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
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
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
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
2005.11.18 in China
RCA: Amplatz, Hockey, Champ
LCA: XB, EBU, Amplatz
1 Catheter selection
2005.11.18 in China
2005.11.18 in China
6F EBU catheter6F EBU catheter
2005.11.18 in China
Enough predilatation (high pressure, large balloon)
Rotablator (calcified lesion）
2 Pre dilatation ,pre debulking
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
2005.11.18 in China
Side branch anchor Peripheral anchor
Anchor techniqueAnchor technique
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
1.5mm balloon pass the lesion1.5mm balloon pass the lesion
Cross of balloon catheter
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)
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
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
2005.11.18 in China
5F cathe.
6F cathe.
Guidewire
Balloon cathe.
Advanced child cathe.
Balloon cathe.
5F in 6F technique5F in 6F technique
2005.11.18 in China
During stenting Post stenting
Child catheter
Child catheter
Child catheterChild catheterChild catheter
5F in 6F technique5F in 6F technique
2005.11.18 in China
6Fr 5Fr
distance
Artery model
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
2005.11.18 in China
2005.11.18 in China
2005.11.18 in China
2005.11.18 in China
RCA tortuous calcified lesion
HD patient
2005.11.18 in China
Two step 5 in 6
2005.11.18 in China
Method of 5F in 6F
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
2005.11.18 in China
CABG (LITA→LAD, SVG→PL) CABG (LITA→LAD, SVG→PL) HemodialysisHemodialysis
50 y.o. male
2005.11.18 in China
Child catheterChild catheter
狭窄部位
2005.11.18 in China
2.5x18mm Cypher2.5x18mm Cypher 3.0x13mm Cypher3.0x13mm Cypher
2005.11.18 in China
直後直後 慢性期慢性期
2005.11.18 in China
ComplicationComplication
•Vessel injury
•Air embolism
2005.11.18 in China
Vessel injury
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
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
2005.11.18 in China
Thank you !!