CTO Intervention via SVG Conduits William Nicholson MD

CTO Intervention via SVG Conduits William Nicholson, MD Director – Interventional Cardiology Wellspan Health System York PA

William Nicholson, MD Advisory Board/Board Member, Consultant, Honoraria : Boston Scientific Abbott Vascular Medtronic Siemens Abiomed

Retrograde Access Selection 1. Septal Collateral – LAD –PDA 2. Epicardial Collaterals – all others

Retrograde Access Selection 1. Saphenous Vein Graft 2. Septal Collateral – LAD –PDA 3. Epicardial Collaterals – all others

• • 175 post cabg cto’s – 97 done retrograde – 34 via SVG – 19 completely occluded – 8 acutely occluded 1 peri-procedural MI (mother daughter guide with dilation) 4 perforations – 1 tamponade 15 coiled at the end • 144 retrograde cto’s – 21 via SVG (14%) – 1 completely occluded – 20 degenerated • 1 peri-procedural MI (diagonal occlusion) 3 perforations – 1 tamponade with death 2 coiled at the end • •

SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter Augmentation Microcatheter Choice Wire choice Arrival / Assessment of Distal Anastamosis

SVG Retrograde Conduit Utilization 1. Guide Support - RCA SVG – Multipurpose Guide - LCA SVG – AL-0. 75

SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter Augmentation Microcatheter Choice Wire choice Arrival / Assessment of Distal Anastamosis

SVG Retrograde Conduit Utilization 1. Guide Support 2. Guide Extension Catheter Augmentation Guideliner 5. 5, 6, 8 fr - Guidezilla 6 fr Mother/Daughter/Granddaughter

Mother / Daughter / Granddaughter CTO / ISR

SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter Augmentation Microcatheter Choice Wire choice Arrival / Assessment of Distal Anastamosis

SVG Retrograde Conduit Utilization 1. Guide Support 2. Guide Extension Catheter Augmentation 3. Microcatheter Choice - Corsair - Turnpike - Micro 14 - Supercross 120

SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter Augmentation Microcatheter Choice Wire choice Arrival / Assessment of Distal Anastamosis

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SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter Augmentation Microcatheter Choice Wire choice Arrival / Assessment of Distal Anastamosis

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To Coil or Not to Coil TIMI 0, I - No TIMI II - Probably TIMI III - Yes