Complex coronary cases
Staged PCI of Proximal LAD/Diagonal Bifurcation Lesions and mid LAD CTO filling via Bridge Collaterals – May 2014

62-year-old-male presented with crescendo CCS Class III angina with positive stress MPI for moderate anterior and lateral ischemia. A Cardiac Cath on April 15, 2014 revealed 2V CAD of multiple lesions in LAD/Diagonal and 80% lesion in OM3 with LVEF 55%. Patient underwent PCI of OM3 using Promus Premier DES. Now planned for staged PCI of complex proximal LAD/Diagonal bifurcation lesions and of mid LAD CTO filling via bridge collaterals.
Moderator: Sameer Mehta, MD

1:10:02

Q&A
Q
Dr. Mehta and yourself have stated that CTO results in the U.S. compare with Japan now. Is that correct?
A.

Yes that is correct as in the recent contemporary US EXPERT CTO trial, the overall success rate of CTO recanalization was over 90%; similar to the Japanese reports.


Q
What are the CTO success rates at your institution presently?
A.

First attempt 85% and with second attempt 92-94%


Q
What is the breakdown of antegrade versus retrograde?
A.

Still 90% antegrade and if fails again antegrade and then retrograde. Rare cases of flush ostial occlusion, retrograde approach may be the first line of attempt.


Q
All 100% femoral access? Will you consider radial access in any case?
A.

Yes CTO procedure in our lab are dual femoral access in majority (>98%). In rare case of difficult femoral access, radial approach has been tried.


Q
What percentage are 6F? Where do you use 7F?
A.

Majority (>95%) are 6Fr. 7Fr is used only in cases where CTO is at the bifurcation and 2 stents might be used after successful recanalization and balloon anchor technique is needed.


Q
Where are you not using a bilateral cannulation?
A.

WE are not using bilateral cannulation, when there are ipsilateral collaterals like LAD giving collaterals to occluded LCx.


Q
100% successful wire crossing is finished with DES?
A.

YES and is clearly supported by trial (PRISON II) and CTO registry data.


Q
What is your reported TVR after CTO success?
A.

One year TVR of successful CTOs is about 6-8% at Mount Sinai Hospital; which in large part be attributed to liberal use of EES.


Q
What contributes more to CTO success - the Guideliner or Corsair, or both?
A.

Both Guideliner and Corsair have improved our CTO success but actually it is the CTO wires which have escalated our success over 90% now compared to in 70% range 6-7 years ago.


Q
What is the most promising device you are looking forward to for further improving CTO success?
A.

Still further improvement in the dedicated CTO guidewires has promise to improve the success rates of CTO further.


comments

Leave a Reply

Your email address will not be published. Required fields are marked *

suggestion
Suggestions
Staged PCI of RCA multilayer DES CTO ISR using rotational atherectomy and IVBT – November 2020
Views 266

Case and Plan: 65-year old male with known long standing history of chronic ischemic heart disease requiring multiple PCI’s over the years after declining CABG, presented with CCS Class III angina and high risk stress MPI for multivessel ischemia. A Cardiac Cath on September 28, 2020 revealed 3 V CAD: 100% proximal RCA due to […]


Complex Multivessel PCI in a High SYNTAX Score Patient – October 2020
Tags: | |
Views 346

Case and Plan: 74-year-old obese male on HD presented with CCS Class II angina and positive SPECT MPI on July 14, 2020 done as pre-op for renal transplant revealing moderate apical, inferior and inferolateral ischemia. A Cardiac Cath on August 20, 2020 revealed 3 V CAD: 70% mid RCA, 100% RCA-AV Cont, subtotal calcified mid-distal […]


Radial PCI of Long Complex Calcified LAD post TAVR – September 2020
Views 270

Case and Plan: 78 year-old-male presented on August 7, 2020 with progressive exertional dyspnea, NYHA class III. Workup revealed severe AS (AVA 0.7cm2), normal LV function and STS mortality of 1.1%. After heart team discussion, patient underwent successful TAVR using 26mm SAPIEN-3 Ultra with excellent results, AV area of 2.0cm2 and no PVL. A coronary […]


Stent Ablation with RA of Underexpanded Multilayer DES – August 2020
Tags: | |
Views 442

63 year-old male with known CAD, CABG x2 (1999) and multiple PCI’s to SVG to RCA and LCx branches presented with CCS Class IV angina and non-STEMI (TnI 1.2U). A Cardiac Cath on June 22, 2020 revealed patent LIMA to LAD, non obstructive LCx branches with patent prior stents and 90% multilayer in-stent restenosis of […]