IVUS Guidance of CTO Recanalizataion Masahiko Ochiai MD

IVUS Guidance of CTO Recanalizataion Masahiko Ochiai MD, FACC, FESC, FSCAI Division of Cardiology Showa University Northern Yokohama Hospital, Kanagawa, JAPAN Dartmouth Medical College, Hanover, NH, USA

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 Company Lecture Fees Abbott Vascular, Asahi Intecc Co, Boston Scientific, Terumo Co. ,

Identification of the Entry into CTO by IVUS

IVUS Guided Wiring from the False Lumen

Eagle Eye Gold (Volcano) Type : 　electronic scan type Characteristics : low entry profile, Virtual Histology Tip-transducer Distance : 10 mm

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO

Effort AP, 54 years, male: Ostial LAD CTO Separated Conus Branch !

Pre-Procedural MDCT Examination

Pre-Procedural MSCT Examination

Pre-Procedural MSCT Examination

Pre-Procedural MSCT Examination

Effort AP, 54 years, male: Ostial LAD CTO 8 Fr Mach 1 FL 4. 0 6 Fr Mach 1 IM

Effort AP, 54 years, male: Ostial LAD CTO 8 Fr Mach 1 FL 4. 0 6 Fr Mach 1 IM

Effort AP, 54 years, male: Ostial LAD CTO 8 Fr Mach 1 FL 4. 0 6 Fr Mach 1 IM

Abyss IM was Re-directed by the Distal Cap

Confianza Pro in the False Lumen

Confianza Pro in the False Lumen

Pre-dilatation with Ryujin Plus 2. 0 mm with Miracle 3. 0

IVUS Examination from the False Lumen

Concept of Antegrade IVUS Guided Re-entry

Marking of IVUS Probe at the Point of Wire Migration

Marking of IVUS Probe at the Point of Wire Migration

Interrelationship between IVUS and Angiogram according to the “Side Branch Method” ↑ pericardium LAD ← RAO 30° caudal 20° Diagonal branch Septal branch LCx ↓ myocardium

Marking of IVUS Probe at the Point of Wire Migration LAO cranial RAO caudal

Penetration into the True Lumen with Confianza Pro 12

Penetration into the True Lumen with Confianza Pro 12

Penetration into the True Lumen with Confianza Pro 12

Distal End of the Antegrade Hematoma

Final Results after Implantation of 4 Xience V Stents and KBT at LMT Bifurcation

Final Results after Implantation of 4 Xience V Stents and KBT at LMT Bifurcation

Final Results after Implantation of 4 Xience V Stents and KBT at LMT Bifurcation