CTO

Apr 13, 2013Download as PPTX, PDF6 likes4,127 views

This document discusses techniques for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention. It describes the distal cap penetration technique using a reverse controlled antegrade and retrograde subintimal tracking (CART) approach. Key aspects of CTO wiring are discussed, including wire features needed for penetration, pushability, steerability, and shaping memory. Retrograde strategies and hardware options are presented, including parallel wiring, the star technique, and snaring. The document shares experience from over 300 CTO cases with a high success rate and low complications.

DISTAL CAP PENETRATION –
Cart Vs REVERSE CART

Dr .V. Surya Prakasa Rao
HOD – Cardiology Department
Apollo Hospitals –Hyderguda, Hyderabad.

Corsair Difficult to Negotiate at an
Acute Bend

CTO Wire
Features required for CTO wires
1. Penetration force for penetrating proximal
fibrous cap and advancing into true lumen
2. Pushability for crossing chronic occlusions and
complex lesions with heavy calcifications and
tough fibrous tissues.
3. Steerability for easy manipulate in various
directions with good torque transmission
4. Shaping Memory of the tip

1st CTO LIVE SUMMIT
June 8th and 9th 2013
at
MUMBAI

COMPLEX CTO – CHOOSING THE
RIGHT HARDWARE.
Dr .V. Surya Prakasa Rao
HOD – Cardiology Department
Apollo Hospitals –Hyderguda, Hyder

ISR - CTO

Fielder XT with
Contralateral
Injection

Ostial LAD CTO – Reverse CART
• 7F / 8F – short guiding ( customized / self made) with
SH.
• 135 / 154 cm Corsair.
• SION Blue - 0.014 ( Fielder XT, Conquest Pro12,
Miracle3 / 9, Fielder XTR)
• RG3 – 300cms.
• Volcano IVUS – Eagle Eye Gold.
• 2.5 / 3.0 mm NC Balloons.
• Snare.
• Coils.
• Covered Stent

CTO – CACTO Experience
• Total No of CTO’S-2006 to Dec 2012 : 326
cases
• Success rate 89.9 %
• Major complications: < 1%

1) Guidewire technology has advanced significantly with a wide selection for different lesion characteristics and vessel anatomies. 2) Guidewires consist of a core material, taper, tip style, coils, and various coatings which determine properties like flexibility and trackability. 3) The choice of guidewire depends on factors like vessel anatomy, lesion morphology, and the intended procedure or device. Workhorse wires are preferred for simple lesions while more complex cases require dedicated wires.

Components and classification of coronary guide wire dr md toufiqur rahman ca...PROFESSOR DR. MD. TOUFIQUR RAHMAN

This document provides information about coronary guidewires. It discusses the history of angioplasty and development of over-the-wire balloon systems. It describes the key components and characteristics of guidewires, including the core, tip, coils, covers, and coatings. It explains properties like torque control, trackability, steerability, and flexibility. It also covers classifications of guidewires based on tip flexibility, device support, coating, and clinical scenario. Examples of commonly used guidewires are provided.

Dedicated CTO kit: microcatheters, balloons, adjunctive devicesEuro CTO Club

Coronary guidewires RIKESH(ppt03).pptRIKESH4

Guiding catheter in coronary interventionkefelegn Tadesse

1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support. 2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation. 3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.

Bifurcation stentinghttps://aiimsbhubaneswar.nic.in/

Significant unprotected left main (LM) coronary artery disease is present in <10% of patients undergoing coronary angiography. In autopsy research, a mean LM length of 10.8 mm ± 5.2 mm (range 2–23 mm), mean LM diameter 4.9 mm ± 0.8 mm and mean angle between the left anterior descending (LAD) and left circumflex (LCx) of 86.7° ± 28.8° has been described. This angle value positively correlated with LM length.2 Further studies showed that long LM developed stenoses more frequently near the distal bifurcation compared to near the ostium (77% versus 18%).7 It is also worth emphasising that LM bifurcation disease is rarely focal and that both sides of the carina are almost never disease-free. Furthermore, continuous plaque from the LM into the proximal LAD artery has been reported in 90% of cases.8 Summarised below are the most crucial LM peculiarities (in comparison with non-LM bifurcations), which should be taken into consideration when distal LM stenosis PCI is planned:

Coronary guidewireshttps://aiimsbhubaneswar.nic.in/

This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It describes the components, classifications, and appropriate uses of guidewires for different clinical scenarios. Guidewires are classified based on tip flexibility, device support, coating, and tip load. Commonly used guidewires include Balance Middleweight Universal, Choice Floppy, and BMW. Guidewire selection depends on vessel anatomy, lesion morphology, devices used, and operator experience. Special guidewires are discussed for procedures like left main PCI, bifurcation PCI, dissections, calcified lesions, and chronic total occlusions.

Svg pciKush Bhagat

Saphenous vein grafts used in coronary artery bypass grafting are prone to occlusion over time. Percutaneous interventions on occluded saphenous vein grafts carry risks of distal embolization. Techniques to reduce this risk include use of embolic protection devices, which filter out debris, and proximal occlusion devices, which block blood flow during the intervention. Drug-eluting stents may reduce restenosis compared to bare-metal stents in saphenous vein grafts, but dual antiplatelet therapy is required. While percutaneous interventions on saphenous vein grafts can relieve symptoms, the underlying disease progression remains an issue.

wires,balloons,stents.pptxPaulTopol1

This document discusses various aspects of guide catheters and guidewires used in percutaneous coronary interventions. It describes the construction, properties, and types of guide catheters as well as strategies for selecting the appropriate guide catheter for different coronary arteries and lesion characteristics. It also explains the components, coatings, and ideal properties of guidewires and provides details on guidewire selection for different scenarios including chronic total occlusions.

Daniel Weilenmann - Guidewiresand microcatheters: how to useEuro CTO Club

The document discusses guidewires and microcatheters for chronic total occlusion procedures. It provides classifications of guidewires including conventional, support, and CTO wires. It describes specific guidewires such as Pilot 200 and Fielder XT and their uses for tasks like penetration, tortuosity, and knuckling. Microcatheters discussed include Corsair, Caravel, and Turnpike. The document presents a hybrid algorithm for CTO crossing incorporating both antegrade and retrograde approaches depending on lesion characteristics.

Microcatheters for antegrade and retrograde approachEuro CTO Club

Coronary guide wires Malleswara rao Dangeti

This document discusses coronary guidewires used in percutaneous coronary intervention (PCI). It begins by outlining the history of angioplasty and guidewire development. It then covers the purpose, components, classifications, and appropriate uses of guidewires. The main components include the core, tip, coils, covers, and coatings. Guidewires are classified based on flexibility, device support, and clinical usage. Complications like vessel perforation, pseudolesions, and entrapment are also discussed. Proper guidewire manipulation and strategies for difficult lesions are outlined to maximize safety and efficacy.

New wires, what we have, what is essential, what is on the horizonEuro CTO Club

Bifurcation stentinghttps://aiimsbhubaneswar.nic.in/

1) Bifurcation stenting approaches are based on the angiographic configuration of lesions in the main and side branches. Significant disease (>50% stenosis) in the side branch ostium increases the risk of side branch closure and restenosis. 2) The default approach is one-stent with provisional side branch treatment. Two-stent techniques are used if the side branch has significant disease and high closure risk features. 3) Techniques like crush, culotte, and T-stenting aim to provide full coverage of both branches, but have limitations and risks. Physiologic assessment with IVUS and FFR can help decide if jailed side branches require intervention.

The essentials of guide wires masahisa yamane 9 13 2019Euro CTO Club

Step by Step Rotational AthrectomyDr Virbhan Balai

Rotational atherectomy is described in detail including vascular access, wiring, burr selection, technique, complications and their management. Key steps include using the smallest burr possible, short ablation runs under 20 seconds, and avoiding sudden drops in rotational speed to minimize complications. Complications can include slow-flow/no-reflow, dissection, perforation and burr entrapment. Prevention focuses on optimal technique and treatment involves reversing anticoagulation, vasodilators, balloons, stents or surgery depending on the complication.

Guide Extension CatheterDr Virbhan Balai

This document discusses guide catheter extensions used in interventional cardiology. It describes four types of guide catheter extensions currently available: Guideliner V2, Guidezilla, Telescope, and Guidion. It provides details on the sizes, lengths, and features of Guideliner V2 and Guidezilla. Applications of guide catheter extensions include increasing backup support, bypassing calcification/tortuosity, limiting contrast use, and facilitating procedures like CTO PCI and thrombus aspiration. Potential complications are discussed, along with tips to minimize risks like dissection or ischemia.

Reverse CART techniques: conventional, directed, extended, assisted …Euro CTO Club

Bifurcation stentigDr. Lokesh Khandelwal

Coronary bifurcation lesions, which occur in 15-20% of PCI cases, are challenging to treat and are associated with increased risk of adverse events. It is important to optimize the bifurcation stenting strategy. Provisional stenting of the main vessel with optional treatment of the side branch is generally the preferred approach and results in similar outcomes as more complex two-stent strategies while reducing procedure time and resource use. Dedicated stenting of both branches may be considered for large side branches with significant disease extending more than 5mm into the branch. Kissing balloon inflations after main vessel stenting are not routinely needed but can be used if the side branch has greater than 75% stenosis or reduced flow after main

CTO in post CABG patientsEuro CTO Club

Strategies of handling side branch during pciManjunath D

This document summarizes strategies for handling side branches during percutaneous coronary interventions (PCI) involving coronary bifurcations. It discusses: 1. Bifurcation lesions account for 15-20% of PCIs and have lower success rates and higher restenosis than other PCIs. 2. Classification systems for bifurcation lesions including the Medina and Duke classifications. 3. Techniques for stenting bifurcation lesions including provisional stenting, T-stenting, crush techniques, and double stenting. 4. Randomized trials have found that provisional stenting is generally as effective as more complex double stenting techniques for treating bifurcation lesions.

03 technical Cohen aimradial20170922 Guiding cathetersInternational Chair on Interventional Cardiology and Transradial Approach

This document discusses selecting guiding catheters for percutaneous coronary interventions (PCI). It provides guidance on catheter selection for different coronary arteries and bypass grafts. Key points include using stiffer, larger guides for support; deep intubation and guide extensions; and balloon anchoring or buddy wires. Techniques like keeping a wire in the catheter during engagement and using the wire backend to modify shape are reviewed. Standard guides can be used for complex PCI like CTO and bifurcations when combined with techniques for support. Maintaining guidewire backup in the catheter is important for successful transradial procedures.

Coronary guidewiresrajijustin

The document discusses coronary guidewires, which are used to access and cross coronary lesions during angioplasty procedures. It provides a brief history of angioplasty and guidewire development. The key components and characteristics of guidewires are described in detail, including core material, tapering, tip design, coil placement, covers, coatings, and how these influence flexibility, torque, and other performance factors. Common guidewire classifications and specific guidewire models are also mentioned along with guidance on optimal guidewire positioning and potential complications.

Approch to bifurcation lesionhttps://aiimsbhubaneswar.nic.in/

The document discusses approaches to bifurcation lesions in coronary arteries. It defines a bifurcation lesion as a lesion located at the bifurcation of a main branch and side branch. Some key points discussed include: - Provisional stenting of the main branch with adjunctive treatment of the side branch is generally the preferred initial approach. - Double stenting techniques like culotte stenting and crush stenting are more complex but may be needed for large side branches or complex lesions. - Factors like side branch size, angle of bifurcation, and extent of disease impact treatment decisions between single versus double stenting. - Techniques for wiring the side branch, optimizing stent placement, and treating

RotablationSR,CARDIOLOGY,JIPMER,PUDUCHERRY

CTO fundamental: Understanding of Wire StructureEuro CTO Club

Chronic total occlusion (CTO)Malleswara rao Dangeti

This document discusses strategies and techniques for managing chronic total occlusions (CTO). CTOs are coronary blockages that are completely blocked for more than 3 months. The document outlines the histopathology of CTOs and factors that predict success or failure of percutaneous coronary intervention (PCI). It also describes various guidewires, microcatheters, and crossing devices that can be used to recanalize CTOs via antegrade or retrograde approaches. Successful PCI of CTOs has been shown to improve angina, reduce the need for bypass surgery, and improve survival.

Chronic total occlusion pcihttps://aiimsbhubaneswar.nic.in/

Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO. Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.

Chronic Total Occlusions: The Road Less TraveledAllina Health

More Related Content

What's hot (20)

Svg pciKush Bhagat

wires,balloons,stents.pptxPaulTopol1

Daniel Weilenmann - Guidewiresand microcatheters: how to useEuro CTO Club

Microcatheters for antegrade and retrograde approachEuro CTO Club

Coronary guide wires Malleswara rao Dangeti

New wires, what we have, what is essential, what is on the horizonEuro CTO Club

Bifurcation stentinghttps://aiimsbhubaneswar.nic.in/

The essentials of guide wires masahisa yamane 9 13 2019Euro CTO Club

Step by Step Rotational AthrectomyDr Virbhan Balai

Guide Extension CatheterDr Virbhan Balai

Reverse CART techniques: conventional, directed, extended, assisted …Euro CTO Club

Bifurcation stentigDr. Lokesh Khandelwal

CTO in post CABG patientsEuro CTO Club

Strategies of handling side branch during pciManjunath D

03 technical Cohen aimradial20170922 Guiding cathetersInternational Chair on Interventional Cardiology and Transradial Approach

Coronary guidewiresrajijustin

Approch to bifurcation lesionhttps://aiimsbhubaneswar.nic.in/

RotablationSR,CARDIOLOGY,JIPMER,PUDUCHERRY

CTO fundamental: Understanding of Wire StructureEuro CTO Club

Chronic total occlusion (CTO)Malleswara rao Dangeti

Svg pciKush Bhagat

wires,balloons,stents.pptxPaulTopol1

Daniel Weilenmann - Guidewiresand microcatheters: how to useEuro CTO Club

Microcatheters for antegrade and retrograde approachEuro CTO Club

Coronary guide wires Malleswara rao Dangeti

New wires, what we have, what is essential, what is on the horizonEuro CTO Club

Bifurcation stentinghttps://aiimsbhubaneswar.nic.in/

The essentials of guide wires masahisa yamane 9 13 2019Euro CTO Club

Step by Step Rotational AthrectomyDr Virbhan Balai

Guide Extension CatheterDr Virbhan Balai

Reverse CART techniques: conventional, directed, extended, assisted …Euro CTO Club

Bifurcation stentigDr. Lokesh Khandelwal

CTO in post CABG patientsEuro CTO Club

Strategies of handling side branch during pciManjunath D

03 technical Cohen aimradial20170922 Guiding cathetersInternational Chair on Interventional Cardiology and Transradial Approach

Coronary guidewiresrajijustin

Approch to bifurcation lesionhttps://aiimsbhubaneswar.nic.in/

RotablationSR,CARDIOLOGY,JIPMER,PUDUCHERRY

CTO fundamental: Understanding of Wire StructureEuro CTO Club

Chronic total occlusion (CTO)Malleswara rao Dangeti

Viewers also liked (20)

Chronic total occlusion pcihttps://aiimsbhubaneswar.nic.in/

Chronic Total Occlusions: The Road Less TraveledAllina Health

Chronic total occlusionAnthony Kaviratne

A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.

Chronic total occlusion-PTCAhttps://aiimsbhubaneswar.nic.in/

This document discusses strategies and techniques for managing chronic total occlusions (CTO). It provides details on the histopathology of CTOs and explains why recanalizing them can provide clinical benefits like relieving angina and improving left ventricular function. It describes various CTO management techniques including pre-procedure planning, guide catheter selection, and use of specialized CTO guidewires. Predictors of procedural success and failure are also reviewed.

Retrograde cto interv.manishdmcardio

The document discusses strategies for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). It describes: 1. The antegrade approach is the most commonly used, with success rates of 60-80%. Tapered guidewires are first-choice to probe microchannels. 2. A four-wire strategy is recommended, starting with a polymer-coated wire and progressing to stiffer wires if needed. 3. Advanced techniques like parallel wiring or antegrade dissection and reentry may be used if initial wiring fails.

INTERVENTIONAL TECHNIQUES IN CHRONIC TOTAL OCCLUSIONSDr. Jose L. Assad-Morell

Alaswad K 2013 06International Chair on Interventional Cardiology and Transradial Approach

Clinical Evaluation in the EU for Medical Devices: Understanding the Changes ...Greenlight Guru

A new revision of MEDDEV 2.7.1 is now available and this revision represents a complete rewrite, with massive changes. The new MEDDEV is both more instructive, and more prescriptive in particular regarding the use of evidence from equivalent devices. So what exactly are the implications of all these changes for device manufactures? How does this affect your CERs? How long is the transition period going to be? (Hint: there’s typically no transition provided for the MEDDEVs). Join us for this free, 60 minute webinar, presented by our guest Keith Morel, VP of Regulatory Compliance at Qserve Group US Inc., on July 21st. (You can view the full webinar at: http://www.greenlight.guru/webinar/clinical-evaluation-eu-meddev-2_7_1-rev-4) Specifically, you will learn: What is MEDDEV 2.7.1. Rev 4 for Clinical Evaluation in EU and why exact does this matter to device makers? What are some of the most significant changes? (There are a lot of them) How does it align with the changes to the new EU MDR? In what ways will demonstrating “equivalence” now be harder? How often you must update your CERs now and what qualifications the evaluators must have? How should you prepare for the increased notified body scrutiny? How do you perform a clinical literature review to meet the new expectations? Do you need to write a CER for CE Marking? If not, when else do you need to do this and with what focus?

Friday 08:01 - Gershlick- Basic CTO TerminologyEuro CTO Club

This document contains a list of medical terminology and techniques that may be discussed at an upcoming conference over two days. Terms relate to chronic total occlusion interventions and include names of devices, catheters, guidewires, imaging modalities, procedural techniques, definitions, and complications. The list covers topics such as antegrade and retrograde approaches, dissection re-entry techniques, septal surfing, contrast surfing, CART and reverse-CART techniques, the use of IVUS and CT imaging, and device options like the Tornus catheter.

17:15 Serra - BVS in CTO PCIEuro CTO Club

1) The document describes a prospective study assessing the safety and performance of bioresorbable vascular scaffolds (BVS) in percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). 2) 35 patients with CTOs underwent PCI with BVS implantation and were followed clinically and with imaging for 6-8 months. 3) Preliminary results found excellent mid-term patency and safety with no deaths, myocardial infarctions, or scaffold thromboses at 6-8 months follow-up.

Sergey Furkalo - Retrograde LAD CTO recanalisation in patient with critical L...Euro CTO Club

Carlo Maccia - The CTO dose registry: a tool for optimizing patient radiation...Euro CTO Club

Friday 1745 – benamer cto and diabetesEuro CTO Club

This document summarizes a study examining long-term outcomes of patients undergoing percutaneous coronary intervention (PCI) to treat chronic total occlusions (CTOs). The study analyzed 1,331 patients with 1,506 CTO lesions treated between 2004-2012. Primary success was achieved in 71.6% of patients. Patients with successful PCI had better long-term outcomes than those with failed PCI, including lower mortality. Among patients with diabetes, those with successful CTO PCI had better outcomes than those with failed PCI. The study demonstrates that successful CTO PCI is associated with improved long-term prognosis, especially in patients with diabetes.

09:15 CASE 8- Karmpaliotis - The Retrograde Approach does not always preserv...Euro CTO Club

Tim Schäufele - SuccessfultransradialretrogradeCTO revascularisation via an e...Euro CTO Club

A 76-year-old female with recurrent angina underwent a transradial retrograde CTO revascularization via an epicardial collateral using a single 6F guide catheter. Baseline angiography and cMRI showed 3-vessel disease with functional stenosis in the RCA and RCX territories. An antegrade wire escalation approach was unsuccessful, so a retrograde approach via an epicardial collateral was used. The CTO was crossed retrogradely and externalized antegradely using the single 6F guide. Final angiography after stent placement in the RCA, LAD and RCX showed good results and the patient's angina was resolved at 9-month follow-up.

14:00 CASE 5 - GagnorEuro CTO Club

This procedure report describes a simple retrograde CTO procedure that took 170 minutes with 58 minutes of fluoroscopy time. The key learnings are that retrograde CTO can be effective, predictable and safe if approached systematically by using the first procedure to prepare the CTO for treatment, such as with kissing techniques on septal or collateral branches. While the procedure was long, it was successful using minimal contrast and radiation by taking the time needed.

Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016Euro CTO Club

This document describes a case of a 55-year-old man with stable angina and risk factors of hypertension, dyslipidemia, and smoking. Coronary angiography revealed 2-vessel disease with an occlusion in the RCA. An initial antegrade approach was unsuccessful, so a retrograde approach through collateral vessels was attempted. This led to successful recanalization of the RCA. However, dissection of the collateral vessel occurred. Rather than stopping the procedure, the collateral vessel was immediately reconstructed, achieving a good final result. The patient was followed up after 6 months with no complications. The case highlights the importance of collateral vessel protection and completing the procedure in one session when possible.

16:55 Antoniucci - Stenting in CTOEuro CTO Club

This document summarizes the results of a study analyzing the angiographic and clinical outcomes of patients who underwent successful percutaneous coronary intervention (PCI) to treat a chronic total occlusion (CTO). The study found that the use of everolimus-eluting stents was associated with significantly lower rates of CTO vessel reocclusion compared to first-generation drug-eluting stents. Additionally, the use of the STAR technique for CTO PCI was associated with a very high rate of vessel reocclusion despite initial success. Patients treated with everolimus-eluting stents or conventional antegrade/retrograde approaches had much higher sustained vessel patency linked to improved one-year clinical outcomes.

16:05 Bufe - Learning to stop and to stage CTO PCIEuro CTO Club

1) The document discusses strategies for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs), including staged procedures and when to stop a procedure. 2) It notes that in cases of failed antegrade PCI, patients should be referred to a CTO specialist center for a second attempt, either immediately with a retrograde approach or in a staged procedure later. 3) Successful CTO recanalization rates have increased in recent years with more use of retrograde approaches, either primarily or after failed antegrade attempts. However, radiation exposure, contrast volume, and complications should be considered in determining when to stop a procedure.

10:50 Werner - Identifying the patients that benefit from CTO PCIEuro CTO Club

This document discusses identifying patients that may benefit from percutaneous coronary intervention (PCI) to treat chronic total occlusions (CTOs). It notes that patients with clinical symptoms like angina or heart failure, or those with viable myocardium, are likely to benefit from CTO-PCI. The document also examines factors like the SYNTAX score and completeness of revascularization that influence whether PCI or coronary artery bypass grafting (CABG) is a better option for treating multi-vessel disease when one of the vessels is a CTO. It emphasizes the importance of assessing a patient's individual clinical presentation and ischemia to determine if CTO-PCI may provide symptom relief.

Chronic total occlusion pcihttps://aiimsbhubaneswar.nic.in/

Chronic Total Occlusions: The Road Less TraveledAllina Health

Chronic total occlusionAnthony Kaviratne

Chronic total occlusion-PTCAhttps://aiimsbhubaneswar.nic.in/

Retrograde cto interv.manishdmcardio

INTERVENTIONAL TECHNIQUES IN CHRONIC TOTAL OCCLUSIONSDr. Jose L. Assad-Morell

Alaswad K 2013 06International Chair on Interventional Cardiology and Transradial Approach

Clinical Evaluation in the EU for Medical Devices: Understanding the Changes ...Greenlight Guru

Friday 08:01 - Gershlick- Basic CTO TerminologyEuro CTO Club

17:15 Serra - BVS in CTO PCIEuro CTO Club

Sergey Furkalo - Retrograde LAD CTO recanalisation in patient with critical L...Euro CTO Club

Carlo Maccia - The CTO dose registry: a tool for optimizing patient radiation...Euro CTO Club

Friday 1745 – benamer cto and diabetesEuro CTO Club

09:15 CASE 8- Karmpaliotis - The Retrograde Approach does not always preserv...Euro CTO Club

Tim Schäufele - SuccessfultransradialretrogradeCTO revascularisation via an e...Euro CTO Club

14:00 CASE 5 - GagnorEuro CTO Club

Mark Rosenberg - Complication CaseEuroCTO Club Meeting 2016Euro CTO Club

16:55 Antoniucci - Stenting in CTOEuro CTO Club

16:05 Bufe - Learning to stop and to stage CTO PCIEuro CTO Club

10:50 Werner - Identifying the patients that benefit from CTO PCIEuro CTO Club

Similar to CTO (20)

CTO Iqbal Dar

This document discusses techniques for recanalizing chronic total occlusions (CTOs). It defines a CTO and explains their etiology. Successful recanalization is associated with improved angina and reduced ischemia. Key steps include careful pre-procedure planning, selecting appropriate guidewires and microcatheters, and using techniques like parallel wiring or penetration when standard wiring fails. Expertise is important for high success rates. Proper wire shaping and handling can help avoid subintimal tracking.

Gerald Werner - AntegradeApproach Step by StepEuro CTO Club

This document discusses the antegrade approach for treating chronic total occlusions (CTOs). The goals are to restore the original artery anatomy with minimal damage or time/resources. The antegrade approach involves analyzing the lesion and patient, using a step-by-step process starting with softer wires and progressing if needed. Parallel wiring is an early bailout option. Guided reentry may be used if retrograde proves difficult. The strategy aims to select the approach most likely to succeed for each specific lesion and patient.

Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...Euro CTO Club

CHIP_CTO_2020_Retrograde_CTO-_Recent_concepts.pptxvaibhavpatil229406

This document discusses techniques for retrograde CTO procedures including reverse CART. It describes the wires and microcatheters used for septal and epicardial collateral crossings. The Suoh 0.3 guidewire is highlighted for its soft tip and flexibility. Different types of reverse CART techniques are defined including conventional, directed, and extended. Contemporary directed reverse CART is noted as superior with less vessel trauma. Recent data shows success rates of 80% using reverse CART and its usage in 55% of retrograde cases. The document concludes with key learnings around mastering antegrade techniques first before retrograde and emphasizing hardware knowledge and proctorship.

M. Kovacic - Flash Highlights: Armentarium of CTO materialsEuro CTO Club

Friday 1600 – werner – antegrade proEuro CTO Club

This document discusses strategies for chronic total occlusion percutaneous coronary intervention (CTO PCI), specifically the criteria for choosing an antegrade versus retrograde approach. The key points are: 1) An antegrade wire should generally be placed first before attempting a retrograde approach to help connect the wires and reduce retrograde dwelling time. 2) Exceptions include when targeting ostial lesions or bifurcations where antegrade wiring risks side branch loss. 3) The decision of when to stop antegrade wiring and switch to retrograde depends on the specific lesion characteristics and may require balancing wire passage risks with procedural time.

Yoshimachi F - AIMRADIAL 2014 Technical - CTO and radialInternational Chair on Interventional Cardiology and Transradial Approach

This document provides tips and tricks for treating chronic total occlusions (CTOs). It discusses: 1. The challenges of CTOs including bending, calcification, long lesions, and complex entry/exit points. 2. The need to select devices appropriately for each case, including guidewires tailored for different lesion characteristics and IVUS guidance. 3. Techniques for using different guidewire types to penetrate microchannels, modify calcified/bending lesions, and penetrate hard lesions. 4. The importance of selecting the right retrograde channel and devices, with the goal of making an antegrade-retrograde connection, as in traditional retrograde techniques. 5. Encourage

Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021Hafeesh Fazulu

This document provides an overview of chronic total occlusion (CTO) revascularization. It discusses diagnosing and assessing CTO difficulty using scoring systems like the J-CTO and PROGRESS-CTO scores. Techniques for CTO include antegrade wiring, retrograde wiring, and hybrid approaches. Key factors in procedural success include careful review of angiograms to identify collaterals, microchannels and vessel characteristics. Proper guidewire manipulation and shaping is important for crossing the occlusion. Parallel wire, see-saw and dual lumen microcatheter techniques may be used if the wire enters the subintimal space. The Crossboss catheter is recommended for antegrade dissection and reentry.

Saturday 1630 – brilakis balloon uncrossableEuro CTO Club

This document summarizes a presentation on techniques for treating coronary chronic total occlusions (CTOs) that are balloon uncrossable or untreatable. The presentation outlines a stepwise approach beginning with crossing techniques using wires, support catheters, and modifications to the lesion. If unsuccessful, anchoring techniques using guide catheter extensions or side branch balloons are recommended. Later steps include excimer laser, rotational atherectomy, subintimal wiring techniques, and retrograde approaches. Combination techniques are emphasized for success in treating the most complex CTOs.

10:05 Gershlick - The kitEuro CTO Club

This document discusses techniques for chronic total occlusion (CTO) recanalization. It describes analysis of data from the UK Central Cardiac Audit Database on over 13,000 patients who underwent elective CTO percutaneous coronary intervention (PCI) between 2005-2009. The document reports that successful revascularization is associated with reduced mortality. It also provides an overview of the CTO PCI timeline and techniques that have been developed for CTO recanalization, including wires, microcatheters, intravascular ultrasound (IVUS), and balloons.

Gregor Leibundgut: When the “uncrossable” becomes crossableEuro CTO Club

14th Experts Live CTO September 2nd - 3rd, 2022 - Mainz, Germany Main Session - Lunch Symposium by Asahi: Road to CTO expert 2022 – how to build your CTO toolkit When the “uncrossable” becomes crossable Gregor Leibundgut, Bâle, Suisse Room: Guteberg Hall (Auditorium) - Saturday 13:30 Speaker: Gerald Werner, Darmstadt, Germany; Kambis Mashayekhi, Lahr, Germany; Jo Dens, Genk, Belgium; Gregor Leibundgut, Bâle, Suisse

Novel antegrade wire dissection techniquesEuro CTO Club

Chronic total occlusion wiringhttps://aiimsbhubaneswar.nic.in/

Karl ISAAZ - CTO withHeavy CalcificationsEuro CTO Club

This document discusses techniques for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) with heavy calcification. It notes the difficulties posed by calcification, including inability to penetrate caps or advance wires and devices. Strategies discussed include long sheaths, large guiding catheters, stiff wires, guideliners, small balloons, microcatheters like Tornus and Turnpike, rotablator, laser, subintimal dissection with reentry, anchoring balloons, and wire escalation. Case examples demonstrate successful crossing with anchoring balloons, guideliner support, Turnpike catheter, and modified dissection and reentry. The conclusion stresses perseverance, augmented backup,

Approach to ctoSwapnil Garde

This document provides an overview of approaches to chronic total occlusion percutaneous coronary intervention (CTO PCI). It defines CTOs and discusses their prevalence. Key points include: - Success rates for CTO PCI are over 90% currently due to improved techniques and tools. - Imaging like angiography, CT angiography, and IVUS help plan procedures by assessing lesion characteristics and collateral circulation. - The retrograde approach and antegrade dissection and re-entry are common techniques in addition to the standard antegrade wire escalation method. - Scoring systems like the J-CTO and W-CTO scores can predict difficulty and likelihood of success to help determine approach. - Careful planning including

A stent inside the CTO segmentEuro CTO Club

Gsw physician teleflexEuro CTO Club

This document discusses advanced techniques for treating coronary chronic total occlusions (CTOs), including the use of guide extensions. Guide extensions provide added support to guide catheters during challenging CTO interventions. They allow coaxial alignment of devices and improved deliverability. The document reviews several case examples where guide extensions facilitated retrograde wiring and reverse CART procedures. It also discusses sizing guide extensions and important factors to consider like vessel size, lesion location, and adjunctive tools.

15:05 Sianos - OptimizingEuro CTO Club

Collateral crossing requires careful evaluation of angiograms to select the optimal collateral connection. Parameters like size, tortuosity, and insertion angle must be considered. Septal channels are initially approached with septal surfing to gently slide the wire through. If this fails, targeted crossing with tip injections may help reveal channel anatomy. Proper guidewire support and balloon anchoring can aid microcatheter advancement when issues arise. The goal is to safely cross collaterals and restore blood flow to the occluded vessel.

Rinfret S 201111International Chair on Interventional Cardiology and Transradial Approach

This document discusses techniques for performing percutaneous coronary intervention (PCI) to treat chronic total occlusions (CTOs) via the transradial approach. It provides an overview of the advantages of transradial access compared to femoral access, including lower rates of bleeding complications. The document reviews various guidewires, catheters and re-entry devices that can be used through 6 French guide catheters to cross CTOs and re-enter the true lumen, including the CrossBoss catheter, Stingray re-entry system and BridgePoint system. It presents data from studies demonstrating high success rates for transradial CTO PCI using modern techniques while maintaining very low complication rates.

17:45 TEC PEARLS 3 - Hanratty - Isr case studiesEuro CTO Club

1) The document describes two cases of patients undergoing percutaneous coronary intervention (PCI) to treat chronic total occlusions (CTOs) in the right coronary artery. 2) In the first case, multiple failed attempts were made using antegrade wire escalation and retrograde strategies before successful re-entry was achieved using antegrade dissection and re-entry with a Stingray balloon. 3) In the second case from 2013, the CTO was successfully treated with antegrade dissection and re-entry, followed by stenting and post-dilation, with follow-up angiogram and OCT showing patent stents.

CTO Iqbal Dar

Gerald Werner - AntegradeApproach Step by StepEuro CTO Club

Stylianos Pyxaras: Keynote: My essential tips & tricks for success in retrogr...Euro CTO Club

CHIP_CTO_2020_Retrograde_CTO-_Recent_concepts.pptxvaibhavpatil229406

M. Kovacic - Flash Highlights: Armentarium of CTO materialsEuro CTO Club

Friday 1600 – werner – antegrade proEuro CTO Club

Yoshimachi F - AIMRADIAL 2014 Technical - CTO and radialInternational Chair on Interventional Cardiology and Transradial Approach

Chronic total ocllusion(cto) dr hafeesh fazulu - pushpagiri - may 14th 2021Hafeesh Fazulu

Saturday 1630 – brilakis balloon uncrossableEuro CTO Club

10:05 Gershlick - The kitEuro CTO Club

Gregor Leibundgut: When the “uncrossable” becomes crossableEuro CTO Club

Novel antegrade wire dissection techniquesEuro CTO Club

Chronic total occlusion wiringhttps://aiimsbhubaneswar.nic.in/

Karl ISAAZ - CTO withHeavy CalcificationsEuro CTO Club

Approach to ctoSwapnil Garde

A stent inside the CTO segmentEuro CTO Club

Gsw physician teleflexEuro CTO Club

15:05 Sianos - OptimizingEuro CTO Club

Rinfret S 201111International Chair on Interventional Cardiology and Transradial Approach

17:45 TEC PEARLS 3 - Hanratty - Isr case studiesEuro CTO Club

Recently uploaded (20)

Starting With a Frontline “Four” in Multiple Myeloma: Case-Based Guidance for...PVI, PeerView Institute for Medical Education

Chair, Suzanne Lentzsch, MD, PhD, discusses multiple myeloma in this CME/AAPA activity titled “Starting With a Frontline “Four” in Multiple Myeloma: Case-Based Guidance for Achieving Durable Remissions With Innovative CD38 Antibody Strategies.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/4gnLEUw. CME/AAPA credit will be available until April 20, 2026.

Cardiac block, B.S.Nursing, CTVS NursingBabli Shama

Powering Genomic Workflows with Upgraded Catalogs in VSWarehouse and VarSeq 3Golden Helix

As clinical laboratories and genomic research centers process ever-growing volumes of data, the need for robust, scalable, and secure data management solutions has never been greater. The latest upgrades to Catalogs in VSWarehouse and VarSeq 3 deliver a transformative approach to storing, managing, and leveraging genomic and clinical data across on-premises and cloud environments. Join us for an exclusive webcast to explore how these enhanced Catalogs unify technology, boost performance, and introduce fine-grained permissions, empowering organizations to streamline workflows and scale with confidence. In this session, we will: - Demonstrate how upgraded Catalogs serve as a flexible backbone for storing genomic records (variants, CNVs, fusions) and clinical support data, seamlessly integrating with VSClinical and VSWarehouse for reusable interpretations - Showcase new automation features in VarSeq 3, including Saved Exports to Catalogs and Sample Catalog management, replacing legacy file-based processes with dynamic, scalable solutions - Highlight enterprise-grade security and lifecycle management, with draft-to-publish workflows, role-based permissions, and REST API integration for external systems like EHRs - Illustrate practical use cases, from custom variant annotations (e.g., blacklisting/whitelisting) to tracking sample analysis progress, all accessible through a browser-based platform Whether you’re optimizing on-premises deployments or integrating with cloud resources via our Bring Your Own Cloud (BYOC) model, discover how these upgrades provide unmatched control over data, security, and workflow automation. Join us to see how your organization can harness the full potential of Catalogs to drive efficiency, collaboration, and innovation in genomic research and clinical interpretation.

The Physiology of Central Nervous System - Neurotransmitters and NeuromodulatorsMedicoseAcademics

Learning Objectives: 1. Describe the characteristics of the transmitter substances 2. Classify the transmitter substances 3. Appreciate the actions initiated by binding of a neurotransmitter to an ionotropic (ligand-gated) versus metabotropic (G-protein-coupled, GPCR) receptor 4. Recognize the major distribution of the various types of receptors that mediate the functional responses of the common neurotransmitters 5. Provide examples of neurotransmitter dysfunction which contributes to some neuropathological disorders

Neurology. 1.2 year.semester subject unit 1JELLA VISHNU DURGA PRASAD

Unit 1: Anatomy and physiology of the nervous system General introduction to basic neurological concepts Organization of the neural system Central, peripheral and autonomic neural system Neural structures - applied anatomy and physiology Cranial nerves and those important for speech, language, hearing and balance Cerebral blood supply, nourishment and protection of the brain General principles of neural organization Transmission of information in neural system nerve fibers, synaptic transmission, action potential, chemical transmission, excitatory and inhibitory potential &neuromuscular transmission Cerebral plasticity and development of neural plasticity and cerebral dominance

Introduction to the Physiology of Central Nervous SystemMedicoseAcademics

HIV AIDS for university students studyingarthurtheophilus56

duce their risk of acquiring HIV.** * **Highly effective when taken consistently.** * **Requires regular HIV testing and medical monitoring.** • **Post-Exposure Prophylaxis (PEP):** * **Antiretroviral medications taken after a potential exposure to HIV to prevent infection.** * **Must be started within 72 hours of exposure.** * **Typically involves a 28-day course of ART.** • **Harm Reduction Strategies:** * **Needle Exchange Programs:** Provide clean needles and syringes to intravenous drug users to reduce the risk of sharing needles and transmitting HIV. * **Opioid Substitution Therapy:** Using medications such as methadone or buprenorphine to treat opioid addiction. • **Education and Awareness:** * **Providing accurate information about HIV transmission, prevention, and treatment.** * **Addressing stigma and discrimination associated with HIV.** **VIII. Global Impact of HIV/AIDS** HIV/AIDS has had a profound impact on global health and development. • **Prevalence:** An estimated 38.4 million people worldwide were living with HIV in 2021. • **New Infections:** Approximately 1.5 million new HIV infections occurred in 2021. • **Deaths:** 650,000 people died from AIDS-related illnesses in 2021. • **Regional Differences:** The burden of HIV/AIDS is disproportionately high in sub-Saharan Africa. • **Impact on Life Expectancy:** HIV/AIDS has significantly reduced life expectancy in many countries. • **Economic Impact:** HIV/AIDS has had a negative impact on economic development, particularly in countries with high prevalence rates. • **Social Impact:** HIV/AIDS has led to stigma, discrimination, and social isolation for affected individuals and communities. **IX. Ongoing Research and Future Directions** Research continues to play a vital role in the fight against HIV/AIDS. • **Cure Research:** Scientists are working to develop a cure for HIV infection, which could involve eliminating the virus from the body or achieving long-term remission without the need for ART. • **Vaccine Development:** Efforts are underway to develop a safe and effective HIV vaccine that could prevent new infections. • **Improved Treatment Strategies:** Researchers are developing new antiretroviral drugs that are more effective, easier to take, and have fewer side effects. • **Prevention Strategies:** Scientists are exploring new prevention strategies, such as long-acting injectable PrEP and broadly neutralizing antibodies. • **Understanding HIV Reservoirs:** Research is focused on understanding HIV reservoirs, which are cells in the body where HIV can hide and persist even during ART. • **Addressing Co-morbidities:** Research is exploring how HIV infection affects other health conditions, such as cardiovascular disease, cancer, and neurological disorders. **X. Conclusion** HIV/AIDS remains a significant global health challenge, but significant progress has been made in recent decad

Biography of Dr. Jose Jacob |Invasive Cardiologist|Dr. Jose Jacob

Nanobiotechnology (Exam Point of View).pptxSchool of Biosciences, MACFAST College, Tiruvalla, Kerala, India

Nanotechnology is the science and engineering of materials at the nanoscale (1–100 nanometers). It involves manipulating matter at the atomic and molecular levels to create novel materials and devices with enhanced properties. Nanobiotechnology is the interdisciplinary field that combines nanotechnology with biological sciences to develop nanoscale tools, materials, and applications for healthcare, agriculture, and environmental sustainability. Example: Carbon nanotubes, quantum dots, and nanomedicine. Drug Delivery Systems Nanoparticles improve drug bioavailability and target specific tissues. Example: Liposomes in cancer therapy (e.g., Doxil for targeted chemotherapy). 2. Nanomedicine and Disease Diagnosis Nanosensors and quantum dots enable early disease detection and imaging. Example: Gold nanoparticles in rapid diagnostic kits for diseases like COVID-19. 3. Tissue Engineering and Regenerative Medicine Nanoscaffolds and nanocomposites aid in wound healing and organ regeneration. Example: Electrospun nanofibers for artificial skin grafts. 4. Biosensors for Disease Detection Nanoparticle-based biosensors detect biomolecules for early disease diagnosis. Example: Glucose biosensors using gold nanoparticles for diabetes monitoring. . Antimicrobial Nanoparticles Nanomaterials inhibit bacterial and viral infections. Example: Silver nanoparticles in wound dressings and antibacterial coatings. 6. Smart Implants and Prosthetics Nanocoatings enhance implant biocompatibility and reduce infection risks. Example: Titanium implants coated with nanohydroxyapatite for bone integration.

LDMMIA Good Vibes Practical Reiki Bday BonusLDM Mia eStudios

In LDM, We are The Serendipity & Synchronicity of Mind, Body, and Spirit. Our mission: To always maintain union and Chi balance in all projects and courses taught.  ♥♥ Yoga is the Umbrella to many related jobs & careers. L.D.M (est 2005), Mia Resorts (est 2010). Departments and Projects rotates A 3rd Free workshop/ Bonus Session REiki - Yoga Good Vibes Session 3 Celebrating my 49th Bday. A Taurus Sun, Born early May 3rd, “76”. Also A Gemini Moon/Rising. I follow Both signs. Welcome to the Bonus Session. Beyond Basics - Good Vibes Only: —Beyond Basics - Good Vibes Only: — For me, within both Reiki and Yoga sessions the essentials boost the energy. Energy can also be called Vibrations and Frequency. So many coaches are specializing within Frequency topics. They can coach entire themes using Frequency success stories. This shows how little we think of energy? We need our coaches to boost our wisdom? To boost the vibes? For Reiki & Yoga Therapy, using ‘Props’ can assist, protect, and heal energies - faster/better. Let’s Explore more. (See Presentation for all sections, THX) Protect Your Energy Pt 1…(See Presentation) Protect Your Energy - Pt 2 We love doing what feels good right? This can be good social, comfort foods, and chill time. It’s all good but caution. Make sure to monitor who you chill with? Who you tell your future goals and secrets too? They could be causing you evil eye attacks. These things appear as bad luck or curses. Sometimes an entire social network will cause psychic attacks alone. Not to scare anyone but it’s getting worse. Be alert to what is shared. Guard Yourselves. Reiki Fusions The Benefits: I swear lol, Some love ASMR while others think its weird lol, I saw Ariana Grande did successful ASMR for a Wicked Promo. But got irritated in another session. So it does take practice lol. Nonetheless, anything holistic wellness to artsy can be added to Reiki and Remote healing. Learn to Relax? Taking breaks, pausing, relaxing, are common things ppl struggle with. Including at times, myself. Reiki requires chill hours or meditations. We often believe our schedules are badges to display for social/approval? This is a generational society belief. It takes courage to bold/quietly declare - the opposite. (The Old Matrix Systems) (See Presentation for all sections, THX) Don’t be shy. Any gift amount helps. Any and all depts of LDM & Mia Office/Studios can use petty cash or larger. So no discriminations. Also I do believe Ko-Fi accepts comments as well. You can leave a public introduction/TY/What you liked. To Donate/Tip/Love Offerings: ♥¸.•♥ ♥¸.•♥ - https://ko-fi.com/ldmmia - CashApp: $ldmmia2 or https://ldmchapels.weebly.com Public Social: https://www.instagram.com/chelleofsl/ https://x.com/OnlineDrLeZ

Staging and Grading of Oral Squamous Cell CarcinomaDr. Mayukh Chattopadhyay

The oral cavity is the site where food is received and therefore an area of body where contact with exogenous material, microorganism and harmful agents is particularly intense. The oral mucosa functions as a mechanical as well as immunological barrier Inflamed lesion, keratosis as well as premalignant and malignant changes in mucosa may be diagnosed on macroscopic inspection and palpation. Squamous cell carcinoma accounts for more than 90% of oral malignancies. Oral cancer is the most common cancer in India, with the incidence of 30–50% of whole body tumours, of which squamous cell carcinoma (SCC) arises from stratified squamous epithelium.

Understanding Acute and Chronic Renal Failure: Pathophysiology, Etiology, Cli...Dr Aman Suresh Tharayil

This presentation provides a comprehensive overview of Acute Renal Failure (ARF) and Chronic Renal Failure (CRF), covering definitions, causes, pathophysiology, signs and symptoms, and stages of disease progression. It is designed for B.Pharm 2nd semester students, pharmacy educators, and healthcare learners seeking a solid foundation in renal pathophysiology. The slides explore key differences between ARF and CRF, highlighting pre-renal, intra-renal, and post-renal causes, and the progression of chronic renal disease from early decline in renal reserve to end-stage kidney failure. Ideal for use in academic lectures, self-learning, or clinical revision.

Bill Faloon discusses age-reversal updates at HEALINC 2025maximuspeto

Anaemia & Polycythaemia Physiological BasisMedicoseAcademics

📌 Title: Anemia – Types, Causes, Pathophysiology, and Clinical Features | Dr. Faiza 🎓 Presented by: Dr. Faiza Assistant Professor of Physiology MBBS (Best Graduate, AIMC Lahore) FCPS Physiology ICMT, CHPE, DHPE (STMU) MPH (GC University, Faisalabad) MBA (Virtual University of Pakistan) 🩸 This presentation is a comprehensive overview of Anemia, designed for medical students and healthcare professionals. It covers: 🔬 Learning Objectives: Classification of anemias: Microcytic, Macrocytic, Normocytic Differentiation based on etiology, lab findings, and clinical presentation Unique features of hereditary and acquired anemias (e.g., thalassemia, sickle cell disease) Diagnostic approaches and pathophysiological mechanisms Impact of anemia on circulatory function An overview of polycythemia vera vs secondary polycythemia 💉 Includes detailed tables, RBC indices, blood picture interpretation, and mnemonics for easier recall. 🧠 Ideal for: MBBS and BDS students FCPS Part 1 candidates Educators revising core physiology Clinical practitioners updating their concepts 📚 Topics Covered: Iron Deficiency Anemia Thalassemia (Alpha & Beta) Sickle Cell Anemia Megaloblastic Anemia (Vitamin B12 & Folate) Aplastic Anemia Acute Blood Loss Hemolytic Anemias (Hereditary Spherocytosis, G6PD Deficiency) Circulatory changes in anemia Primary & Secondary Polycythemia

Parasitic Infections and Long COVID OK.pptxIbrahimAboAlasaad

Cell culture techniques M pharmacy Sem 228SamruddhiKadam

Sensory receptors and its properties_AntiCopy.pdfMedicoseAcademics

Title: Sensory Receptors | Comprehensive Physiology Lecture by Dr. Faiza (MBBS, FCPS Physiology, CHPE, MPH, MBA) Description: This in-depth lecture on Sensory Receptors, delivered by Dr. Faiza, Assistant Professor of Physiology, is designed for undergraduate and postgraduate medical students, particularly those studying MBBS, BDS, or allied health sciences. It provides a comprehensive overview of the physiology of sensory receptors, integrating foundational concepts with clinical relevance. Key Topics Covered: Classification of sensory receptors based on stimulus type, location, and structure Mechanism of sensory transduction: from stimulus to receptor potential and generation of action potential Differences between tonic (slow-adapting) and phasic (rapid-adapting) receptors Detailed comparison of major mechanoreceptors: structure, location, adaptation, and innervation Modality, intensity, location, and duration as principles of sensory coding Labeled Line Principle and Lateral Inhibition: how the brain identifies and localizes stimuli Clinical insights into receptor adaptation, two-point discrimination, and rate receptors Summary of graded vs action potentials and their roles in encoding stimulus strength Overview of afferent fiber types and nerve fiber classification Why Watch? Conceptual clarity supported by well-organized diagrams and comparative tables Designed for high-yield retention with clinical applications and exam relevance Ideal for students preparing for university exams, FCPS/MD entrance tests, and health sciences educators revisiting core concepts Created by a well-qualified educator with diverse expertise: MBBS (Best Graduate, AIMC Lahore), FCPS Physiology, CHPE, DHPE (STMU), MPH, and MBA Target Audience: MBBS and BDS students Postgraduate Physiology and Basic Sciences trainees Nursing and Allied Health students

Diseases of Bones and Joints: Rheumatoid Arthritis, Osteoporosis, Gout, and C...Dr Aman Suresh Tharayil

This slide deck outlines major disorders affecting bones and joints, including rheumatoid arthritis, osteoporosis, gout, and an introduction to cancer. It includes etiology, pathogenesis, clinical features, and treatment strategies for each condition. The presentation is intended for pharmacy, physiotherapy, and nursing students looking to strengthen their grasp of musculoskeletal pathology and its management. Simple visuals and structured content make it ideal for classroom teaching and personal revision.

The Physiology of Central Nervous System - Sensory PathwaysMedicoseAcademics

Learning Objectives: 1. Enumerate the sensory pathways 2. Enlist the sensations carried by the Dorsal Column Medial Lemniscus (DCML) system 3. Trace the DCML tract 4. Describe the characteristics of DCML system 5. Enlist the sensations carried by the Spinothalamic tract/Anterolateral System (ALS) 6. Trace the Spinothalamic tract/Anterolateral system 7. Compare the characteristics of DCML and ALS 8. Correlate the functions of DCML and ALS with the sensory loss seen in Brown-Sequard syndrome

Diseases of Gallbladder - Acute Cholecystitis & Other Diseases of GBUthamalingam Murali

This topic is very essential for MBBS Students, because for sure they will come across diseases of gallbladder in their medical career. Moreover, Lap Cholecystectomy is one of the commonest Laparoscopic surgery being performed across the world. The MBBS Students should know most of the important landmarks while watching or assisting the above case. Also included in the PPT is the recent Tokyo Guidelines for Cholecystitis....

Starting With a Frontline “Four” in Multiple Myeloma: Case-Based Guidance for...PVI, PeerView Institute for Medical Education

Cardiac block, B.S.Nursing, CTVS NursingBabli Shama

Powering Genomic Workflows with Upgraded Catalogs in VSWarehouse and VarSeq 3Golden Helix

The Physiology of Central Nervous System - Neurotransmitters and NeuromodulatorsMedicoseAcademics

Neurology. 1.2 year.semester subject unit 1JELLA VISHNU DURGA PRASAD

Introduction to the Physiology of Central Nervous SystemMedicoseAcademics

HIV AIDS for university students studyingarthurtheophilus56

Biography of Dr. Jose Jacob |Invasive Cardiologist|Dr. Jose Jacob

Nanobiotechnology (Exam Point of View).pptxSchool of Biosciences, MACFAST College, Tiruvalla, Kerala, India

LDMMIA Good Vibes Practical Reiki Bday BonusLDM Mia eStudios

Staging and Grading of Oral Squamous Cell CarcinomaDr. Mayukh Chattopadhyay

Understanding Acute and Chronic Renal Failure: Pathophysiology, Etiology, Cli...Dr Aman Suresh Tharayil

Bill Faloon discusses age-reversal updates at HEALINC 2025maximuspeto

Anaemia & Polycythaemia Physiological BasisMedicoseAcademics

Parasitic Infections and Long COVID OK.pptxIbrahimAboAlasaad

Cell culture techniques M pharmacy Sem 228SamruddhiKadam

Sensory receptors and its properties_AntiCopy.pdfMedicoseAcademics

Diseases of Bones and Joints: Rheumatoid Arthritis, Osteoporosis, Gout, and C...Dr Aman Suresh Tharayil

The Physiology of Central Nervous System - Sensory PathwaysMedicoseAcademics

Diseases of Gallbladder - Acute Cholecystitis & Other Diseases of GBUthamalingam Murali

CTO

1. DISTAL CAP PENETRATION – Cart Vs REVERSE CART Dr .V. Surya Prakasa Rao HOD – Cardiology Department Apollo Hospitals –Hyderguda, Hyderabad.

6. Antegrade Retrograde Approach

7. CLASSIFICATION – Retrograde Procedures

8. CART Technique

11. Position of Retrograde wire.

12. A B C D E

13. Retro Grade Strategy

15. A B C D E

17. CTO

18. Corsair Difficult to Negotiate at an Acute Bend

19. Corsair induced Subintimal Haematoma

20. CTO Wire Features required for CTO wires 1. Penetration force for penetrating proximal fibrous cap and advancing into true lumen 2. Pushability for crossing chronic occlusions and complex lesions with heavy calcifications and tough fibrous tissues. 3. Steerability for easy manipulate in various directions with good torque transmission 4. Shaping Memory of the tip

21. CTO Wire

22. CTO Wire

23. CTO Wire

25. CTO Wiring

26. CTO Wiring – Tip Shaping

27. CTO – Wire Manipulation

29. 1st CTO LIVE SUMMIT June 8th and 9th 2013 at MUMBAI

31. COMPLEX CTO – CHOOSING THE RIGHT HARDWARE. Dr .V. Surya Prakasa Rao HOD – Cardiology Department Apollo Hospitals –Hyderguda, Hyder

32. CTO Wiring

33. CTO

34. CTO

35. CTO

36. CTO

37. Low Profile Balloons • ACROSTAT – 1.1mm. • FALCON – 1.0mm. • SAPHIRE- 1.0mm. • MINI TREK – 1.25mm (Hydrophilic). • TERUMO - 1.25mm.

38. Antegrade Parallel Wire Technique

39. Strategy : • 7F Femoral approach and 5F Trans Radial for Contralateral Injection. • XB / EBU / Amplatz. • Plastic Jacket: Fielder XT. • Conquest / Confluenza / Miracle – Parallel wire. • Micro catheter – Corsair. • Low Profile Balloons. • DES

40. CTO

41. CTO Wire

42. CTO Wire

43. CTO Wire

44. SB Parallel wire with GAIA crossing

45. CRUSADE

46. GAIA Wire

47. Antegrade IVUS guided.

48. CTO Wiring

49. Star Technique

50. Cont..

51. Cross Boss catheter

52. String Ray

53. TORNUS

54. TORNUS

55. ISR - CTO Fielder XT with Contralateral Injection

56. ISR - CTO

57. Retro Grade Strategy

58. Ostial LAD CTO – Reverse CART • 7F / 8F – short guiding ( customized / self made) with SH. • 135 / 154 cm Corsair. • SION Blue - 0.014 ( Fielder XT, Conquest Pro12, Miracle3 / 9, Fielder XTR) • RG3 – 300cms. • Volcano IVUS – Eagle Eye Gold. • 2.5 / 3.0 mm NC Balloons. • Snare. • Coils. • Covered Stent

62. Snare: Gooseneck

63. Covered Stent

64. COILS WITH DELIVERY CATHETER

65. Pericardiocentesis Tray

67. CTO – CACTO Experience • Total No of CTO’S-2006 to Dec 2012 : 326 cases • Success rate 89.9 % • Major complications: < 1%

68. 1st CTO LIVE SUMMIT June 8th and 9th 2013 at MUMBAI

70. GUIDEWIRES - CTO

CTO

Recommended

More Related Content

What's hot (20)

Viewers also liked (20)

Similar to CTO (20)

Recently uploaded (20)

CTO