Chronic Total Occlusion (CTO) Devices Are Key - VascularWeb
Chronic Total Occlusion (CTO) Devices Are Key - VascularWeb
Chronic Total Occlusion (CTO) Devices Are Key - VascularWeb
- No tags were found...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Chronic</strong> <strong>Total</strong> <strong>Occlusion</strong> (<strong>CTO</strong>)<strong>Devices</strong> <strong>Are</strong> <strong>Key</strong> -What’s Out There and NewNeal S Cayne, MDDirector of Endovascular SurgeryDivision of Vascular SurgeryNew York University Langone Medical CenterNew York, NYDivision of Vascular and Endovascular Surgery
NO DISCLOSURES2Division of Vascular and Endovascular Surgery
Crossing <strong>Devices</strong>•3Division of Vascular and Endovascular Surgery
Crossing <strong>Devices</strong>• Avenger - Wild Cat• Bard - Crosser• Baylis - Powerwire• BSC - Truepath• Cordis - Frontrunner• Coviden - Viance4Division of Vascular and Endovascular Surgery
Re-entry <strong>Devices</strong>• BSC - Offroad• Cordis - Outback• Coviden - Enteer• Medtronic - Pioneer5Division of Vascular and Endovascular Surgery
Avenger - Wildcat• Rotatable Tip• Passive and Active• 6 Fr, 0.035”• Hydrophilic coating• Manual or Powered6Division of Vascular and Endovascular Surgery
Avenger - Wildcat7Division of Vascular and Endovascular Surgery
Avenger - Wildcat•8Division of Vascular and Endovascular Surgery
Avenger - Wildcat• CONNECT Trial- Technical Success – 89.3%- Average <strong>CTO</strong> length – 17.4 CM9Division of Vascular and Endovascular Surgery
Avenger - Kittycat• Kittycat, Kittycat 2• .014” versions• Tight lesions/tibial lesions10Division of Vascular and Endovascular Surgery
Avenger - OCELOT• Optical Coherence Tomography(OCT)• Real time intravascular cross sectionalimaging• CONNECT II - 97% Crossing successDivision of Vascular and Endovascular Surgery11
Bard - Crosser• High Frequency Mechanical Vibration• Reusable Electronic Generator• 3.9-4.8 Fr (5 Fr sheath)• .014” or .018”• Stainless Steel Tip• Hard or calcified lesionsDivision of Vascular and Endovascular Surgery12
Bard - Crosser• Support Catheter (Microsheath)• Angled• Requires 7 Fr sheath13Division of Vascular and Endovascular Surgery
Bard - Crosser14Division of Vascular and Endovascular Surgery
Bard - Crosser15Division of Vascular and Endovascular Surgery
Bard - Crosser16Division of Vascular and Endovascular Surgery
Bard - Crosser17Division of Vascular and Endovascular Surgery
Bard - Crosser18Division of Vascular and Endovascular Surgery
Bard - Crosser• PATRIOT Trial- Technical Success – 84%- Average <strong>CTO</strong> – 11.8 CM19Division of Vascular and Endovascular Surgery
Baylis - PowerWire• Radiofrequency Energy• Generator – Optimized for Venous• Await Arterial Generator in US• OD - .035”• Wire can be used for intervention20Division of Vascular and Endovascular Surgery
Baylis PowerWire21Division of Vascular and Endovascular Surgery
Boston Scientific - TruePath• Rotating Diamond Tip• On table power source• .018” Wire22Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath23Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath24Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath25Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath26Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath27Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath28Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath29Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath30Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath31Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath32Division of Vascular and Endovascular Surgery
Boson Scientific - TruePath• ReOpen Trial- 80% Success33Division of Vascular and Endovascular Surgery
Cordis - Frontrunner• Blunt Microdissection• Mechanical Jaws• Manually Operated• .039”34Division of Vascular and Endovascular Surgery
Cordis - Frontrunner• Micro Guide support catheter• Conduit for rapid wire exchange35Division of Vascular and Endovascular Surgery
Cordis - Frontrunner•36Division of Vascular and Endovascular Surgery
Cordis - Frontrunner•37Division of Vascular and Endovascular Surgery
Cordis - Frontrunner•38Division of Vascular and Endovascular Surgery
Coviden - Viance• Intraluminal or subintimal• .014”, blunt• Spun – torque device• Rapid Manual Turning• No capital equipment39Division of Vascular and Endovascular Surgery
Coviden - Viance40Division of Vascular and Endovascular Surgery
Coviden - Viance41Division of Vascular and Endovascular Surgery
Coviden - Viance42Division of Vascular and Endovascular Surgery
Coviden - Viance43Division of Vascular and Endovascular Surgery
Coviden - Viance44Division of Vascular and Endovascular Surgery
Coviden - Viance45Division of Vascular and Endovascular Surgery
Coviden - Viance• PFAST-<strong>CTO</strong>s• 84% Technical success46Division of Vascular and Endovascular Surgery
Re-entry <strong>Devices</strong>• BSC - Offroad• Cordis - Outback• Coviden - Enteer• Medtronic - Pioneer47Division of Vascular and Endovascular Surgery
Boston Scientific - Offroad• Conical balloon 5.4mm• When inflated, points toward truelumen• Microcatheter lancet• Clinical Trials48Division of Vascular and Endovascular Surgery
Boston Scientific - Offroad49Division of Vascular and Endovascular Surgery
Cordis - Outback• 6 Fr Catheter• .014” wire• Premounted needle• Fluoroscopic orientation-“T” or “L”• Poke into true lumen50Division of Vascular and Endovascular Surgery
Cordis Outback• Orient “L”shapedmarkertowardslumen51Division of Vascular and Endovascular Surgery
Cordis Outback• Orient “L”shapedmarkertowardslumen52Division of Vascular and Endovascular Surgery
Cordis Outback• Orient “L”shapedmarkertowardslumen53Division of Vascular and Endovascular Surgery
Coviden - Enteer• Flat balloon orients itself in subintimalspace - .018”• Points needle toward true lumen• Balloon (2.75/3.75mm)• Below and above kneeDivision of Vascular and Endovascular Surgery54
Coviden - Enteer55Division of Vascular and Endovascular Surgery
Coviden - Enteer56Division of Vascular and Endovascular Surgery
Coviden - Enteer57Division of Vascular and Endovascular Surgery
Coviden - Enteer58Division of Vascular and Endovascular Surgery
Coviden - Enteer59Division of Vascular and Endovascular Surgery
Medtronic - Pioneer• Similar to Outback• 6F• Premounted needle• IVUS guided• Volcano60Division of Vascular and Endovascular Surgery
Conclusion• <strong>CTO</strong>/re-entry devices add to ourarmamentarium for the treatmentof <strong>CTO</strong>s.• <strong>Devices</strong> can increase the likelihoodof success when standardwires/catheters fail.• Future - Cost of these devices maybe a limiting factor.61Division of Vascular and Endovascular Surgery
Division of Vascular and Endovascular Surgery