrograde wire crossing technique, (3) the CART technique, and (4) the reverse CART technique. The first step is to carefully analyze the anatomy of the occlusion and the presence of collateral circulation. William L. Lombardi and Kathleen E. Kearney, will focus on Chronic Total Occlusion. Kahn JK, Hartzler GO. Wire escalation may be used for this technique if the workhorse wire does not cross the CTO. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. To our knowledge, this is the first publication to describe a step-by-step approach to retrograde CTO PCI using official or home-made snares. Panel 1. The first eBook edition titled A guide to mastering Retrograde CTO PCI has been designed to simplify one of the most complex CTO PCI procedures.Featuring over 300 illustrations and 70 angiographic case examples, this eBook provides the reader with a unique and highly interactive learning experience, written by one of the worlds leading CTO operators and a global team of Conduits. Description. Many techniques and devices are used in the antegrade approach for CTO revascularization. difficult CTO with an anterograde approach might often be surprisingly easy on retrograde approach. February 20, 2020. To appreciate the step-by-step antegrade and retrograde approach to CTO PCI To learn about the selection of tools and devices for CTO PCI To obtain Real-world performance of Novel Shock Wave wire in complex CTO lesions Marianne Brodmann. Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach, Second Edition, is an easy to read reference for coronary chronic total occlusion interventions (CTO). @article{Joyal2012TheRT, title={The retrograde technique for recanalization of chronic total occlusions: a step-by-step approach. 1042 Step by step procedure to perform LCx non-stump CTO via retrograde epicardial channel from the #4AV of RCA CTO distal [Target Lesion] LCx#13non-stump CTO and RCA#1(ISO)-3 CTO improvement of myocardial perfusion step by step. Coronary CTO and CHIP Procedures at the University Of Colorado Hospital PTCA radial approach CTO of LAD - YouTube. Coronary angiogram revealed 2 V CAD (CTO of RCA and subtotal occlusion of LCx-LPL branch). Retrograde approach through the collateral channel has been recently proposed and has the potential to improve the success rate of percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) lession of the coronary arteries. After crossing the CTO lesion in the retrograde approach, wire externalization is a pivotal step to complete the PCI. First, a decision is made to proceed with retrograde crossing as primary strategy or after failure of antegrade crossing. Watch this session to learn step by step techniques to treat and manage patients with chronic total occlusion, with a LIVE case from the University Heart Center Freiburg - Bad Krozingen, Germany. Gain access in vessel distal to CTO. However, the techniques, equipment and, more importantly, the concepts of retrograde CTO PCI have changed considerably since 2012. The proper next step is to exchange the retrograde wire to a stiffer higher penetration force wire to puncture towards the antegrade space, better with real-time IVUS guidance. Stepwise guidewire successfully passes the CTO segment to AsAo, a snare balloon angioplasty was performed through the antegrade or device can catch the retrograde guidewire also as an anchor retrograde routes, and an antegrade soft-tip wire was subse- effect to facilitate retrograde microcatheter pass the CTO quently advanced into the distal portion of the occluded vessel REGISTER for free or LOG IN to view this content. 2. Step-by-step illustration of the controlled antegrade and retrograde tracking and dissection technique (reproduced with permission from reference 12). Presentation. 262 Retrograde Percutaneous Intervention of CTO Step by Step Rao. STEP 1: Choose the right collateral X NO! TAVRcathAID is an educational tool with step-by-step instructions on how to perform diagnostic coronary angiogram and percutaneous coronary intervention after implantation of a transcatheter aortic valve. National Congress of French Cardiologists Krakw Poland Angiogram and CTO Euro CTO summit Nice, France Retrograde approach aster by step method Multi Level CTO course, Cross CTO and gain true lumen control proximal and distalTechniques. From angio to mud A. Gagnor 17.30-19.00My Worst Nightmare CTO case of the year: Clinical case competition A Gordian Knot during CTO PCI Damiano Regazzoli - Humanitas Research Hospital, Milano IT 2. The retrograde technique for recanalization of chronic total occlusions: a step-by-step approach. Tuesday 17 May 2022. Invasive Cardiol. Dual injection allows good visualization of the proximal and distal vessel and the collateral circulation, allowing selection of the most suitable initial crossing technique. 2. Riga Retrograde CTO a step-by-step approach Reunion Cardiorun Ping pong technique 2 0 1 7 Paris How teaching CTO GRCI Toulouse review of CTO devices JIF CTO Nice CTO and strategies. As it pointed out, the majority of retrograde CTO would be crossed with r-CART, using the techniques described in the previous section. ( a) Flush aorto-ostial RCA CTO, with septal collaterals, mandating a retrograde approach (Video 9.14 ). Reverse controlled antegrade and retrograde subintimal tracking is the most commonly used out of various retrograde approaches. Illustration of re-entry techniques utilized during retrograde CTO interventions. Demonstrate Step by Step approach for Septal Surfing -wire choices. Retrograde approach : a step by step method Lecture by Dr. Alexandre Avran . Cathet. Antegrade and retrograde approach. Plan each step RETROGRADE AT A GLANCE SPRAAT J. septal collateral cross. improving the overall success. However, progression to cardiac tamponade following a The proper next step is to exchange the retrograde wire to a stiffer higher penetration force wire to puncture towards the antegrade space, better with real-time IVUS guidance. See more of: ABCs of CTO Its time to assemble the modified shorter GC. New concept for CTO recanalization using controlled antegrade and retrograde subintimal tracking: the CART technique. The retrograde approach is a cornerstone technique of the hybrid chronic total occlusion (CTO) percutaneous coronary intervention (CTO) portfolio [14].Mastering the retrograde approach substantially improves treatment options and success rates [].This chapter will provide the reader with a framework on how to select cases for the retrograde approach based on the angiographic Many techniques have been described to accomplish externalization in This issue of Interventional Cardiology Clinics, guest edited by Drs. Browse our listings to find jobs in Germany for expats, including jobs for English speakers or those in your native language. Two comprehensive, step-by-step descriptions of the procedures were published this year (Catheter Cardiovasc Interv. Over the course of this edition, you will learn to identify indications for retrograde coronary CTO revascularisation, with an emphasis on case selection and how to build your skill sets. The Continuum of CTO PCI Dissection Reentry Antegrade Retrograde Adoption of only 1 or 2 of these limbs will limit the patients that can be treated on the basis of coronary anatomy 5. Moreover, in post-bypass patients the bypass itself can be used as a conduit to tackle the CTO using a retrograde approach. Although successful recanalization rates of CTO have remained suboptimal in percutaneous coronary intervention, evolving techniques including retrograde approach, have raised hopes for improving the overall success. Overview and proposed terminology for the reverse controlled antegrade and retrograde tracking (reverse CART) techniques EuroIntervention 2018;14:94-101 published online January 2018. Final Angiograms. 14:00 -15:00. The reverse CART technique consists of dilating the subintimal space of the CTO lesion with the balloon inflated over the antegrade guidewire, creating a space in to which the retrograde guidewire is advanced . The recanalization rate increases even further when one combines a retrograde and an anterograde approach. Surmely et al. It has been recently updated with more detailed animations, a series of case reviews, and an overhauled UI. STEP 1 Penetration of Proximal Cap or Micro Channel Tracking STEP 2 Intimal Tracking of CTO-Body STEP 3 Penetration of Distal cap, Advance to Distal True Lumen. Retrograde SFA Recanalization 21 G needle 0.0018 V-18 control wire Sheathless approach: support catheter Alternative: 4F sheath . Retrograde recanalization is one of the most significant amendments of the technique and has become an important complement to the classical antegrade approac A step-by-step guide to mastering retrograde coronary chronic total occlusion intervention in 2018: The author's perspective Indian Heart J. 2019. In a recent study, procedural retrograde CTO PCI success in cases in which the retrograde channel was successfully crossed with a guidewire was 99 % with the Corsair versus 92.5 % with standard techniques ( p = 0.030). Ischemic area calculated by scintigraphy decreased from 24% ,13% to 9%. Chronic total occlusion (CTO) of coronary arteries are found in about 20% of patients undergoing percutaneous coronary intervention (PCI) and in about 50% of post-CABG patients. ABC of Retrograde CTO. Retrograde CTO PCI is an effective method to improve the success rate of CTO PCI. The retrograde approach to CTO crossing can significantly increase success rates, particularly in challenging lesions. - Daniel Weilenmann Start time : 55min.1s. "Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach, Second Edition, is an easy to read reference for coronary chronic total occlusion interventions (CTO). Summary. To do this, you need to push the retrograde MC across the CTO body into the proximal true lumen of the CTO vessel. 18ml) 16. Septal collaterals. An initial strategy of wire escalation with 0.014, 0.018 or 0.035 wires with a support catheter can be tried to cross the CTO (Figures 1 to Antegrade and Retrograde Access Strategies for SFA CTO Michael J. Singh, MD FACS RPVI We, the Asia Pacific Chronic Total Occlusion (APCTO) club, propose a new algorithm for retrograde CTO PCI (Figure 1). Presenter: Colm Hanratty. 7 - Step 3 - Ive crossed the CTO retrograde, whats next? Keywords: Chronic Total Occlusion (CTO) and Coronary View Recording Download Slides. The Retrograde Technique for Recanalization of Chronic Total Occlusions: A Step-by-Step Approach JACC Cardiovasc Interv , 5 ( 1 ) ( 2012 ) , pp. Cardiovasc. Retrograde dissection re-entry technique 20(2), 8893 (1990). 5 - Step 1 - Collateral selection and crossing - Masahisa Yamane Start time : 28min.55s. Retrograde Wire Crossing (RWE) LVEF 60% and SYNTAX score 24. Almost 20 to 50% of CTO PCIs are performed through the retrograde approach. To our knowledge, this is the first publication to describe a step-by-step approach to retrograde CTO PCI using official or home-made snares. 10 CTO PCI Retrograde collateral channel 2022722 15:0016:00 11 G318+G319 Our aim was to illustrate a specific te Application of a snare technique in retrograde chronic total occlusion percutaneous coronary intervention - a step by step practical approach and an observational study The development of the retrograde approach has pro - vided more opportunities for using old and creating new techniques. Coronary. In a substantial population of patients previously labeled as unrevascularizable, retrograde recanalization of CTO offers a valuable option. Unique to retrograde CTO PCI is the risk for donor collateral-vessel perforation. Topics discussed in this issue include, but are not limited to: Indications for percutaneous coronary intervention of CTO; Pre-procedure planning for CTO PCI; Toolbox for CTO PCI; Antegrade Wire Escalation Case Selection and The first and most important step of CTO PCI is to perform dual coronary injection, in nearly all cases. JPMorgan 'loosens working from home restrictions for staff from two days a week to three' after bankers moaned they were being 'forced' After a retrograde guidewire has crossed the CC and reached the lumen of the coronary artery distal to the CTO, the following four strategies [13] are available: direct retrograde wiring; the kissing wire technique; the Controlled Antegrade and Retrograde Tracking (CART) technique; and the reverse CART technique. 2012;79:3-19 and J Am Coll Cardiol Cardiovasc Interv. The retrograde wiring technique confirms successful and effective CTO-PCI because stents are usually implanted in the true lumen in the far end of the CTO lesion, which is different from the antegrade approach alone. Bypass grafts. The success rate of CTO PCI increased from 70 to 90% with use of retrograde approach Visualization of collaterals is the most important step in retrograde PCI intervention. Successful Presenter: Simon Walsh. Antegrade and retrograde wire escalation in CTO PCI Add this session to my programme. We have provided an updated step-by-step approach to demystify the procedure. Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach is a practical, easy to read reference for coronary chronic total occlusion interventions (CTO). Surmely JF, Tsuchikane E, Katoh O et al. Should a significant perforation occur, the first step is to prevent continuing blood loss. This Password requirements: 6 to 30 characters long; ASCII characters only (characters found on a standard US keyboard); must contain at least 4 different symbols; Charging the cut outer sheath tube segment (connector) on the inner sheath, you have the needed support to advance it on the distal GC part (Video 2). sive step-by-step description of the retrograde approach to date. There was also a strong trend toward lower fluoroscopy and procedural time [ 15. The 190 cm retrograde wire is gently advanced along the ascending aorta and the common trunk to reach the venue of the catch-it maneuver, where it can enter the distal tip of the antegrade guide. STEP 3: How to pass epicardial collaterals >1,5mm Wire of choice: Sion black Technique: Fast rotation Stop when there is resistance 19. The very vast majority of retrograde accesses do not require the insertion of a sheath, and an 0.018 wire and a compatible catheter are usually sufficient to cross the occlusion. ( b) Small septal channels connecting to PDA and PLV (Video 9.15 ). Tether's CTO declined to reveal details on its $40B US government bond holdings, a similar amount to Vietnam, for fear of revealing its secret sauce Token's tech chief says providing specifics on vast holdings of US debt would divulge secret sauce The retrograde approach can be divided into ten steps. Furthermore, the retrograde wire is a visible penetration mark that makes contrast medium unnecessary. The retrograde wire penetrates from the distal true lumen into the CTO and then into the subintimal space at the CTO site. TCTAP C-099 Coronary Thrombosis During Complex PCI Using Step by Step Retrograde Approach for LAD#7 CTO Journal of the American College of Cardiology, 2016, 67, S207-S208 Shingo Hosogi, Tsuyoshi Miyaji, Takashi Nishimoto, Wataru Takagi. Manual of Coronary Chronic Total Occlusion Interventions: A Step-by-Step Approach is a practical, easy to read reference for coronary chronic total occlusion interventions (CTO). Aorto-ostial RCA CTO treated with the retrograde approach. The actual outer diameter of the sheath is always 2Fr bigger than the indicated size, so by going sheath-less one avoids greater trauma to the punctured vessel. For the purpose of this review, only supporting equipment available in North America will be discussed.