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Parallel wire technique with dual lumen catheters · Gerald S. Werner . FESC, FACC, FSCAI....
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Parallel wire technique with dual lumen catheters Gerald S. Werner FESC, FACC, FSCAI Medizinische Klinik I Klinikum Darmstadt GmbH
Transcript of Parallel wire technique with dual lumen catheters · Gerald S. Werner . FESC, FACC, FSCAI....
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Parallel wire technique with dual lumencatheters
Gerald S. Werner FESC, FACC, FSCAIMedizinische Klinik I
Klinikum Darmstadt GmbH
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Disclosure
• Speaker honoraria fromASAHI INTECC
Terumo
IMDS
Boston Scientific
Abbott Vascular
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Technical options for recanalization of a CTO
Bilateral Maximal Guide
backup
AntegradeFielder XT->Gaia 2
or -> Progress 200T/Conf.Pro 12
Penetration, then step down
When subintimal ->Parallel (DL cathehters)
ReentrysystemBridgePoint
Antegradeno Stump
IVUS for guided Penetration ?
RetrogradeWith feasible collateral
pathways
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The parallel wiretechnique is classic, but classic is not old-fashioned
Crossit 200-400 or Conquest 3g-6g
N.Reifart/O.Katoh 1996
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Why parallel wiring works :the wire modifies and straightens the vessel architecture
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Why parallel wiring works :the wire modifies and straightens the vessel architecture
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Why parallel wiring works :the wire modifies and straightens the vessel architecture
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Dual lumen catheter for parallel wiring
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Case example using the SASUKE DL catheter
50’s year-old male
LAD CTOJ-CTO score 3
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Ante: 7Fr EBU3.75SH via Rt FemoralRetro: 4Fr AR1.0 via Lt Femoral
Dual injection
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Ante: Teleport with FielderXT
Antegrade approach with IVUS
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IVUS guided puncture of the proximal cap
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Ante: Teleport with FielderXT
Antegrade wire advancement subintimal
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Why a Double Lumen Catheter?
Rx lumen / OTW lumen⇒ 2 lumens in one catheterUsing multiple GWs (regardless of tip shape and tip load) during a procedure, 2nd GW can be inserted safely and easily where the 1st GW is.
What is a Double Lumen Catheter？
Rx lumen GW
OTW lumen GW
Example: Sasuke
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Ante: SASUKE with FielderXTGaia2nd→Conquest pro12
Parallel wire technique with SASUKE
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Ante: SASUKE with FielderXTGaia2nd→Conquest pro12
Contra lateral injection
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IVUS confirmation of true lumen position
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EES:2.25x18mm
Stenting
EES:3.0x28mm
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NC:3.5xx8mm
POT
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Final
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Parallel wiring with dual lumencatheters
•The dual lumen catheter increasesthe penetration strength up to 5 to10 fold
• It makes the second wire passageeasier in tortuous anatomy
• It reduces the wire freedom to thatpart of the vessel segment whereyou think the wire went wrong
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Darmstadt center experience 2014-2018
Approach 2014 2015 2016 2017 2018
Number of proc 259 306 325 371 378
Antegrade only 49% 47% 46% 51% 53%
Parallel of all procedures 21% 24% 23% 20% 17%
Parallel success 69% 57% 69% 70% 75%
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Darmstadt center experience 2014-2018
Approach 2014 2015 2016 2017 2018
Number of proc 259 306 325 371 378
Antegrade only 49% 47% 46% 51% 53%
Parallel of all procedures 21% 24% 23% 20% 17%
Parallel success 69% 57% 69% 70% 75%
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Darmstadt center experience 2014-2018
Approach 2014 2015 2016 2017 2018
Number of proc 259 306 325 371 378
Antegrade only 49% 47% 46% 51% 53%
Parallel of all procedures 21% 24% 23% 20% 17%
Parallel success 69% 57% 69% 70% 75%
Parallel wire technique with dual lumen cathetersDisclosureTechnical options for recanalization of a CTODiapositiva numero 4Why parallel wiring works :�the wire modifies and straightens the vessel architectureWhy parallel wiring works :�the wire modifies and straightens the vessel architectureWhy parallel wiring works :�the wire modifies and straightens the vessel architectureDual lumen catheter for parallel wiringDiapositiva numero 9Diapositiva numero 10 Why a Double Lumen Catheter? Parallel wiring with dual lumen cathetersDarmstadt center experience 2014-2018Darmstadt center experience 2014-2018Darmstadt center experience 2014-2018
