CTO64

 CTO64

LAD CTO シオンブラック通過後にロタ1.25で、CB2.5  CB3.0  DCBで終了。

https://www.youtube.com/watch?v=wwTkTsu5wi0&list=PLuzawSa5VWjEgtwNIK_Exw5wcmnptKfnt&index=1

CTO63

 RCA CTO 

M12Gで奥にはいったが、MCの造影では先端は血管外にみえたが、その後に上は、もっと上に血管がある感じがあり、試みるも、G4がはいったが、血管外であり、その時のIVUSでIVUSの最初のwireが血管ないにあったので、そのまま奥までナックルでいって、IVUSguideでSTで上をTDADRで穿刺も皮一枚でfalseにもどるために、RAO caudalでしたに向けてMCの位置を調整して、STで差し直して、Sion balackが奥に抜けた。

G4出血は、papyrusで治療した。

https://www.youtube.com/watch?v=5Fa2uU5Lh5g&list=PLuzawSa5VWjEgtwNIK_Exw5wcmnptKfnt&index=1&t

CTO 61.62

 CTO 61.　CABG turndown.  LMT RCA CTO 

RCA  CTO XTA passing stenting

CTO62  same turndown.  RCA CTO XTA passing.

CTO 60

 RCA col  Low EF 20%  rich col from LAD and LCX

RCA  CTO sionblack to gradius。 go for SI.  retrograde  IVUS guided reverse CART , success recanaize,

CTO 59

 RCA CTO  #2-#3CTO 

AL8Fr sionblack advanced just proximal to the end of CTO lessio. GAIA2 3D wiring failed.  Then exchanged GW to Konfienza ST with MC. AG shows SI was created with some contrast.  SI is huge space.Anyone would think that this condition would be difficult to treat with antegrade. but we can do it. 

IVUS guide ,IVUS shows wire in intimal without distal part of CTO. When starting TDADR, sion black accidentally advaned to true lumen media, Swithed sionblack and guradius failed, change GW to ST advancing  with intentional direction to upper and front on AG(it means toward DTL), ST advanced DTL, swiched sionblack to cross.

big SI are fenestrated by CB. Stentigng

皮一枚でST効果。

got talent

 無料で、招待します。やる気のある若者集まれ。

CTO 58

 LMT CTO  post CABG to LAD.  reffered to SCVC  ,for doing PCI. CT examintion and col from bronchial A shows  LCX cTO lesion.

XB 7fr  first M3to HL then IVUS check. LCXOS is coverd by calcium plate by IIVUS. G2,G4 does not work.  MG12w/ susuke is advanced LCX CTO lesion.but not cross lesion. then STAR for LCX branch .TIP injection shows DTL, next step sionblack rerouting with susuke.   Success.

stenting

yutube

https://www.youtube.com/watch?v=zGcCUODOjH8&list=PLuzawSa5VWjEgtwNIK_Exw5wcmnptKfnt&index=1

CTO 57

 CTO microtinny channerl connected.

AL  sion black not crossed, XTR serching wire movement go for DTL.

CTO56

 RCA#4AV CTO

AL8fr  IVUSguided G4 rerouting ,  MC advanced CTO , change sion black ,to get DTL

CTO55

 RCA CTO . retry refferd pts.  JCTO5

AL1 8fr  with anker 1.5mm BC.  first UB 3 is not enterd in CTO .  GAIA2 penetrated proximal cap. But GAIA is no advanced any more. SO with ankering was started.  With strong backup, GAIA 2 penetrate TDL(landmark by calcification) with 3D wiring .

After crossing wire, no device was crossed.  Tornus pro was only advance. Change wire GAIA to sion black. 

rota 1.5,1.75 CB  stent  OK

watchi video 

https://www.youtube.com/watch?v=EYPjYoGUWcU&list=PLuzawSa5VWjEgtwNIK_Exw5wcmnptKfnt&index=1

CTO 54

 LCX CTO case.

JCTO 2. blunt angle lesion.  XTA inserted CTO lesion with IVUS confirmed . But not advanced anymore. change to Gradius with MC. Gradius is easy to cross proximal small branch at proimal DTL

Exchange wire to sion blue with using MC advancing.Next sion black was advanced DTL with DLC.  

CB ,then Stent . finished.

CTO 53

 RCA CTO 曲がりで、CTでは石灰化があるケースであり、シオンブラックが枝にはいり、UB3でファルスに入るも、入り口も、途中も石灰でreroutingできず、TDADRをこころみるも石灰化に無理やす差し込んだが、奥で再度でる感じであり、その後に４PDにSTARで抜いて、減圧してから、TDADRでワイヤーをSTからblackに変えたら、4PDの末梢まで抜けたが、その後にPOBAしたら、falseにワイヤーが戻ってしまった。心電図変化もなく、＃4AV領域も狭く、今回は、その後にinbvestmentで終了した。