cct @ linc 2019 various techniques to recanalize cto trans

27
CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans-collateral Wiring Kazushi Urasawa, MD, PhD, FJCC Vice President, Tokeidai Memorial Hospital Sapporo, Japan LINC 2019 – Jan. 22-25, 2019, Leipzig, Germany

Upload: others

Post on 13-May-2022

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

CCT @ LINC 2019

Various Techniques to Recanalize CTO

Trans-collateral Wiring

Kazushi Urasawa, MD, PhD, FJCC

Vice President, Tokeidai Memorial Hospital

Sapporo, Japan

LINC 2019 – Jan. 22-25, 2019, Leipzig, Germany

Page 2: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Disclosure Statement

Kazushi Urasawa, MD, PhD, FJCC

Consulting for

Cardinal HealthCordis Endovascular JapanBoston ScientificTerumoKanekaAsahi InteccTokai Medical ProductsFuture Medical Devices (FMD)NiproMedikit

Page 3: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Target arterial lesions of CLI casesare always ・・・・・

long total occlusions of BTK arteries.

Page 4: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

The techniques we can use to recanalizeBTK CTOs

1. Antegrade wiring2. Bi-directional wiring

1) Trans-collateral wiringTrans-pedal arch wiringTrans-perforator branch wiringTrans-(pure) collateral wiring

2) Distal punctureATA, PTA, PADorsalis Pedis A., Plantar A.Digital A.

Page 5: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Case: 80’s Female

Diagnosis: CLI (Rutherford 5, Right 1st & 5th toe)DM, Old cerebral infarction

Skin Perfusion Pressure:Right dorsal 10mmHgRight plantar 28mmHg

Page 6: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Control angiography

Page 7: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

POBA for SFA lesions

4.0 x 300mm

Page 8: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Angiography after POBA

Page 9: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Stent implantation

Life stent solo6.0 x 150mm

Page 10: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Post dilatation of stented segment

Page 11: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Angiography after stenting

Page 12: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Selective Angiography from distal PA

Page 13: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Wiring to plantar artery via perforator branch

Regalia 0.014”

Page 14: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Wiring to DP via pedal arch

Page 15: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Retrograde wiring

Chevalier floppyCorsair PAD

Page 16: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Antegrade wiring to ATA-CTO

Jupiter FCProminent

Page 17: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Guidewire Rendezvous

Page 18: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Advance antegrade guidewire to plantar A.

Page 19: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

POBA for DP and pedal arch

Shiden HP2.0 x 200mm

Page 20: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

POBA for distal ATA

Shiden HP2.0 x 200mm

Page 21: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

POBA for POP - proximal ATA

Shiden HP2.0 x 200mm

Page 22: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Angiography of BTA area after POBA

Page 23: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Final angiography

Page 24: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Result of the Case

Skin Perfusion Pressure:Rt dorsal 10mmHg → 45mmHgRt plantar 28mmHg → 48mmHg

Page 25: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Take Home Message

Bi-directional wiring techniques are very powerful to achieve successful result in complex BTK lesions.

Trans-collateral wiring and various distal puncture techniques are essential for the interventionists who treat CLI patients.

Page 26: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

Thank you for your attention

Page 27: CCT @ LINC 2019 Various Techniques to Recanalize CTO Trans

CCT @ LINC 2019

Various Techniques to Recanalize CTO

Trans-collateral Wiring

Kazushi Urasawa, MD, PhD, FJCC

Vice President, Tokeidai Memorial Hospital

Sapporo, Japan

LINC 2019 – Jan. 22-25, 2019, Leipzig, Germany