Antegrade Dissection Reentry for CTO PCI Craig A

Antegrade Dissection Reentry for CTO PCI Craig A. Thompson, M. D. , MMSc. Director, Invasive Cardiology and Vascular Medicine Yale University School of Medicine/Yale New Haven Hospital Consultant (Hon) Heart Hospital, London and London Chest Hospital

Craig A. Thompson, MD Consulting: Abbott Vascular Terumo Cardiovascular Systems Group Stocks, Stock Options, other ownership interest: Bridge. Point

Disclosure Statement of Financial Interest 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 • Grant/Research Support • Consulting Fees/Honoraria • • • Major Stock Shareholder/Equity Royalty Income Ownership/Founder Intellectual Property Rights Other Financial Benefit Company • • n/a Abbott Vascular, Bridgepoint Medica Volcano, Terumo Bridgepoint n/a n/a

The Cross. Boss™ CTO Catheter • • • Cross. Boss is designed to quickly and safely deliver a guidewire via true lumen or subintimal pathways Multi-wire coiled shaft Tracks via FAST Spin Technique – Highly torqueable coiled-wire shaft – FAST Spin reduces push required to cross CTO • • Atraumatic distal tip advanced across a CTO ahead of the guidewire OTW 0. 014” guidewire compatible

The Stingray™ CTO Re-Entry System • • Stingray System (catheter and guidewire) is designed to accurately target and re-enter the true lumen from a subintimal position Unique self-orienting balloon has a flat shape for true lumen targeting 180° opposed and offset exit ports for selective guidewire re-entry Re-entry probe at Stingray Guidewire tip

Antegrade Dissection Reentry Cross. Boss® and Stingray® Technologies

RCA CTO Primary Dissection Reentry Strategy

RCA CTO Primary Dissection Reentry Strategy

Mechanism for Stingray Reentry and Reverse CART are similar Precise reentry and control of outflow vessels Meaningful outflow vessels True Lumen Control

Technique development Knuckle Boss • Manage resistant lesions • Negiotiate sidebranches

Technique development Stick and Swap • Puncture with stingray guidewire, exchange and follow channel with polymer jacket wire • Manage small targets • Wire in diffuse disease

‘STRAW’ Aspiration Sub-intimal Hematoma Distal lumen compression Decompression & re-entry