CTO介入治療策略的選擇復旦大學附屬中山醫院心內科上海市心血管病研究所葛雷CTO介入治療策略的選擇復旦大學附屬中山醫院心內科上海市心DualCatheterAngiographyClearproximalcapGoodDistalTarget3.Length<20mmAntegradeRetrogradeyesnoWireescalationDissectionReentry(crossboss-stingray)WireescalationDissectionReentry(reverseCART)yesyesnonoBrilakisESetal.JACCCardiovascInterv2012TheHybridAlgorithmforCTOPCIinUSACTO介入治療策略的選擇僅僅評價了CTO正向的解剖結構，對側枝血管的評估不夠正向技術和逆向技術的相互轉化條件不夠細化忽略了平行導引鋼絲技術忽略了IVUS在CTOPCI中的作用過分強調了ADR技術DualCatheterAngiographyClearCTO介入治療策略的選擇一百個觀眾心中就有一百個哈姆雷特，與之相似，不同的術者，就有不同的手術策略……,盡管手術策略多種多樣，但仍然有規律可循！CTO介入治療策略的選擇一百個觀眾心中就有一百個哈姆雷特，與Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235

Case1:Male,47yrsTinystump,healthydistalvessel,length<20mmCTO介入治療策略的選擇060235Case1:Male,47yrsTiCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya060235Corsair+FielderXTCTO介入治療策略的選擇060235Corsair+FielderXTCTO介060235GaiaFirstCTO介入治療策略的選擇060235GaiaFirstCTO介入治療策略的選擇060235StentingandFinalResultCTO介入治療策略的選擇060235StentingandFinalResul68323Case2:Male,69yrsCTO介入治療策略的選擇68323Case2:Male,69yrsCTO介入68323CTO介入治療策略的選擇68323CTO介入治療策略的選擇683237FEBU3.5CTO介入治療策略的選擇683237FEBU3.5CTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya68323KDL(Crusade)+SionCTO介入治療策略的選擇68323KDL(Crusade)+SionCTO介入68323IVUS(iLab)FrameCTO介入治療策略的選擇68323IVUS(iLab)FrameCTO介入治療策略68323FrameGAIASecond+130cmFineCrossCTO介入治療策略的選擇68323FrameGAIASecond+130cm68323CTO介入治療策略的選擇68323CTO介入治療策略的選擇68323TipInjection+150cmFineCrossCTO介入治療策略的選擇68323TipInjection+150cmFin68323Sion+150cmFineCrossToughSituation1CTO介入治療策略的選擇68323Sion+150cmFineCrossTou68323Sion+150cmFineCrossCTO介入治療策略的選擇68323Sion+150cmFineCrossCTO68323GAIASecond+150cmFineCrossCTO介入治療策略的選擇68323GAIASecond+150cmFineC68323PositionofRetrogradeWireFrameCTO介入治療策略的選擇68323PositionofRetrogradeWi68323RetroWnotintoAnteGC,eventhroughGuidezillausedToughSituation2GuidezillaCTO介入治療策略的選擇68323RetroWnotintoAnteGC,68323HomemadeSnarewith5Fchildcatheter150cmFineCrossRG3BigloopofSion5FchildcatheterCTO介入治療策略的選擇68323HomemadeSnarewith5Fc68323HomemadeSnarewith5FchildcatheterCTO介入治療策略的選擇68323HomemadeSnarewith5Fc68323Pre-dilationandIVUSCTO介入治療策略的選擇68323Pre-dilationandIVUSCTO介68323abacdebcdeTruetotruelumentrackingCTO介入治療策略的選擇68323abacdebcdeTruetotruelu68323FinalResultsCTO介入治療策略的選擇68323FinalResultsCTO介入治療策略的選擇大連醫科大學2015Case3:Male,55,2015-9-8failedtoattemptrecanalizationLADCTO介入治療策略的選擇大連醫科大學2015Case3:Male,55,20Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya大連醫科大學2015FielderXT-R,GAIASecond+CorsairCTO介入治療策略的選擇大連醫科大學2015FielderXT-R,GAIAS大連醫科大學2015IpislateralCCtrackingwith150Corsair+SionCTO介入治療策略的選擇大連醫科大學2015IpislateralCCtrack大連醫科大學2015PingpangTechniqueandReverseCARTwith2.5mmballoon(A:GAIAFirst;R:

GAIASecond)CTO介入治療策略的選擇大連醫科大學2015PingpangTechniquea大連醫科大學2015PingpangTechniqueandExternalizaitionwithRG3CTO介入治療策略的選擇大連醫科大學2015PingpangTechniquea大連醫科大學2015FinalResultsCTO介入治療策略的選擇大連醫科大學2015FinalResultsCTO介入治療56439Case

4:Male,48yrs,2015-3-10D1stented(misrecognitionforLAD)CTO介入治療策略的選擇PrimaryRetro:

Nostump,Stentstruts,PromisingCC56439Case4:Male,48yrs,201Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya56439150Finecross+SionCTO介入治療策略的選擇56439150Finecross+SionCTO介入56439150Finecross+FielderXTCTO介入治療策略的選擇56439150Finecross+FielderX56439ModifiedReverseCART+GAIASecond,SionCTO介入治療策略的選擇56439ModifiedReverseCART+G56439ModifiedReverseCART+Sion,SionnotintoAnteGCCTO介入治療策略的選擇56439ModifiedReverseCART+S56439GuidezillaCTO介入治療策略的選擇56439GuidezillaCTO介入治療策略的選擇56439FinecrosschangedtoCorsair,externalizationwithRG3CTO介入治療策略的選擇56439FinecrosschangedtoCors56439FinalResultsCTO介入治療策略的選擇56439FinalResultsCTO介入治療策略的選擇廣西南寧2015CASE5：Male,58yrs,IDDM,LVEF60%,FirstattemptfailedCTO介入治療策略的選擇廣西南寧2015CASE5：Male,58yrs,I廣西南寧2015CTO介入治療策略的選擇廣西南寧2015CTO介入治療策略的選擇廣西南寧2015R:6FSALL:7FEBU3.75CTO介入治療策略的選擇J-CTOScore2:Stump,length＜20mm,re-trycase廣西南寧2015R:6FSALCTO介入治療策略的選擇JCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015130cmFineCross+FielderXT-RCTO介入治療策略的選擇廣西南寧2015130cmFineCross+Fiel廣西南寧2015150cmFineCross+Sion,AVGrooveChannelinjuredCTO介入治療策略的選擇廣西南寧2015150cmFineCross+SionCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015ParallelWiringwithGAIAFirstCTO介入治療策略的選擇J-CTOScore3:WithoutStump,length＜20mm,re-trycase廣西南寧2015ParallelWiringwithG廣西南寧2015SionintoRCA-PLCTO介入治療策略的選擇廣西南寧2015SionintoRCA-PLCTO介入治廣西南寧2015FinalResultsCTO介入治療策略的選擇廣西南寧2015FinalResultsCTO介入治療策略廣西南寧2015CASE6：Male,55yrs,OMIR:AL0.75SHL:

7FEBU3.5SHCTO介入治療策略的選擇J-CTOScore1:length＞20mm廣西南寧2015CASE6：Male,55yrs,OCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015Balloonanchoring+Parallelwiring(FielderXT-R,GAIAFirst)CTO介入治療策略的選擇J-CTOScore3:length＞20mm,calcification,bending＞45degrees廣西南寧2015Balloonanchoring+PaCarefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya廣西南寧2015150Corsair+SionCTO介入治療策略的選擇廣西南寧2015150Corsair+SionCTO介廣西南寧2015Knucklewiring(FielderXT,ConquestPro)CTO介入治療策略的選擇廣西南寧2015Knucklewiring(Fielde廣西南寧2015PreparingforReverseCARTwithGAIAFirstCTO介入治療策略的選擇廣西南寧2015PreparingforReverse廣西南寧2015GAIAFirstintothetruelumenCTO介入治療策略的選擇廣西南寧2015GAIAFirstintothetr廣西南寧2015FinalResultsCTO介入治療策略的選擇廣西南寧2015FinalResultsCTO介入治療策略61887Case7.Male,60yrsoldCTO介入治療策略的選擇61887Case7.Male,60yrsoldC618877FEBU3.5SH6FSAL1.0SHCTO介入治療策略的選擇618877FEBU3.5SHCTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringFeaturesfavouringearlyuseofdissection-reentry:AmbiguouscourseinCTOLength>20mmTortuousCTOsegmentHeavycalcificationLength>20mmPreviousfailedattemptConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvesselNoRetrogradeapproachAPCTOClubPCIAlgorithmSuccessfulcrossingIFAntegradeapproachesFailedCarefulanalysisofcoronarya61887CrossBoss,FielderXT,Ultimatebros3CTO介入治療策略的選擇61887CrossBoss,FielderXT,Ul61887FinalresultsCTO介入治療策略的選擇61887FinalresultsCTO介入治療策略的選擇Carefulanalysisofcoronaryangiogram/MSCTDissection-reentry(CrossBoss/StingrayIfsuitablereentryzoneParallelwiring+/-IVUS-guidedwiringConsiderstoppingif>3hr;3.7xeGFRmlcontrast;AirKerma>5Gyunlessprocedurewelladvanced.In-stentrestenosisUseofCrossBossasprimarycrossingstrategyYesNoProximalcapambiguityNoIVUS-guidedentryYesAntegradewirebasedapproachYesYesInterventionalcollateralspresentNoPoorqualitydistalvessel