16:05 Bufe - Learning to stop and to stage CTO PCI

Neue HELIOS- Prsentationsvorlage

A. Bufe

HELIOS Heart Center KrefeldDepartment of CardiologyLearning to stop and to stageCTO PCI

HELIOS Klinikum Wuppertal - HerzzentrumHELIOS Klinikum Wuppertal - HerzzentruA. Bufe: HELIOS Heart Center Krefeld1

Experience and limitations of the operatorRadiation andContrast mediaComplicationsWhen to stage and to stop the procedureCTO PCIPatients and operators condition

HELIOS Klinikum Wuppertal - HerzzentrumHELIOS Klinikum Wuppertal - HerzzentruA. Bufe: HELIOS Heart Center Krefeld

%Interventional cardiologies performing CTO PCIand referring to Krefeld Heart Center after failure91,68,4n = 24n=22n=2



LAD lesions



RCA-CTO

SYNTAX Score = 21

J-CTO Score = 2




RCA CTO antegrade at firstCABGComplete revascularization is mandatory

if unsuccessful







RCA CTO antegradeCABGComplete revascularization is mandatory

unsuccessful

1. LAD2. RCA1. RCA2. LAD


Septalchannels

Epicardialchannels


Step by StepStaged procedure



Xience Pro 2,5/38Xience Pro 2,75/18


SeptalchannelStent


Epicardialchannels




Reverse CART



Experienced operators who provide all techniques Less experienced(antegrade only)Strategy and thinking about staging a procedure is very different amongCTO operators




Even if you are not so experiencedCTO operator your work can give informationfor second try and can prepare the lesiontwomonths later




48,023,528,5n =175EuroCTO Club: retrograde recanalization strategy 2005 - 2007%

Sianos et al., EuroIntervention 2008;4:84-92

HELIOS Klinikum Wuppertal - HerzzentrumHELIOS Klinikum Wuppertal - HerzzentruA. Bufe: HELIOS Heart Center Krefeld89,365,988,0n =175EuroCTO Club: succes rates according to strategy 2005 - 2007Erfolg in %

Sianos et al., EuroIntervention 2008;4:84-92


76.223.8Galassi et al., EuroIntervention 2014; in progressn =1582EuroCTO Club: retrograde recanalization strategy 2008 - 2012


8253Galassi et al., EuroIntervention 2014; in pressn =1582sucess %

EuroCTO Club: succes rates according to strategy 2008 2012(overall success: 75.3%in 2012: 79.3%)


When to stop.

The issue of radiation:

air kerma should not reach 10 Gy (alert at 5 Gy)

we can reduce fluoroscopic pulse rate down to 4/sec

we can reduce radiographic frame rate down to 7.5/sec

The issue of contrast media:

Volume of contrast should not excced 4 x GFR

preventive pre-, post-, intraprocedural hydration


When to stop.

The issue of complication:


Try to solve the problem immediately

Perforation: balloon, covered stent, coil, pericardial drain

donor artery complication: PCI, ACT measurements

stop the procedure if it seems to be safer for the patient


ConclusionIn complex coronary artery disease with CTO staged procedure strategy is reasonable

In case of antegrade failure by operator with limited experience patient should be referred to CTO specialist for analysis transport our achievements to general cardiologists

In very complex CTO primary retrograde approach is favourable

If complications occur solve it. Go on with the intervention only if it is safe for the patient.Determine limits of contrast medium and radiation


Thank you!

Heart Center Krefeld GermanyWe like toreopenCTOs




Morino J et al, JACC Cardiovasc Interv 2011;4:213-21


Date post:	16-Feb-2017
Category:	Health & Medicine
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16:05 Bufe - Learning to stop and to stage CTO PCI

Health & Medicine