慢性完全闭塞之个人观点课件.ppt

LAD ostial CTO Candidate channels Retrograde channel wiring Dilatation and MC advance My way of retrograde CTO crossing Try hydrophilic GW for less than 5 minutes and avoid over-steering Try to advance the MC gently When MC cannot be advanced Extend GW and remove MC Advance 1.25 OTW balloon for channel dilatation Exchange the hydrophilic GW to CTO GW inside MC Bi-plane imaging for retrograde CTO crossing Retrograde CTO crossed Next step options Antegrade wire advancement? Balloon dilatation from the retrograde wire? “Level 4” technique Advance GW and MC into antegrade GC Withdraw retrograde GW Advance 300cm GW inside MC into antegrade GC until out of Touhy-Borst Use the tip of 300cm GW as the back-end for antegrade ballooning Retro GW/MC into ante GC Remove MC and back-end balloon After back-end dilatation What next? Finish the case with back-end stenting? Lesion distal to the take-off of the retro channel? Injury by the 300cm GW stiff end if withdrawn from ante GC! Advance another floppy GW from ante GC across CTO? May be difficult, and with increased risk of vessel rupture! Back-end advancement of MC from ante GC over 300cm GW into retro GC (MC reversal) Remove 300cm GW from the retro GC Withdraw MC until proximal to the channel take-off Advance another floppy GW inside MC into distal vessel 300cm GC removed and ante GW 2 DSEs implanted Final angiogram Summary on retrograde technique Level 1: GW kissing Level 2: retrograde dilatation Level 3: CART Level 4: Back-end dilatation + MC reversal Follow-up results Successfully recanalized CTO (N=197) N (%) Clinical f/u 154 (78) Time since PCI (month) 11.2 ± 9.7 Angiographic f/u 71 (36) Time since PCI (month) 8.7 ± 5.5 Binary restenosis 5 (7) Re-occlusion 3 (4) TLR 4 (3) Death/MI 2/4 (1/3) RCA CTO 7y Final and 9m follow-up Summary for CTO PCI With the improvement in equipments and interventional techniques, the success rate and long term results of CTO PCI is excellent CTO should no longer regarded as an absolu