using a deflectable tipped catheter to treat previously inaccessible lesions
DESCRIPTION
Using a deflectable tipped Catheter to treat previously inaccessible lesions. Helen Routledge Interventional Fellow Institut Cardiovasculaire Paris Sud SpR Cardiology, University Hospital Birmingham. Multiple PCI procedures LCA. Failed PCI to CTO RCA - PowerPoint PPT PresentationTRANSCRIPT
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Using a deflectable tipped Catheter to Using a deflectable tipped Catheter to treat previously inaccessible lesionstreat previously inaccessible lesions
Helen Routledge Interventional Fellow
Institut Cardiovasculaire Paris SudSpR Cardiology, University Hospital Birmingham
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Multiple PCI procedures LCA. Failed PCI to CTO RCA
CABG Feb 2006 - RIMA to proximal PDA + SVG to distal RCA
May 2006 - Unstable angina
51 year old male
Occluded SVG to RCA
Patent RIMA to PDA
Lesion at ostium of PLA
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1st Attempt at PCI : Guiding Catheter dissection ostium of RIMA
Recurrent Angina CCS 3 in Nov 06
Treated for ISR in LCA and DES in proximal RIMA
Recurrent angina
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Intractable Angina
Extreme angulationLesion tortuosityAccess 6f RRA, IMAMinimal support
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BMW (Guidant Corp.)PT2 (Boston Scientific)Whisper (Guidant Corp.)Cross-it (Terumo)Steer-It (Cordis)
Impossible to Wire?
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Re-do bypass graftingMedical therapyTry and get round the bend…..!Venture Catheter
Solutions?
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Venture Venture TMTM Catheter Catheter
Over the wire or Monorail low profile, 3.5F catheter Steerable radiopaque tip
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Venture catheter advanced over Whisper
Whisper advanced into PLA
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Venture Catheter advanced further into PLA
Whisper exchanged for BHW (Guidant Corp.)
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Predilatation, Cypher 2.5 x 18mm Stent, Wire Exchange, Kissing
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Final result – free of Angina
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SVG to LCx
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Venture BHW guidewire Cypher 2.5 x 13mm
SVG to LCx
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Lesion compromising large PLA
Venture Catheter deflected towards PLA
SVG to PDA
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Pre-dilated
Unable to stent
Buddy wire
Endeavour
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Post-dilated, final result
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Difficult Side Branch Access
Before
and after Main Branch Stenting
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62 year old female - ACS
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Failure to Wire SB
BMW (Boston Scientific)Whisper (Guidant Corp.)Choice PT(Terumo)Venture Monorail + BMW
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Taxus 3 x 20 12 ATM
PTS strategy
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PTS strategy
Taxus 3 x 20 12 ATM
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Final Kissing, Final Result
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Failure to Re-wire SB
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Subocclusion, Occlusion
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Venture Monorail, kissing
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Result
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Side Branch Access - Trifurcation
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Side Branch Access - Trifurcation
Difficult to wire Septal.. Venture and Whisper
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Angulation & Tortuous AnatomyAngulation & Tortuous Anatomy
Difficult side branchesDifficult side branches
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LMS PCI – recrossing to LCx
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Side Branch Access - Trifurcation
MB StentPre-dilatation septal
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Side Branch Access - Trifurcation
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Tortuosity, double bend, angulation
SVG to LAD
Venture?
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Retrograde?Wire advanced to native vessel
Angulated and tortuous lesions beyond Grafts 4