Using a deflectable tipped Catheter to treat previously inaccessible lesions Helen Routledge Interventional Fellow Institut Cardiovasculaire Paris Sud.

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Presentation transcript:

Using a deflectable tipped Catheter to treat previously inaccessible lesions Helen Routledge Interventional Fellow Institut Cardiovasculaire Paris Sud SpR Cardiology, University Hospital Birmingham

Multiple PCI procedures LCA. Failed PCI to CTO RCA CABG Feb RIMA to proximal PDA + SVG to distal RCA May Unstable angina 51 year old male Occluded SVG to RCA Patent RIMA to PDA Lesion at ostium of PLA

1 st 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 angulation Lesion tortuosity Access 6f RRA, IMA Minimal support

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

Re-do bypass grafting Medical therapy Try and get round the bend…..! Venture Catheter Solutions?

Venture TM 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

VentureBHW 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 ATM PTS strategy

Taxus 3 x ATM

Final Kissing, Final Result

Failure to Re-wire SB

Subocclusion, Occlusion

Venture Monorail, kissing

Result

Side Branch Access - Trifurcation

Difficult to wire Septal.. Venture and Whisper

Angulation & Tortuous Anatomy Difficult side branches

LMS PCI – recrossing to LCx

Side Branch Access - Trifurcation MB Stent Pre-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