J CTO score ≥3

J CTO score ≥3
Pietro Mazzarotto, Lodi, Italy

10th Experts „Live“ CTO Workshop - Day1

1. AL1 7 Fr, EBU 4.0 7 Fr Ambiguous cap: 1 ≥ 20 mm: 1 Calcium: 1 Re-try: 1 Bending: 0 JCTO Score 4 Male pt , 73-year-old RCA-CTO found in 2009 - MVD Stress-CMR: viability and ischemia, LVEF 40%

2. SEPTAL CC0 ATRIAL CC2 from LCx Collateral channels EPICARDIAL CC1 from OM

3. Tazuna 1.25 to open stent cells Caravel First approach: 2 nd septal branch In-stent take off Corsair Pro does not cross

4. Tip injection Sion, Sion Blue Septal branch perforation Tip Injection Sion Black for surfing Surfing unsuccessful

5. Suoh 03 Straight, good landing in PL Second approach: e picardial from OM

6. Caravel Prolapse Finecross ok

7. Step-up UB3 >>> Conquest Pro 12 Subintimal Antegrade Gaia Third Subintimal Reverse CART CTO uncrossable for retrograde Finecross

8. Tip-in CTO uncrossable for antegrade Caravel (no chance for anchoring) Purpose: to cross with the antegrade Micro

9. Antegrade Caravel – Retrograde Finecross Intracoronary Rendezvous Purpose: to cross with a low-profile balloon CTO uncrossable for Caravel Finecross Tazuna 1.25

10. BAM with Tazuna 1.25 Tornus 2.6 Fr Further techniques Unsuccessful Unsuccessful

11. Last bailout: Rota Rotawire placement Burr 1.25

12. 2.75 x 38 2.75 x 38 3.0 x 38 Ultimaster IVUS-guided stenting Remodeling and calcific disease Severe disease Ostial disease Calcific stenosis Subintimal tracking

13. Final result

14. Devices Microcatheters have different structures, and therefore different performances in a given setting Insights from the case Techniques A step-up workflow optimizes the use of a variety of technical options for “ uncrossable ” CTO