48 year old morbidly obese male with diabetes and ESRD on HD (pre-renal transplant), presented with CCS Class I angina and high risk stress MPI for moderate to severe lateral and inferior ischemia and EF of 50%. A Cardiac Cath on April 27, 2018 revealed 2V CAD: calcified long CTO of mid RCA, (J-CTO Score 4), 80% LCx-OM1, mild diffuse LAD/D1/D2 with LVEF of 55% and SYNTAX Score of 12. Patient underwent successful intervention of LCx-OM1 using Promus Premier DES. Now patient is planned for staged PCI of complex mid RCA CTO via antegrade recanalization and if fails, then retrograde recanalization technique.
Moderator: Sameer Mehta, MD
We start with Gaia 3, then Miraclebro 6 and then go to Confianza 9 and then 12. We repeat the same sequence all the time.
For retrograde recanalization, it is usually softer wire of Fielder FC and rarely Gaia 2.
Finecross is the workhorse microcatheter followed by Corsair.
Over last 2-3 years, success of first attempt CTO recanalization is around 85-88%.
The success after second attempt for CTO recanalization is 92-94%.
We do retrograde in 6-8% of our CTOs and success rate is about 80%.
Actually these complex CTOs with high JCTO score are usually referred to specialists and special center (like Mount Sinai). That is what we get; of the 40 CTOs we do per month, about 20 are referred from other hospitals and Interventionalists.
There are 2 important reasons to decline the CTO PCI; 1) If not needed clinically and fits in Inappropriate of the ACC AUC category 2) If heavily calcified CTO with extensive bridge collaterals, as in these cases, likelihood of success is <50%.
My guess will be that even CABG would have had similar 5 year outcome as MT or PCI in the Decision CTO.
Yes we plan 2-3 complex CTOs for the CCVVC symposium. All CTO recanalizations in the CCVVC will be tried antegrade first.
86 year old female with chronic stable angina CCS Class II and positive MPI for two years being managed on medication.
62 year old male presented with CCS Class II angina and positive SPECT MPI for basal inferior and inferolateral moderate size area of ischemia and infarction.
53 year old male with CKD on HD, known extensive inoperable severe calcific CAD and s/p SAVR in Nov 2017.
74 year old male with CKD Stage III presented with CCS Class II angina and positive stress MPI for moderate inferoapical ischemia.