1. Intraluminal Coronary Reentry Bridgepoint Medical CTO Crossing Systems
Craig A. Thompson, M.D., MMSc.
Director, Invasive Cardiology and Vascular Medicine
Yale University School of Medicine
New Haven, CT USA

2. Craig A. Thompson, MD DISCLOSURES
Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship Company
Grant/Research Support Abbott Vascular, Boston Scientific, Cordis
Consulting Fees/Honoraria Abbott Vascular , Bridgepoint Medical, Medtronic, Sanofi-Aventis
Major Stock Shareholder/Equity None
Royalty Income None
Ownership/Founder None
Intellectual Property Rights None
Other Financial Benefit None

3. Acknowledgements M. Nicholas Burke, M.D.
Minneapolis Heart Institute Foundation, Minneapolis, MN USA
R. Michael Wyman, M.D.
Torrance Memorial Medical Center, Los Angeles, CA USA
Etsuo Tsuchikane, M.D.
Toyohashi Heart Center, Toyohashi, Aiichi, Japan
Jeffery Moses, M.D.
New York Presbyterian Hospital, Columbia University, New York, NY USA
Bridgepoint Medical
Minneapolis, MN, USA
Eduardo Cebasas
CAMIR Ltd., Viña del Mar, Chile
William L Lombardi, M.D. (Co-PI)
St. Joseph Hospital, Bellingham WA, USA
Mario Araya, M.D.
Christian Dauvergne, M.D
Instituto Nacional del Tơrax, Santiago, Chile
Humberto Torres, M.D.
Mauricio Anina, M.D.
Hospital Gustavo Fricke, Viña del Mar, Chile
Arnoldo Aguirre, M.D.
Ruben Lamich, M.D.
Hospital Barros Luco Truddeau, Santiago, Chile
Patrick Whitlow, M.D. (PI)
Cleveland Clinic Foundation, Cleveland, OH, USA

4. Bridgepoint Medical Systems Crossboss™ technique
Support catheter
Highly torqueable coiled-wire shaft
0.014 wire compatible
Spinning displaces friction and promotes forward movement
Can redirect with wire
Atraumatic tip rarely exits vessel
True lumen or subadventitial CTO crossing

5. Bridgepoint Medical Systems Stingray™ and Stingray GW technique
Flat balloon
Self orientation
3 wire ports
OTW port
Adventitial port
Lumen port

6. Bridgepoint Medical Systems Stingray™ and Stingray GW technique
Wire probe
Find lumen access port
Stingray Guidewire
Distal fiber allows wire to “grip” tissue
Facilitates reentry

7. Bridgepoint Medical Devices technique

8. BridgePoint FIM Data 41 patients with de novo CTO Centers
Instituto Nacional del Tórax, Santiago, Chile
Hospital Gustavo Fricke, Viña del Mar, Chile
Hospital Barros Luco Truddeau, Santiago, Chile
Primary Efficacy Endpoint: ability to place a guidewire into the true lumen distal to the CTO
Primary Safety Endpoint: In-hospital MACE

9. BridgePoint FIM 76% male 47% diabetic Average length of 23.3 mm
37% RCA
37% LAD
27% LCX
Technical Success: 36/41 (87.8%)
In-hospital MACE: 0/42.
30 Day MACE: 0/13 (13 patients followed for 30 days to date)

10. The Bridgepoint FIM Chilean Experience --- early lessons
Safe and feasible as intended
The system is versatile
Several tools to complement technique, rather than supplant technique
The Crossboss, Stingray balloon, and Stingray guidewire can be used alone and in combination
Device iteration
Wire-balloon compatibility
Crossboss torquing --- stress relief

11. The Bridgepoint FIM Chilean Experience --- early lessons 2
Lesion length is less relevant
Crossboss is good with Calcium, but not great
May need aggressive wire manipulation to push dissection forward
Distal target and visualization is most important

12. Lesson- Crossboss can pass true lumen to true lumen in straight segments

13. Lesson – lesion length less important, distal target very important

14. Limited Subadventitial Tracking and Reentry (LAST)

15. Limited Subadventitial Tracking and Reentry (LAST)

16. Limited Subadventitial Tracking and Reentry (LAST)

17. Limited Subadventitial Tracking and Reentry (LAST)

18. Limited Subadventitial Tracking and Reentry (LAST)

19. Lesson – lesion length, sidebranch access, reposition balloon to good target

20. The value of the distal target for reentry
Longitudinal
Cross Section
Longitudinal
Cross Section

21. Chilean FIM Experience Crossboss™ lessons
Can cross straight CTOs true lumen to true lumen often
Will predictably go subadventitial on curves
May need to be redirected with conventional guidewires at shallow angle sidebranches
Good with calcium, but not great
May need additional stiffwire or knuckle wire
Spin fast
Minimal forward pressure…let device do the work
Leaves smooth channel…very easy to rewire if needed
Tracks tortuosity very well
Stores torque…stop spinning and let slow to a stop

22. Chilean FIM Experience Stingray™ and Stingray Guidewire lessons
Prep with large syringe to improve visualization
Works best with large target
Reposition if necessary
Works best in segments with good contrast filling
Guidewire reentry should occur in proximity to Stingray balloon (0-15mm)
Stingray GW is very effective of lumen reentry
Stingray GW is not effective for CTO lesion wiring over long distance

23. Bridgepoint Medical Devices for CTO conclusions
Complement, rather than supplant, technique
Devices used alone or in combination
Good for primary CTO therapy
Good for recovery of “failing” cases (e.g. dissection/false channel)
Fast
Successful
CTO length, tortuosity less relevant
Safe