CTO Intervention via SVG Conduits William Nicholson MD

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

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

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

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.

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

• • 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

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 -

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

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.

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

Mother / Daughter / Granddaughter CTO / ISR

SVG Retrograde Conduit Utilization 1. 2. 3. 4. 5. Guide Support Guide Extension Catheter

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

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

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

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 -

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