1、Saiseikai Yokohama-City Eastern Hospital Current strategy of retrograde wire for CTOToshiya Muramatsu MDDivision of Cardiology, Saiseikai Yokohama-City Eastern HospitalSaiseikai Yokohama-City Eastern Hospital Strategic ChangesRetrograde approach 25.1%Seesaw wiring 33.2%GW 4.0 2.4 (max 10)Total 46.4
2、%Seesaw wiring 43.1%Conquest trialN=116July, 2019 - March, 2019J-CTON=378April, 2019 - December, 20192 years laterSaiseikai Yokohama-City Eastern Hospital Approach site (Overall) femoral 80.8% 97.4%radial 5.1% 1.8%brachial 14.2 % 0.9%Single site puncture 35.4% 49.5%Dual site puncture 64.6% 50.5%GC s
3、ize 6.9 0.5 Fr 7.1 FrGC size (contralateral) 6.0 1.0 FrContrast amount (cc) 312 155 365 146Fluoro scopic time (min) 52.9 37.8 50.9 35.7 Total procedural time (min) 123.3 65.7 Emergent procedure 1.8%Basic Procedural CharacteristicsJ-CTO ConquestN= 451Saiseikai Yokohama-City Eastern Hospital N=337Proc
4、edural Success90.0 %89.8 %90.5%（initial success 87.9%)88.8%Conquest trialSaiseikai Yokohama-City Eastern Hospital Single wire 94.0% 277 133 43.2 31.5 (54.6%)Seesaw 82.1% 339 153 50.2 29.3(20.3 %)Retrograde 93.3 % 436 203. 76.4 45.6(11.9 %) Seesaw + Retrograde66.0 % 423 150 97.9 9.0(12.7%) N=378 Proc
5、. success (%DS 3 times) 4.2%Stent thrombosis 0%Stroke 0%In-hospital outcomesN=451Saiseikai Yokohama-City Eastern Hospital Perforation 4.4% (18/408)tanponade 0.5%(2/408)Treatment balloon compression 2.7% (11/408)drainage 0.2% (1/408)coil embolization 0.5% (2/408)covered stent 0% (0/408)surgery 0% (0/
6、408)Emergent PCI 0.9% (4/451)Emergent CABG 0% (0/451)Blood transfusion 2.0% (9/451)Access site surgery 0.4% (2/451)GI bleeding 0.2% (1/451)ComplicationsSaiseikai Yokohama-City Eastern Hospital Retrograde Wire TechniqueGuidewire cross from CTO distal site through collaterals channels supplied from co
7、ntrallateral vessel.Saiseikai Yokohama-City Eastern Hospital Indication of Retrograde ApproachlFailed Antegrade ApproachlHopeless Antegrade ApproachUnknown Entry PointLong CTO(40mm) Heavy CalciumRCA Bent Point CTOAnte GW into Subintimal SpacelGood CollateralsStraight, Big, VisibleSaiseikai Yokohama-City Eastern Hospital Systems of retrograde techniqueRetrograde guiding cathetershort GC(85-90cm), 7 or 8F, good back-upRetrograde guidewirefloppy type GW( fielder, whisper, runthrough etc)Retrograde balloonlong and small balloon(150cm,1.25mm), 23atm
