Die neue HELIOS- Patientenbefragung
Ipsilateral retrograde approach in chronic total occlusion of
the RCADr. Kambis MashayekhiHELIOS Vogtland-Klinikum Plauen
Nr.
0
Ipsilateral retrograde approach to the RCAThe typical setup in
retrograde CTO procedures is an occluded RCA Regarding the RCA, we
can achieve high revascularisation rates up to 85-90% (88,6%
success rate: Euro CTO-Club-Data 01-08/2014)
Ipsilateral approach of the left coronary system is a more
frequent retrograde approach nowadays
But there are no data about the ipsilateral retrograde approach
of the RCA occlusion
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Anatomy of the collaterals to the RCA - occlusionContralateral
collaterals:Septal collaterals from LADEpimyocardial collaterals
from an LAD and LCX-Branch
Ipsilateral collaterals:SeptalEpimyocardialBypass
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Topography of collaterals and collateral function in coronary
artery occlusionsIpsilateral Approach to the RCA - Euro-CTO-Meeting
Madrid 2014Dr. Kambis MashayekhiChronic total occlusion A GUIDE TO
RECANALIZATION Sec. Edition Waksmann and Saito 2013
RCA: contralateral collaterals
Nr.
PDA: posterior descending arteryPLA: posterolateral branchRMA:
right marginal arteryAM: acute marginal branchOM: obtuse marginal
branch
3
Topography of collaterals and collateral function in coronary
artery occlusions
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
RCA: ipsilateral epimyocardial collateralsChronic total
occlusion A GUIDE TO RECANALIZATION Sec. Edition Waksmann and Saito
2013
Nr.
PDA: posterior descending arteryPLA: posterolateral branchRMA:
right marginal arteryAM: acute marginal branch
4
Topography of collaterals and collateral function in coronary
artery occlusions
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
RCA: ipsilateral epimyocardial collaterals
Nr.
The Right superior septal artery (RSSA) was identified in 51
(3,9%) of 1290 patients. Diameter 0,8-2.0mmAnatomy of right
superior septal artery demonstrated on the coronary CT scan
Takeguchi T, Ibukuro K, Fuuda H Acta Radiol 2012 Feb. 5
Septal collaterals: Right superior septal artery
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis MashayekhiRCA: ipsilateral septal collaterals
Nr.
The Right superior septal artery (RSSA) was identified in 51
(3,9%) of 1290 patients. Diameter 0,8-2.0mmAnatomy of right
superior septal artery demonstrated on the coronary CT scan
Takeguchi T, Ibukuro K, Fuuda H Acta Radiol 2012 Feb. 6
Ipsilateral RCA CTO 1
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
7
Ipsilateral RCA CTO 1
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
8
Ipsilateral RCA CTO 1
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi300ml contrast; 129min procedure time;
14611uGym2
Nr.
Ipsilateral RCA CTO 2
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 2
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 2
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi270ml contrast; 78min procedure time;
15315uGym2
Nr.
Ipsilateral RCA CTO 3
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 3Ipsilateral Approach to the RCA -
Euro-CTO-Meeting Madrid 2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 3Ipsilateral Approach to the RCA -
Euro-CTO-Meeting Madrid 2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 3 260ml contrast117min procedure
time16119uGym2
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 4Ipsilateral Approach to the RCA -
Euro-CTO-Meeting Madrid 2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 4
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 4
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 4
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral RCA CTO 4
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis MashayekhiIpsilateral RCA CTO 4
Nr.
Ipsilateral RCA CTO 4
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi110ml contrast112min procedure
time21629uGym2
Nr.
Type of Retrograde Pathways:Contralateral vs. Ipsilateral
Approach in retrograde CTO:Ipsilateral Approach to the RCA -
Euro-CTO-Meeting Madrid 2014Dr. Kambis Mashayekhi
Nr.
Target vessel:Contralateral vs. Ipsilateral Approach in
retrograde CTO:Ipsilateral Approach to the RCA - Euro-CTO-Meeting
Madrid 2014Dr. Kambis Mashayekhi
Nr.
Procedural Data:Contralateral vs. Ipsilateral Approach in
retrograde CTOContralateral (n=62)Ipsilateral(n=29)RCA Ipsilateral
(n=6) without bypassProcedure success rate90,3%79,3% 83,3%Patient
success rate90,3%86,2% (2 successful 2nd attempts)100%(1 conversion
to conventional contralateral procedure)
Contrast (ml)268281290 Fluoro time (min)64 7576Proc.- time
(min)131144137Radiation (uGym2)164931760719592
Ipsilateral Approach to the RCA - Euro-CTO-Meeting Madrid
2014Dr. Kambis Mashayekhi
Nr.
Complications: Contralateral vs. Ipsilateral Approach in
retrograde CTOContralateral (n=62)Ipsilateral(n=29)RCA Ipsilateral
(n=6) without bypassTamponaden=1 (1,6%) n=1 (3,4%)n=0Major
collateral vessel perforationn=1 (1,6%) n=1 (3,4%)n=0
Any damage of a collateral arteryn=5 (8,1%) n=3
(10,3%)n=0Dissection of the donor arteryn=1 n=0n=0Contrast induced
nephropathyn=2 (3,2%) n=0n=0 Death (procedural)n=0 n=0n=0Death
