andrea gagnor - femoral is (still) better
TRANSCRIPT
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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
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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
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Burzotta, CCI 2013
Impact of the “learning curve”
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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
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Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons
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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?
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860
880
900
920
940
960
980
1000
1020
1040
1060
Air Kerma
radial
femoral
mGy
Jolly,JACCCardiovascInterv2013
p=0.05
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Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons
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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
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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
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2.5 balloon
Corsair
6F
No Corsair trapping
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Entry point
6F, 7F
No IVUS and micro
wire
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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
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Please, no radial…
• Scientific reasons: none
• Technical reasons
• Empirical reasons
![Page 16: Andrea Gagnor - Femoral is (still) better](https://reader031.vdocuments.site/reader031/viewer/2022030303/587ae2d71a28ab542b8b6bb3/html5/thumbnails/16.jpg)
Radial: limitations
spasm
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RADIALSPASMRADIALSPASM
Radial: limitations
RADIAL/BRACHIALLOOPRADIAL/BRACHIALLOOP
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RADIALSPASMRADIALSPASM
Radial: limitations
RADIAL/BRACHIALLOOPRADIAL/BRACHIALLOOP
Subclavian kinking
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and even tortuosity ….
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Radial: limitations. Support
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2.5 balloon
Corsair
1.25 Tazuna
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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
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Radial: complications
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Conclusion
• Personal view
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Conclusion
• Personal view
• CTO PCI is a complex procedure: efficacy AND
safety
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Conclusion
• Personal view
• CTO PCI is a complex procedure: efficacy AND
safety
• Procedural time, RX time, contrast dye
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(personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
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(personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection
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(personal) conclusion
• Radial access can be used:
– “simple” antegrade (no IVUS, no pluridevices,
small guiding catheter)
– Antegrade with radial controlateral injection
– “simple” retrograde
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(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
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(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