Retrograde CTO PCI in leftdominant coronary arteryRetrograde CTO PCI in leftdominant coronary artery

Nicolas Boudou, MD,

Cardiology department

Rangueil university hospital

Toulouse, France

Pôle Cardiovasculaire et Métabolique

Pôle Cardiovasculaire et Métabolique

Potential conflicts of interest

Speaker's name: Dr Nicolas Boudou

I do not have any potential conflict of interest

LAD occlusion and collaterals

Conus artery

Guide catheter extension for ping pongtechnique

Monorail, rapid exchange:

- Guidezilla®, Boston SC 5F dans 6F- Guidion®, IMDS…

Guideliner®, Vascular Solutions 5F dans 6F

• Coaxial, over the wire:

5F in 6F, 120 cm

Heartrail II®, Terumo

Guide catheter extension for ping pongtechnique

Ping Pong technique: 2 guiding catheters in the same coronary artery

Brilakis ES, Grantham JA, Banerjee S. “Ping-pong” guide catheter technique for retrogradeintervention of a chronic total occlusion through an ipsilateral collateral.

Catheter Cardiovasc Interv 2011;78:3959.

• Retrograde approach through a septal colllateral• Guide catheter extension in LCx to protect the left main• Pure retrograde wire crossing and wiring in the Guide cath extension

Ping Pong technique: 2 guiding catheters in the Left coronary artery

CTO in ostial LAD

• Previous failure in another institution with dissection and haematoma of the proximal LAD

• Retrograde approach through septal from LCx

Retro CART with Guide extension

FU @ 3 months

Key points

• Retrograde in same coronary artery: left dominant

artery

• Septal or epicardial collateral

• Ping Pong technique

• Guide catheter extension

– To protect a branch not diseased

– To secure retrograde crossing