当前治疗CTO的逆向疗法PPT.pptVIP

Saiseikai 　Yokohama-City 　Eastern 　Hospital Saiseikai 　Yokohama-City 　Eastern 　Hospital Current strategy of retrograde wire for CTO Toshiya Muramatsu MD Division of Cardiology, Saiseikai Yokohama-City Eastern Hospital Strategic Changes Retrograde approach 25.1% Seesaw wiring 33.2% GW 4.0 ± 2.4　(max 10) Total 46.4 % Seesaw wiring 43.1% Conquest trial N=116 July, 2003 - March, 2004 J-CTO N=378 April, 2006 - December, 2007 2 years later Approach site (Overall) 　　　　　femoral 　　　　　　80.8% 97.4% 　　　　　radial 5.1% 1.8% 　　　　　brachial 　　　　　　14.2 % 0.9% 　　　　　Single site puncture 35.4% 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= 451 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%) Contributions of Supplemental Strategies Procedural Time (min) Contrast (cc) 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 Calcium 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 balloon(150cm,1.25mm), 2~3atm GW St