Application and limitation of anchor technique and ... - summitMD.com
Application and limitation of anchor technique and ... - summitMD.com
Application and limitation of anchor technique and ... - summitMD.com
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<strong>Application</strong> <strong>and</strong> <strong>limitation</strong> <strong>of</strong><br />
<strong>anchor</strong> <strong>technique</strong> <strong>and</strong> child<br />
mother guiding <strong>technique</strong><br />
Sendai Kousei Hospital, Japan<br />
Naoto Inoue M.D. FJCC, FSCAI<br />
TCT-ASIA 2007
Conflict statement<br />
There is no disclosure related to this presentation<br />
TCT-ASIA 2007
Anchor <strong>technique</strong><br />
•Guiding catheter stabilization<br />
•Penetration power <strong>of</strong> guide wire<br />
•Cross <strong>of</strong> balloon catheter<br />
•Stent delivery<br />
TCT-ASIA 2007
Anchor <strong>technique</strong><br />
•Guiding catheter stabilization<br />
•Penetration power <strong>of</strong> guide wire<br />
•Cross <strong>of</strong> balloon catheter<br />
•Stent delivery<br />
TCT-ASIA 2007
Anchor by guide wire<br />
TCT-ASIA 2007
Anchor by guide wire<br />
TCT-ASIA 2007
Anchor <strong>technique</strong><br />
•Guiding catheter stabilization<br />
•Penetration power <strong>of</strong> guide wire<br />
•Crossability <strong>of</strong> balloon catheter<br />
•Stent delivery<br />
TCT-ASIA 2007
Anchor by guide wire<br />
The GW in LCX<br />
stabilized guiding catheter.<br />
But there was not enough<br />
power to advance GW<br />
into the CTO lesion.<br />
TCT-ASIA 2007
To get back up support<br />
Anchor balloon<br />
TCT-ASIA 2007
GW penetration succeeded<br />
TCT-ASIA 2007
Anchor <strong>technique</strong><br />
•Guiding catheter stabilization<br />
•Penetration power <strong>of</strong> guide wire<br />
•Cross <strong>of</strong> balloon catheter<br />
•Stent delivery<br />
TCT-ASIA 2007
Cross <strong>of</strong> balloon catheter<br />
LAD CTO<br />
LCX guide wire<br />
2.5mm balloon dilatation<br />
Conquest guide wire pass<br />
But balloon cath. could not pass<br />
TCT-ASIA 2007
Cross <strong>of</strong> balloon catheter<br />
1.5mm balloon pass the lesion<br />
TCT-ASIA 2007
Previous strategy<br />
Switch to the back up type catheter<br />
or try many kinds <strong>of</strong> low pr<strong>of</strong>ile balloons<br />
Marverick 1.5<br />
Sprinter 1.5<br />
Voyager 1.5<br />
Failed<br />
Ryujin 1.25<br />
TCT-ASIA 2007
Now we are using TORNUS catheter<br />
screw on the surface<br />
TORNUS goes forward with left turns <strong>of</strong> catheter<br />
TCT-ASIA 2007
PCI for LCX<br />
Whisper wire passed the lesion<br />
Balloon could not pass the lesion<br />
TORNUS<br />
TORNUS microcatheter could pass the lesion<br />
TCT-ASIA 2007
PCI for LCX<br />
Cypher 2.5x28mm<br />
Cypher 3.0x28mm<br />
Final angiogram<br />
TCT-ASIA 2007
Anchor <strong>technique</strong><br />
•Guiding catheter stabilization<br />
•Penetration power <strong>of</strong> guide wire<br />
•Cross <strong>of</strong> balloon catheter<br />
•Stent delivery<br />
TCT-ASIA 2007
Stent delivery<br />
Anchor at side branch<br />
Anchor at same artery<br />
TCT-ASIA 2007
Stent delivery by side branch <strong>anchor</strong><br />
TCT-ASIA 2007
The use <strong>of</strong> <strong>anchor</strong> <strong>technique</strong><br />
for stent delivery in DES era<br />
Risk <strong>of</strong> vessel injury<br />
Stent dislocation<br />
Drug coating peels away<br />
TCT-ASIA 2007
Child mother guiding <strong>technique</strong><br />
6F mother cath. (Heartrail Terumo Co.)<br />
6F>0.070 inch (Launcher, Heartrail<br />
Radiguide)<br />
5F child cath. (20cm longer than mother cath.<br />
Terumo Co.)
Child mother guiding <strong>technique</strong><br />
Hemostatic valve<br />
Hemostatic valve<br />
Heartrail 6Fr<br />
Heartrail 6Fr<br />
Heartrail 5Fr Yconnector<br />
Heartrail straight 5Fr Y connector<br />
straight
Original child mother guiding <strong>technique</strong><br />
Balloon cathe.<br />
5F cathe.<br />
Guidewire<br />
6F cathe.<br />
Balloon cathe.<br />
Advanced child cathe.<br />
TCT-ASIA 2007
The <strong>com</strong>bination <strong>of</strong> child-mother<br />
<strong>and</strong> <strong>anchor</strong> <strong>technique</strong> can get<br />
more power<br />
TCT-ASIA 2007
Method <strong>of</strong> 5F in 6F
Alternative Child mother guiding<br />
<strong>technique</strong><br />
Child catheter goes beyond the stenotic lesion<br />
No risk <strong>of</strong> stent dislocation<br />
No risk <strong>of</strong> DES polymer peeling <strong>of</strong>f
CABG (LITA→LAD, LAD, SVG→PL)<br />
Hemodialysis<br />
50 y.o. male
Child catheter<br />
Stenosis<br />
Child catheter<br />
狭 窄 部 位
Complication <strong>of</strong> child-mother <strong>technique</strong><br />
•Vessel injury<br />
•Air embolism<br />
TCT-ASIA 2007
Complication <strong>of</strong> child-mother guiding<br />
techniqude<br />
TCT-ASIA 2007
Air embolism<br />
•We have two air embolisms<br />
•Air embolism will occur when child catheter is<br />
wedged<br />
TCT-ASIA 2007
Safety use for child-mother <strong>technique</strong><br />
•Gently advancement <strong>of</strong> child catheter into the<br />
coronary artery<br />
•Careful monitoring distal coronary pressure<br />
•Check the blood back flow from Y-connector just<br />
after stent deployment<br />
TCT-ASIA 2007
Conclusion <strong>of</strong> <strong>anchor</strong> <strong>technique</strong><br />
•Guiding catheter stabilization<br />
Useful<br />
•Guide wire penetration<br />
Useful<br />
•Cross <strong>of</strong> balloon catheter<br />
TORNUS catheter replaced <strong>anchor</strong> <strong>technique</strong><br />
•Cross <strong>of</strong> stent<br />
Useful<br />
Child-mother <strong>technique</strong> is useful as well.<br />
The <strong>com</strong>bination child-mother <strong>and</strong> <strong>anchor</strong> can<br />
get most powerful backup support<br />
TCT-ASIA 2007
Conclusion<br />
In the Era <strong>of</strong> Tornus Catheter <strong>and</strong> 5F in<br />
6F<br />
Guiding Technique, Original Anchor<br />
Technique<br />
Might Play a Limited Role In Specific<br />
Situations:<br />
GC Stabilization, Penetration <strong>of</strong> GW etc.<br />
But the Combination with These<br />
Techniques are<br />
Promising.<br />
TCT-ASIA 2007
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