How to Build Your Own CTO PCI Program Barry D. Rutherford, MD CRT 2012

How to Build Your Own CTO PCI Program Attract some important and skilled friends Create a CTO Day Educate your partners and particularly your surgical colleagues Create a referral base CTO mini courses CTO clubs Visiting skilled operators Attend national and international meetings

Attract some important and skilled friends Ken Huber Chuck Barth Osamu Katoh BDR Masahiko Ochiai

Hideo Tamai, MD & Osamu Katoh, MD

440 Institutions Reported 737,675 Cases to ACC/NCDR V3.04 The Influence of Operator Volume on Attempt Rate of Percutaneous Coronary Intervention for CTO 440 Institutions Reported 737,675 Cases to ACC/NCDR V3.04 39,502 patients with CTO PCI to the 100% Occlusion Within 90 Days? Yes No 6,331 (16%) 33,171 Excluded from Data: Recent MI, Indication for Surgery, Prior CABG, Shock

Chronic Total Coronary Occlusion Low Attempt Rates Fear of failure Complications Doubt regarding long term results Time and cost constraints Radiation exposure — patient and operator Apathy

How to Build Your Own CTO PCI Program CTO Day 1-2 days per month Dedicated lab, senior technicians Two interventional cardiologists 4 CTO cases per day 4-6 visiting physicians Lecture, case review, handout materials Industry support Utilization of new technology

How to Build Your Own CTO PCI Program No Ad hoc procedures Detailed angiographic evaluation Proximal cap Distal cap Length of lesion Angulation of lesion Calcification Collaterals (septals, epicardials, and SVGs)

How to Build Your Own CTO PCI Program CTO Cart Guides/GuideLiner Wires Delivery Catheters Snares Balloons Coils

How to Build Your Own CTO PCI Program

How to Build Your Own CTO PCI Program

Educate your partners and surgical colleagues on how to evaluate the CTO Angiogram

CTOFundamentals.org Founders Aaron Grantham, Bill Lombardi, Craig Thompson Faculty Mike Wyman, Tony DeMartini, Nick Burke, James Spratt, Ashish Pershad, Nick Lembo, Dimitri Karmapliotis, Stéphane Rinfret, Pat Whitlow, Format US 501c(3) NFP under the MAHI Foundation Educational grant funded from industry IT partnership with Socius Medical, Inc

CTOFundamentals.org Mission An online resource for CTO operators; novices, and experts, to systematically teach techniques and technologies that enhance procedural success and safety in CTO-PCI Format CTO University 13 didactic lectures, case examples CTO Community Online sharing and interactive mentoring Go Live 3/1/2012, register today @ CTOFundamentals.org

Bellingham, WA January 2011 17 patients from 6 states (9 previous failures) 13 physicians 5 CTO operators working in pairs C Thompson, B Lombardi, A Grantham, T DeMartini, M Wyman Strategy determined by group blinded to operator assignment Hybrid approach Initial strategy/device Time and progress parameters to switch strategies Operator unblinding immediately prior to case Primary and secondary operator Execute assigned strategy

Baseline Demographics, 17 pts Bellingham, WA CTO Workshop – January 2011 Mean age (yrs) 63.7 Gender (M) 94% Prior CABG 35% CTO location LAD 47% RCA 29% LCx 24% Previous failure 53% Lesion Length (mm) 23.5 Proximal RVD (mm) 2.89mm Distal RVD (mm) 2.60mm

Procedure Outcomes Bellingham, WA CTO Workshop – January 2011 EFFICIENCY Case time (mean) 89.9 min Cases < 2hrs 82% Contrast 273.5 cc Fluoro Time 39.6 min EFFECTIVENESS Technical Success 100% SAFETY MACE 5.8% (perf) Death/MI 0%

THANK YOU