andrea gagnor - femoral is (still) better
TRANSCRIPT
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