5f in 6f (7f) technique in des era (parent-child catheter technique)
DESCRIPTION
5F in 6F (7F) technique in DES era (Parent-child catheter technique). Kyoto 2 nd Red Cross Hospital, Japan Naoto Inoue M.D. FJCC FSCAI. Key Points in DES era. Simple procedure is recommended Debulking device plays a small role except calcified or bifurcated lesion - PowerPoint PPT PresentationTRANSCRIPT
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2005.11.18 in China
5F in 6F (7F) technique in DES era (Parent-child catheter technique)
Kyoto 2nd Red Cross Hospital, Japan
Naoto Inoue M.D. FJCC FSCAI
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2005.11.18 in China
•Simple procedure is recommendedSimple procedure is recommended
•Debulking device plays a small role except calcified or Debulking device plays a small role except calcified or
bifurcated lesionbifurcated lesion
•Safe DES implantation is importantSafe DES implantation is important
Key Points in DES eraKey Points in DES eraKey Points in DES eraKey Points in DES era
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2005.11.18 in China
For the DES deliveryFor the DES deliveryFor the DES deliveryFor the DES delivery
•Longer is better → 23, 28, 33mm stents are frequently used
•The deliverability of long stent is not good especially in the calcified or tortuous lesion
•We need the technique for the safe DES delivery
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2005.11.18 in China
RCA: Amplatz, Hockey, Champ
LCA: XB, EBU, Amplatz
1 Catheter selection
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2005.11.18 in China
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2005.11.18 in China
6F EBU catheter6F EBU catheter
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2005.11.18 in China
Enough predilatation (high pressure, large balloon)
Rotablator (calcified lesion)
2 Pre dilatation ,pre debulking
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2005.11.18 in China
Strong guide cathe, enough pre dilatation, debulking failed Strong guide cathe, enough pre dilatation, debulking failed
Buddy wire, Support wireBuddy wire, Support wire
Anchor techniqueAnchor technique 5F in 6F 5F in 6F guiding techniqueguiding technique
Large size Large size guiding catheterguiding catheter
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2005.11.18 in China
Side branch anchor Peripheral anchor
Anchor techniqueAnchor technique
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LAD CTOLAD CTO
Conquest guide wire passConquest guide wire passBut balloon cath. could not passBut balloon cath. could not pass
LCX guide wireLCX guide wire2.5mm balloon dilatation2.5mm balloon dilatation
Cross of balloon catheter
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1.5mm balloon pass the lesion1.5mm balloon pass the lesion
Cross of balloon catheter
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2005.11.18 in China
6F mother cath. (Heartrail Terumo Co.)
5F child cath. (20cm longer than mother cath.
Terumo Co.)
5F in 6F(7F) technique5F in 6F(7F) technique
6F>0.070 inch (Launcher, HeartrailRadiguide)
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2005.11.18 in China
Heartrail 5Fr straight
Hemostatic valve
Heartrail 6Fr
YconnectorHeartrail 5Fr straight
Hemostatic valve
Heartrail 6Fr
Y connector
5F in 6F technique5F in 6F technique
Hemostatic valve not good
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2005.11.18 in China
G.C.: 6F Heartrail JL 3.5
G.W.: BMW wire
dissection
5F in 6F technique5F in 6F technique
S670 could not cross the lesion
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2005.11.18 in China
5F cathe.
6F cathe.
Guidewire
Balloon cathe.
Advanced child cathe.
Balloon cathe.
5F in 6F technique5F in 6F technique
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2005.11.18 in China
During stenting Post stenting
Child catheter
Child catheter
Child catheterChild catheterChild catheter
5F in 6F technique5F in 6F technique
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2005.11.18 in China
6Fr 5Fr
distance
Artery model
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2005.11.18 in China
0
20
40
60
80
100
120
140
160
0 5 10 15 20 25
Distance from 6F guiding catheter tip[mm]
Resi
stance
[gf]
5F in 6F6 Fr only7Fr only8Fr only
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2005.11.18 in China
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2005.11.18 in China
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2005.11.18 in China
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2005.11.18 in China
RCA tortuous calcified lesion
HD patient
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2005.11.18 in China
Two step 5 in 6
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2005.11.18 in China
Method of 5F in 6F
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2005.11.18 in China
Child catheter goes across the stenotic lesionChild catheter goes across the stenotic lesion
Alternative 5F in 6F (7F) techniqueAlternative 5F in 6F (7F) technique
No risk of stent dislocationNo risk of stent dislocation
No risk of DES polymer peeling off No risk of DES polymer peeling off
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2005.11.18 in China
CABG (LITA→LAD, SVG→PL) CABG (LITA→LAD, SVG→PL) HemodialysisHemodialysis
50 y.o. male
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2005.11.18 in China
Child catheterChild catheter
狭窄部位
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2005.11.18 in China
2.5x18mm Cypher2.5x18mm Cypher 3.0x13mm Cypher3.0x13mm Cypher
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2005.11.18 in China
直後直後 慢性期慢性期
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2005.11.18 in China
ComplicationComplication
•Vessel injury
•Air embolism
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2005.11.18 in China
Vessel injury
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2005.11.18 in China
Air embolism
•We have one air embolism
•Air embolism will occur when child catheter is wedgedor angiography after stent deployment
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2005.11.18 in China
Safety use for 5 in 6F techniqueSafety use for 5 in 6F technique
•Gently advancement of child catheter into the coronaryartery
•Careful monitoring distal coronary pressure
•Check the blood back flow from Y-connector just after stent deployment
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2005.11.18 in China
Thank you !!