1、CTO介入治疗策略的选择复旦大学附属中山医院心内科 上海市心血管病研究所葛 雷Dual Catheter Angiography1.Clear proximal cap2.Good Distal Target3.Length 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided ent
2、ryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 060235 Case 1:Male,47 yrs Tiny stump,healthy distal vessel,length 20 mmTortuous CTO segmentHeavy calci
3、ficationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmS
4、uccessful crossingIF Antegrade approaches Failed 060235Corsair+Fielder XTCTO介入治疗策略的选择060235Gaia FirstCTO介入治疗策略的选择060235Stenting and Final ResultCTO介入治疗策略的选择68323Case 2:Male,69 yrsCTO介入治疗策略的选择68323CTO介入治疗策略的选择683237F EBU 3.5CTO介入治疗策略的选择Careful analysis of coronary angiogram/MSCTDissection-reentry(Cro
5、ssBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYe
6、sNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 68323KDL(Crusade)+SionCTO介入治疗策略的选择68323IVUS(iLab)FrameCTO介入治
7、疗策略的选择68323FrameGAIA Second+130cm FineCrossCTO介入治疗策略的选择68323CTO介入治疗策略的选择68323Tip Injection+150cm FineCrossCTO介入治疗策略的选择68323Sion+150cm FineCrossTough Situation 1CTO介入治疗策略的选择68323Sion+150cm FineCrossCTO介入治疗策略的选择68323GAIA Second+150cm FineCrossCTO介入治疗策略的选择68323Position of Retrograde WireFrameCTO介入治疗策略的
8、选择68323Retro W not into Ante GC,even through Guidezilla usedTough Situation 2GuidezillaCTO介入治疗策略的选择68323Home made Snare with 5F child catheter150cm FineCrossRG3Big loop of Sion5F child catheterCTO介入治疗策略的选择68323Home made Snare with 5F child catheterCTO介入治疗策略的选择68323Pre-dilation and IVUSCTO介入治疗策略的选择68
9、323abacdebcdeTrue to true lumen trackingCTO介入治疗策略的选择68323Final ResultsCTO介入治疗策略的选择大连医科大学2015Case 3:Male,55,2015-9-8 failed to attempt recanalization LADCTO介入治疗策略的选择Careful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wi
10、ringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based app
11、roachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 大连医科大学2015Fielder XT-R,GAIA Second+CorsairCTO介入治疗策略的选择大连医科大学2015Ipislateral CC tracking with 150 Corsair+SionCTO介入治疗策略的选择大连医科大学2015
12、Pingpang Technique and Reverse CART with 2.5 mm balloon(A:GAIA First;R:GAIA Second)CTO介入治疗策略的选择大连医科大学2015Pingpang Technique and Externalizaition with RG3CTO介入治疗策略的选择大连医科大学2015Final ResultsCTO介入治疗策略的选择56439Case 4:Male,48 yrs,2015-3-10 D1 stented(misrecognition for LAD)CTO介入治疗策略的选择Primary Retro:No stu
13、mp,Stent struts,Promising CCCareful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 2
14、0 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossi
15、ngIF Antegrade approaches Failed 56439150 Finecross+SionCTO介入治疗策略的选择56439150 Finecross+Fielder XTCTO介入治疗策略的选择56439Modified Reverse CART+GAIA Second,SionCTO介入治疗策略的选择56439Modified Reverse CART+Sion,Sion not into Ante GCCTO介入治疗策略的选择56439Guidezilla CTO介入治疗策略的选择56439Finecross changed to Corsair,externali
16、zation with RG3CTO介入治疗策略的选择56439Final ResultsCTO介入治疗策略的选择广西南宁2015CASE 5：Male,58 yrs,IDDM,LVEF 60%,First attempt failedCTO介入治疗策略的选择广西南宁2015CTO介入治疗策略的选择广西南宁2015R:6F SALL:7F EBU 3.75CTO介入治疗策略的选择J-CTO Score 2:Stump,length20 mm,re-try caseCareful analysis of coronary angiogram/MSCTDissection-reentry(Cros
17、sBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYes
18、NoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 广西南宁2015130cm FineCross+Fielder XT-RCTO介入治疗策略的选择广西南宁2015150cm
19、 FineCross+Sion,AV Groove Channel injuredCTO介入治疗策略的选择Careful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHe
20、avy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI A
21、lgorithmSuccessful crossingIF Antegrade approaches Failed 广西南宁2015Parallel Wiring with GAIA FirstCTO介入治疗策略的选择J-CTO Score 3:Without Stump,length20 mm,re-try case广西南宁2015Sion into RCA-PLCTO介入治疗策略的选择广西南宁2015Final ResultsCTO介入治疗策略的选择广西南宁2015CASE 6：Male,55 yrs,OMIR:AL 0.75 SHL:7F EBU 3.5 SHCTO介入治疗策略的选择J-
22、CTO Score 1:length20 mmCareful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmP
23、revious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF
24、Antegrade approaches Failed 广西南宁2015Balloon anchoring+Parallel wiring(Fielder XT-R,GAIA First)CTO介入治疗策略的选择J-CTO Score 3:length20 mm,calcification,bending 45 degreesCareful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wi
25、ringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based app
26、roachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 广西南宁2015150 Corsair+SionCTO介入治疗策略的选择广西南宁2015Knuckle wiring(Fielder XT,Conquest Pro)CTO介入治疗策略的选择广西南宁2015Preparing for Reverse CART w
27、ith GAIA FirstCTO介入治疗策略的选择广西南宁2015GAIA First into the true lumenCTO介入治疗策略的选择广西南宁2015Final ResultsCTO介入治疗策略的选择61887Case 7.Male,60 yrs oldCTO介入治疗策略的选择618877F EBU 3.5 SH6F SAL 1.0 SHCTO介入治疗策略的选择Careful analysis of coronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParal
28、lel wiring+/-IVUS-guided wiringFeatures favouring early use ofdissection-reentry:Ambiguous course in CTOLength 20 mmTortuous CTO segmentHeavy calcificationLength 20 mmPrevious failed attemptIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entry
29、YesAntegrade wire based approachYesYesInterventional collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmSuccessful crossingIF Antegrade approaches Failed 61887CrossBoss,Fielder XT,Ultimatebros 3 CTO介入治疗策略的选择61887Final resultsCTO介入治疗策略的选择Careful analysis of c
30、oronary angiogram/MSCTDissection-reentry(CrossBoss/StingrayIf suitable reentry zoneParallel wiring+/-IVUS-guided wiringIn-stent restenosisUse of CrossBoss as primary crossing strategyYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesInterventional collaterals presen
31、tNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmIF Antegrade approaches Failed Careful analysis of coronary angiogram/MSCTParallel wiring+/-IVUS-guided wiringIn-stent restenosisYesNoProximal cap ambiguityNoIVUS-guided entryYesAntegrade wire based approachYesYesIntervention
32、al collaterals presentNoPoor quality distal vesselNoRetrograde approachAP CTO Club PCI AlgorithmIF Antegrade approaches Failed 市东医院Case 8:Male,75,one month ago attempt recanalization for ISR-CTO,but failedCTO介入治疗策略的选择市东医院7F SAL 1.0 SH135cm Corsair+Fielder XT-RCTO介入治疗策略的选择市东医院Parallel wiring:Ultimate
33、 Miracle 3CTO介入治疗策略的选择市东医院150cm Corsair+SionCTO介入治疗策略的选择市东医院Reverse CART with 2.5mm balloonCTO介入治疗策略的选择市东医院Fielder XT-R into Ante GCCTO介入治疗策略的选择市东医院Externalization with RG3CTO介入治疗策略的选择市东医院KDL(Crusade)+Sion to RCA-PLCTO介入治疗策略的选择市东医院Final ResultsCTO介入治疗策略的选择CTO介入治疗策略的选择1.CTO-PCI治疗策略的选择应根据闭塞近端、闭塞远段解剖学特征，有无合适的侧枝血管来进行；2.进行复杂CTO PCI时，术者不应拘泥于某一种治疗方法，应灵活使用正向介入治疗和逆向介入治疗；3.当无合适侧枝血管，且无ADR器械时，平行导引钢丝技术不失是一种可行、有效的治疗选择，尤其是远段血管相对健康时。小 结
