22 Sep 2023
Complex CTO - LIVE case
Retrograde CTO and modified reverse CART in calcified circumflex artery
Operators:
S. Gallagher, E. Smith
Procedural Analyst:
S. Lo
Summary
View the case of an 82-year-old man with history of CABG in 2003 (LIMA LAD, VG RCA, VG CX), PCIs on VG RCA in 2021, PCIs VG-CX in 2022, PPM in 2023 with preserved LV function, and follow the retrograde approach of calcified CX CTO using veingraft.
The problem was the proximal cap with lots of calcifications, countered with modified reverse cap and veingraft wire externalisation to anterograde guide.
IVUS was used for final check.
LIVE case from Barts Heart Center - London, United Kingdom
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Key moments
- 18:23-20:04 - Imaging analysis
- 35:40-39:12 - Wire strategy
- 40:47-01:02:27 - Modified reverse CART
- 01:12:40-01:13:48 - Wire externalization
- 01:19:28-01:22:03 - Final IVUS and stenting strategy
- 01:23:20-01:26:31 - Summarized procedural analysis
Keywords: retrograde CTO, modified reverse CART, IVUS
Learning Objectives
- To understand how the CTO anatomy dictates interventional strategy
- To understand how integration of emerging microcatheter and wire technologies facilitates the interventional strategies used
- To observe how CTO cases can be set up to allow any approach needed, and when to switch strategies