IVUS in CTO PCI. sidebranch technique and intralesional rewiring

Transcription

1 IVUS in CTO PCI sidebranch technique and intralesional rewiring Craig A. Thompson, M.D., MMSc. Director, Invasive Cardiology and Vascular Medicine Yale University School of Medicine/Yale New Haven Hospital Consultant (Hon) Heart Hospital, London and London Chest Hospital

2 Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below. Affiliation/Financial Relationship Company Grant/Research Support Consulting Fees/Honoraria Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit n/a Abbott Vascular, Bridgepoint Medical, Terumo Bridgepoint Medical n/a n/a n/a n/a

3 Standardized Antegrade CTO PCI IVUS guidance Blunt occlusion at sidebranch takeoff IVUS in SB IVUS probe Penetration wire/technique Confianza lumen proximal cap CTO distal cap lumen

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5 IVUS sidebranch imaging proximal cap assessment and puncture 1. Place IVUS in SB near proximal cap 2. Mark proximal cap with angio 1. Location 2. Lesion analysis 3. Withdraw IVUS into guide 4. Puncture proximal cap 5. Confirm wire position with in CTO and proceed

6 IVUS sidebranch imaging proximal cap assessment and puncture 1. Place IVUS in SB near proximal cap 2. Mark proximal cap with angio 1. Location 2. Lesion analysis 3. Withdraw IVUS into guide 4. Puncture proximal cap 5. Confirm wire position with in CTO and proceed

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8 IVUS sidebranch imaging proximal cap assessment and puncture 1. Place IVUS in SB near proximal cap 2. Mark proximal cap with angio 1. Location 2. Lesion analysis 3. Withdraw IVUS into guide 4. Puncture proximal cap 5. Confirm wire position with in CTO and proceed

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10 Sidebranch IVUS localization and confirmation of proximal capp access

11 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

12 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

13 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

14 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

15 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

16 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

17 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

18 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS

19 IVUS guided intralesional rewiring

20 IVUS guided intralesional rewiring 1. Wire into dissection 2. Enlarge false lumen if necessary (1.5, 2.0 mm balloon) 3. Place IVUS within CTO 4. Place second wire into CTO beside IVUS 5. Orient Fluro to position IVUS unit and wire side-byside 6. Examine and interpret IVUS Where is CTO in relation to IVUS and wire? How far away is new wire from CTO? 7. Redirect wire and confirm with IVUS