Andrea Gagnor - Femoral is (still) better

Femoral is (still) better

Andrea Gagnor

FINAL PROGRAM

The Experts „ Live“Workshop 2016

www.eurocto2016.com

September 30th - October 1st, 2016

Krakow, PolandICE Krakow

Course Directors

Jaroslaw Wójcik,

Lublin, Poland

Leszek Bryniarski,

Krakow, Poland

ECC-President

Alfredo R. Galassi,

Catania, Italy

Co-Directors

Nicolas Boudou,

Toulouse, France

George Sianos,

Thessaloniki, Greece

Gerald S. Werner,

Darmstadt, Germany

FINAL PROGRAM

The Experts „ Live“Workshop 2016

www.eurocto2016.com

September 30th - October 1st, 2016

Krakow, PolandICE Krakow

Course Directors

Jaroslaw Wójcik,

Lublin, Poland

Leszek Bryniarski,

Krakow, Poland

ECC-President

Alfredo R. Galassi,

Catania, Italy

Co-Directors

Nicolas Boudou,

Toulouse, France

George Sianos,

Thessaloniki, Greece

Gerald S. Werner,

Darmstadt, Germany

0

2

4

6

8

10

12

14

16

18

8,6

12,2

15,7 15

17,5

2011

2012

2013

2014

2015

%

CTO: radial approach

EURO CTO data

Burzotta, CCI 2013

Impact of the “learning curve”

Double radial approach 21

Crossover t o f emoral approach 3 (15%)

Guiding catheter 6 F 19 (95%)

Microcatheter to start 15 (75%)

OTW balloon to start 5 (25%)

Fielder XT to star t 12 (60%)

Fielder XT successf ul t o cross 9 (45%)

Anchoring balloon t echnique 2 (20%)

DES implant at ion (in case of success) 100%

CARDI AC COMPLI CATI ONS (perf orat ion, dissect ion, pericardial

ef f usion or t amponade) NONE

ACCESS SI TE COMPLI CATI ONS NONE

MACE I N HOSPI TAL NONE

PROCEDURAL SUCCESS 21/ 25 (67%)

PATI ENT SUCCESS 21/ 24 (70%)

Double radial approach 21

Crossover t o f emoral approach 3 (15%)

Guiding catheter 6 F 19 (95%)

Microcatheter to start 15 (75%)

OTW balloon to start 5 (25%)

Fielder XT to star t 12 (60%)

Fielder XT successf ul t o cross 9 (45%)

Anchoring balloon t echnique 2 (20%)

DES implant at ion (in case of success) 100%

CARDI AC COMPLI CATI ONS (perf orat ion, dissect ion, pericardial

ef f usion or t amponade) NONE

ACCESS SI TE COMPLI CATI ONS NONE

MACE I N HOSPI TAL NONE

PROCEDURAL SUCCESS 21/ 25 (67%)

PATI ENT SUCCESS 21/ 24 (70%)

Courtesy Prof. Burzotta

Please, no radial…

• Scientific reasons: none

• Technical reasons

• Empirical reasons

7,2

7,4

7,6

7,8

8

8,2

8,4

8,6

8,8

9

9,2

9,4

fluoro time

radial

femoral

min

Jolly, JACC Cardiovasc Interv 2013

P<0.001

None?

860

880

900

920

940

960

980

1000

1020

1040

1060

Air Kerma

radial

femoral

mGy

Jolly,JACCCardiovascInterv2013

p=0.05

Please, no radial…

• Scientific reasons: none

• Technical reasons

• Empirical reasons

Distribution of Radial Artery Diameter

Saito S et al. Cathet Cardiovasc Interv 1999;46:173-178

Distribution of Radial Artery Diameter

Saito S et al. Cathet Cardiovasc Interv 1999;46:173-178

Saito, CCI 1999

Modified from David Smith

diameter devices techniques

6F Balloon/stent anchoring

Rotablator 1.5-1.75 Trapping (2.0 and Finecross)

Guiding catheter extension

Microcatheter/Corsair/Torns

Double lumen catheters

IVUS

7F Rotablator (larger burrs) Trapping (2.5 and Corsair/double lumen cath)

8F CrossBoss IVUS guided

butbut

2.5 balloon

Corsair

6F

No Corsair trapping

Entry point

6F, 7F

No IVUS and micro

wire

Modified from David Smith

diameter devices techniques

6F Balloon/stent anchoring

Rotablator 1.5-1.75 Trapping (2.0 and Finecross)

Guiding catheter extension

Microcatheter/Corsair/Torns

Double lumen catheters

IVUS

7F Rotablator (larger burrs) Trapping (2.5 and Corsair/double lumen cath)

8F CrossBoss IVUS guided

Please, no radial…

• Scientific reasons: none

• Technical reasons

• Empirical reasons

Radial: limitations

spasm

RADIALSPASMRADIALSPASM

Radial: limitations

RADIAL/BRACHIALLOOPRADIAL/BRACHIALLOOP

RADIALSPASMRADIALSPASM

Radial: limitations

RADIAL/BRACHIALLOOPRADIAL/BRACHIALLOOP

Subclavian kinking

and even tortuosity ….

Radial: limitations. Support

2.5 balloon

Corsair

1.25 Tazuna

0

0.5

1

1.5

2

2.5

2008 2009 2010 2011 2012 2013 2014

0.5 0.5

0.3

0 0.030.08 0.07

0.8

1.1

0.9

1

0.8

0.5

0.4

2.2

1

2.5

1.5

1.9

2.3

2.5

0.1

0.6

0.3

0.6

0.5

0.6

0.5

1

0.8

0.3

0.7

1

0.5 0.50.5

1.2

0.3

0.7

0.8

0.6

0.5

Death

Myocardial infarction Vascular complication

Donor vessel dissection

Cardiac tamponade

Coronary perforation

Procedural Complications

0

0.5

1

1.5

2

2.5

2008 2009 2010 2011 2012 2013 2014

0.5 0.5

0.3

0 0.030.08 0.07

0.8

1.1

0.9

1

0.8

0.5

0.4

2.2

1

2.5

1.5

1.9

2.3

2.5

0.1

0.6

0.3

0.6

0.5

0.6

0.5

1

0.8

0.3

0.7

1

0.5 0.50.5

1.2

0.3

0.7

0.8

0.6

0.5

Death

Myocardial infarction Vascular complication

Donor vessel dissection

Cardiac tamponade

Coronary perforation

Procedural Complications

Radial: complications

Conclusion

• Personal view

Conclusion

• Personal view

• CTO PCI is a complex procedure: efficacy AND

safety

Conclusion

• Personal view

• CTO PCI is a complex procedure: efficacy AND

safety

• Procedural time, RX time, contrast dye

(personal) conclusion

• Radial access can be used:

– “simple” antegrade (no IVUS, no pluridevices,

small guiding catheter)

(personal) conclusion

• Radial access can be used:

– “simple” antegrade (no IVUS, no pluridevices,

small guiding catheter)

– Antegrade with radial controlateral injection

(personal) conclusion

• Radial access can be used:

– “simple” antegrade (no IVUS, no pluridevices,

small guiding catheter)

– Antegrade with radial controlateral injection

– “simple” retrograde

(personal) conclusion

• Radial access can be used:

– “simple” antegrade (no IVUS, no pluridevices,

small guiding catheter)

– Antegrade with radial controlateral injection

– “simple” retrograde

– Retrograde with antegrade radial guiding catheter

(personal) conclusion

• Radial access can be used:

– “simple” antegrade (no IVUS, no pluridevices,

small guiding catheter)

– Antegrade with radial controlateral injection

– “simple” retrograde

– Retrograde with antegrade radial guiding catheter

– aortic/iliac/femoral vasculopaty