Date post: | 15-Apr-2017 |
Category: |
Health & Medicine |
Upload: | eurocto |
View: | 196 times |
Download: | 4 times |
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
14:30-14:45
New Devices for CTO PCI
Masahisa Yamane , MD, FACC
St Luke‘s International Hospital ,Tokyo, JapanSaitama Sekishinkai Hospital, Saitama, Japan
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Disclosure Statement of Financial Interest
I, Masahisa Yamane MD,DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in this presentation.
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
RCA CTO c Left Coronary Anomaly
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
RCA CTO c Left Coronary Anomaly
IVUS (VOLCANO) for Proximal Cap AmbiguityGaia 2RAO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
RCA CTO c Left Coronary Anomaly
LAORAO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
RCA CTO c Left Coronary Anomaly
LAORAO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
RCA CTO c Left Coronary Anomaly
FineDuo ( Dual Lumen catheter ) for Parallel WiringConfianza Pro 12g
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
FineDuo: Product SpecificationOTW lumen to deliver (2nd
guidewire, contrast media, drugs)
RX lumen for the 1st guidewire
Usages:
o Any complex PCI whenever stronger GW control & support are required
o Drug diffusion
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Double markers facilitate an accurate placement to access
• Any side branch or collaterals
• The most distal stent strut
0.5 mm
1.0 mm0.5
mm
5 mm
Double radiopaque markers are located specifically for better visualization
OTW lumen exit port in between both markers
1 mm Distal marker on RX lumen part
Distal marker on RX lumen part is located at 0.5 mm
FineDuo: Double radiopaque markers
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
GW advances obliquely thanks to the “bump”: 5 degree
This angle enables to expand the rotation range of the GW
Angle and position of distal part of GW GW rotatable range
RX lumen
OTW lume
n
RX lumen
OTW lume
n
5 degree
GW
RX lumen
OTW lume
n
RX lumen
OTW lume
nGW
Better GW Manipulation for maneuvrability
Standard dual lumen microcatheter
FineDuo*
FineDuo: Rotatable range of Guidewire
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Reverse Wire Technique - Steps • Insert the FineDuo microcatheter along the main
vessel GW with 2nd GW (for side branch) inside the OTW lumen
• Protrude the tip of 2nd GW from the distal side hole
• Pull back the FineDuo microcatheter toward the proximal side and orient the 2nd GW tip to face the side branch by torque force
• Pull back the 2nd GW toward the side branch (pre-shaping of GW tip enables easy access into the side branch)
• After capturing the appropriate stent strut, advance the 2nd GW distally to the side branch. Appropriate stent strut position; most distal part at carina for open cell stent, and central part of ostial for closed cell stent
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LAD Ca CTO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
MDCT/LAD Ca CTO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LAD Ca CTO
Gaia 1 >> 2 >> 3Step down to XT-RRotablator 1.5 mm
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Suoh 03
• Tip load 0.3g, coreless , so fragile, pre-shaped
• Can not predict to navigate at discretion
• Push, pull, rotate :
• Pull while rotate/Push while rotate
• Physics not applied to the tip “behavior”
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LCX CTO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LCX CTO
Suoh 03
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LCX CTO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
EPI DIASTOLE EPI SYSTOLE
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Tipping bend in Epicardial
EPI DIASTOLE EPI SYSTOLE
“ Under steer “
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
EPI DIASTOLE EPI SYSTOLE
“ Over steer “
1. Soft tip deflection2. Bend opening angle3. Hydrophilic tip favoring over-steering4. Conformable tip with torque transmission5. Adequate “space” for flip-flopping the tip for next turn
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LCX CTO
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Suoh-03
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Suoh-03
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
LAD CTO with Ca++
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Prior PCI
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Re-Attempt
Suoh 03 on Caravel
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Re-Attempt
Retrograde Gaia 2XCART attemptGuide liner Assisted XCARTRG3 Externalization
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Caravel® structure (135 cm and 150 cm)
Hydrophilic coating: 75cm
Caravel Prox.
0.55mm 0.85mm
PTFE
0.62mm
Caravel Dis.
0.43mm
PTFE
ProductsO.D. I.D.
LengthCoating
Entry Distal Proximal Entry Distal Proximal Length
ASAHI Caravel
ASAHI Corsair
Finecross MGNot publicly
available
Finecross GTm
m
ⒸASAHI INTECC CO., LTD 2014; This document is for training of staff and contains confidential or privileged information. Any
distribution, copying, forwarding or citation is strictly prohibited.
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
ASAHI Gaia nextCTO guide wire
• New generation of Gaia Family
• More torquable and penetrating power
• 3 different stiffness
Gaia Next 1 st
Gaia Next 2 nd
Gaia Next 3 rd
• Specifications finalized
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
The Plasma wire system
• Novel device for CTO PCI
• FIM performed successfully in 7
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
New devices for CTO PCI from Japan
• New technologies has changes our approaches to CTO.
• Wires, micro-catheters, Guide-catheter(system), and Imaging (IVUS, CT scan) are backbone
• As the technologies has developed, the operators can adopt very fast, worldwide
• However advanced, there are always “ remaining” challenges, as we push further
• We select the technology “wisely” and “we” use them in appropriate context
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
CCT 2016 Oct 20-22, Kobe, Japan
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
Post CABG RCA CTO
IVUS Navigated PuncturingGaia 2SionCorsair ProRetro: XT to Sion Black KnuckleGuide liner assisted XCART
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
ASAHI CORSAIR PROMicrocatheter
Hydrophilic Coating:60cm
Usable Length
More slender distal tip and more trackabilityMore torque resistance to go through complex collaterals and CTOs
Euro CTO CLUB The Experts “Live” Workshop 2016, Sep 30-Oct 1, 2016, Krakow, Poland
現行Corsairでは回転操作を加えても超えることができない屈曲モデルを用いて通過性能の比較評価を行った現行Corsairでは回転操作を加えても超えることができない屈曲モデルを用いて通過性能の比較評価を行った
ASAHI Corsair ASAHI Corsair Pro
動画
結果回転操作を加えても、挿入不可 押し操作のみで挿入可
剛性徐変の最適化②
39