using a deflectable tipped catheter to treat previously inaccessible lesions

Using a deflectable tipped Catheter to Using a deflectable tipped Catheter to treat previously inaccessible lesionstreat previously inaccessible lesions

Helen Routledge Interventional Fellow

Institut Cardiovasculaire Paris SudSpR Cardiology, University Hospital Birmingham

Multiple PCI procedures LCA. Failed PCI to CTO RCA

CABG Feb 2006 - RIMA to proximal PDA + SVG to distal RCA

May 2006 - Unstable angina

51 year old male

Occluded SVG to RCA

Patent RIMA to PDA

Lesion at ostium of PLA

1st Attempt at PCI : Guiding Catheter dissection ostium of RIMA

Recurrent Angina CCS 3 in Nov 06

Treated for ISR in LCA and DES in proximal RIMA

Recurrent angina

Intractable Angina

Extreme angulationLesion tortuosityAccess 6f RRA, IMAMinimal support

BMW (Guidant Corp.)PT2 (Boston Scientific)Whisper (Guidant Corp.)Cross-it (Terumo)Steer-It (Cordis)

Impossible to Wire?

Re-do bypass graftingMedical therapyTry and get round the bend…..!Venture Catheter

Solutions?

Venture Venture TMTM Catheter Catheter

Over the wire or Monorail low profile, 3.5F catheter Steerable radiopaque tip

Venture catheter advanced over Whisper

Whisper advanced into PLA

Venture Catheter advanced further into PLA

Whisper exchanged for BHW (Guidant Corp.)

Predilatation, Cypher 2.5 x 18mm Stent, Wire Exchange, Kissing

Final result – free of Angina

SVG to LCx

Venture BHW guidewire Cypher 2.5 x 13mm

SVG to LCx

Lesion compromising large PLA

Venture Catheter deflected towards PLA

SVG to PDA

Pre-dilated

Unable to stent

Buddy wire

Endeavour

Post-dilated, final result

Difficult Side Branch Access

Before

and after Main Branch Stenting

62 year old female - ACS

Failure to Wire SB

BMW (Boston Scientific)Whisper (Guidant Corp.)Choice PT(Terumo)Venture Monorail + BMW

Taxus 3 x 20 12 ATM

PTS strategy

PTS strategy

Taxus 3 x 20 12 ATM

Final Kissing, Final Result

Failure to Re-wire SB

Subocclusion, Occlusion

Venture Monorail, kissing

Result

Side Branch Access - Trifurcation

Side Branch Access - Trifurcation

Difficult to wire Septal.. Venture and Whisper

Angulation & Tortuous AnatomyAngulation & Tortuous Anatomy

Difficult side branchesDifficult side branches

LMS PCI – recrossing to LCx

Side Branch Access - Trifurcation

MB StentPre-dilatation septal

Side Branch Access - Trifurcation

Tortuosity, double bend, angulation

SVG to LAD

Venture?

Retrograde?Wire advanced to native vessel

Angulated and tortuous lesions beyond Grafts 4