Staged PCI of RCA CTO via Antegrade Approach using CenterCross Device – May 2016

36 year-old diabetic male presented with new onset CCS Class III angina and had positive stress MPI for moderate anterior, septal, apical and inferior ischemia. A Cardiac Cath on April 14, 2016 revealed 3V CAD: CTO of RCA with distal vessel filling via antegrade bridge and retrograde collaterals, 95% prox LAD, 80% LCx-OM2, 90% LCx-LPL1 with mild systolic LV dysfunction; SYNTAX Score of 26. In view of diabetes and multi-vessel CAD, Heart Team discussion took place and patient elected for PCI. Patient underwent successful PCI of proximal LAD (Xience DES), LCx-OM2 (Atherotomy PTCA and Xience DES) and LCX-LPL1 (Xience DES). Patient did well and still has residual Class II angina on medical therapy. Patient is now planned for staged PCI of RCA CTO via antegrade approach using CenterCross device or via retrograde LAD-septal collaterals.

Moderator: Sameer Mehta, MD



Q What are the implications of the new publication about the mortality information with CTO?
A. I personally believe that this Korean report is outlier in terms of lack of mortality benefit after successful CTO recanalization. Majority of the studies including last being from UK, has shown gradient of benefit with complete and incomplete successful CTO recanalization. Also NYS registry report published in Circulation last week also revealed benefit of CTO recanalization after 2.5 years of follow-up.
Q Have we been blindsided with these results?
A. Yes it was really alarming to see this publication. I am sure the data of Korean registry are reliable and may be explained on the basis of young age of pts and >90% CTO success rates.
Q Or, this is simply an outlier?
A. Simply an Outlier at the present time.
Q Should other centers collaborate on similar data to resolve the important issues raised by this paper?
A. As I mentioned, last week’s issue of NYS registry data had contradictory results to the Korean study and found lower death at 2.5yrs of follow-up after successful CTO recanalization vs unsuccessful group; CTO success was only 61%.
Q How do you compare Guide Liner with the Center Cross?
A. Guideliner is a great device to provide support in tortuous and distal lesions while CenterCross is only useful for CTO recanalization by keeping CTO wire passage in the center of the artery and hence less forward dissection or chances of perforation. We now have used this device in about 2 dozen cases and have seen that CenterCross really hugs the vessel and provides extreme support by anchoring the devices.
Q A term was used today about Dual Purpose webcast - education of interventional cardiologists in PCI and advancement of technology? Are both equally important?
A. I really loved the terminology you used ‘Dual Purpose Webcast’ and that really is the educational mission of our CCCLive cases. I will say that PCI education is 2/3rd important and 1/3rd important will be the advancement of technology. That really will be true mission of our CCCLive cases going forward.
Q You have pioneered several new devices in your webcast - which do you feel are the three most important?
A. Three most important devices we have shown in our CCCLive cases are; Guideliner use, OCT use and Orbital atherectomy procedure.
Q Should we continue to see newer devices in your live webcast?
A. Absolutely we will continue to showcase newer devices in our Live webcasts; next device we plan to showcase likely will be ABSORB BVS in July 19th webcast.
Q Does industry seek feedback from you or the sponsors are merely interested in marketing of their device?
A. Industry definitely looks for the feedback about their device to make the necessary improvement as Vascular solutions did for the Guideliner modification.
Q Does any of you have any conflict of interest in any equipment that you demonstrate?
A. No conflict of interest or equity interest in the devices we show case in our Live webcast cases.


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