Coronary Chronic Total Occlusion Interventions. Coronary chronic total occlusions CTOs are lesions with thrombolysis in myocardial infarction TIMI 0 flow for 3 months. Patients with coronary CTOs are often referred for coronary artery bypass graft surgery CABG,2,3 but percutaneous coronary intervention PCI is the preferred mode of revascularization for several patients, especially those with prior CABG and those with isolated right coronary artery CTO. Although no randomized controlled clinical trials comparing CTO PCI with medical therapy have been published to date, there is a growing body of evidence suggesting clinical benefits of CTO PCI. These benefits include an improvement in anginal symptoms,7,8 decreased anti anginal medication intake, improved exercise capacity,9 improved left ventricular systolic function,1. CTO PCI. 1. 2 Moreover, CTOs are the most common reason for failing to achieve complete revascularization,1. Traditionally, CTO PCI has been considered a highly challenging procedure with low success rates. Asahi Soft Guidewire' title='Asahi Soft Guidewire' />Get the latest news and analysis in the stock market today, including national and world stock market news, business news, financial news and more. Asahi%20Meister%202.jpg' alt='Asahi Soft Guidewire' title='Asahi Soft Guidewire' />In a recent analysis from the American College of Cardiology ACC National Cardiovascular Data Registry NCDR Cath. PCI Registry, CTO PCI represented only 3. PCI volume for stable coronary artery disease and was associated with lower procedural success 5. CTO PCI. 1. 6 However, higher operator annual CTO PCI volume was associated with improved success without a significant increase in major complications. The major reason for CTO PCI failure is inability to cross the lesion with a guidewire. Many experienced centers have reported that contemporary crossing techniques and devices have significantly improved the likelihood of CTO PCI success. CTO PCI starts with a careful review of the coronary angiogram that, in nearly all cases, should be performed using dual injection Figure 1. Procedural plans are then made based on the lesion angiographic characteristics, while maintaining flexibility in case the initially selected crossing approach fails to achieve progress. Guide Wires. Regalia XS 1. ASAHI Gladius 014 200cm, 300cm ASAHI Halberd 014 200cm, 300cm Astato XS 20 180cm, 300cm Astato XS 40 200cm, 300cm. VOLVER AL NDICE Notas Aranceles 2017. Las prestaciones realizadas en horario inhbil tienen un recargo del 50. El horario inhbil se considera. Catalog Number Catheter Usable Length cm O. D. of Distal Shaft mminch O. D. of Proximal Shaft mminch I. D. of Distal and Proximal Shaft mminch O. D. of Tip. AS0 Reserved AS ZZ AS1 LVLT1 Level 3 Communications, Inc., US AS2 UDELDCN University of Delaware, US AS3 MITGATEWAYS Massachusetts Institute of. Asahi Soft Guidewire' title='Asahi Soft Guidewire' />The three major CTO crossing techniques currently being used are 1 antegrade wire escalation, 2 antegrade dissectionre entry and 3 retrograde. A brief overview of the basics and recent developments of each approach follows. Figure 1 Hybrid Algorithm for Crossing CTOs. Antegrade Wire Escalation. Game Time Crisis 3 Full Version. Antegrade wire escalation is the most commonly used CTO crossing approach. A microcatheter is advanced to the proximal cap of the occlusion, followed by crossing attempts using various guidewires. Currently, the most common initial guidewire choice is a soft tip, polymer jacketed tapered guidewire such as the Fielder XT, Asahi Intecc. If this fails to cross, then either a stiff, polymer jacketed wire such as the Pilot 2. Abbott Vascular Santa Clara, California or a stiff, tapered wire such as the Confianza Pro 1. Asahi Intecc are used. The recent introduction of composite core stiff guidewires Gaia first, second, and third, Asahi Intecc could further improve antegrade wiring success due to good torque control, but also require different manipulation slower manipulation to allow torque transmission from the proximal to the distal end of the guidewire. Asahi Soft Guidewire' title='Asahi Soft Guidewire' />Understanding the course of the guidewire is critical both for enhancing the likelihood of success and for minimizing the risk for complications. This can be accomplished in most cases using dual coronary injection. If the guidewire enters the distal true lumen as confirmed in two orthogonal projections, the microcatheter is advanced past the occlusion, and the guidewire is exchanged for a workhorse guidewire, followed by balloon angioplasty and stenting. Frontline Cases ASAHI SION Tip load O Tip radiopacity. First choice guidewire with proprietary composite core construction for excellent tip. If the guidewire exits the vessel, it is withdrawn and redirected. If the guidewire crosses the occlusion but enters the subintimal space, true lumen re entry could be achieved using a parallel wire technique or more commonly in North America using a dedicated re entry system Stingray balloon and guidewire, Boston Scientific. Antegrade DissectionRe Entry. Dissectionre entry refers to the intentional use of the subintimal space for crossing coronary CTOs. This technique was introduced by Antonio Colombo, MD, FACC, who originally advanced a knuckled guidewire through the subintimal space until it spontaneously re entered into the distal true lumen subintimal tracking and re entry STAR technique. Various modifications of this technique have been subsequently developed, but a challenge with all extensive dissectionre entry strategies is the high rate of restenosis and reocclusion that accompanies them. As a result, these techniques are currently used only as a last resort if all other approaches fail. Limited dissectionre entry strategies appear to have better short and long term outcomes. Dissection can be achieved with the Cross. Boss catheter Boston Scientific Natick, Massachusetts, which is a stiff, metallic, over the wire catheter with a 1 mm, blunt, rounded, hydrophilic coated, distal tip that can advance through the occlusion when the catheter is rotated rapidly using a proximal torque device fast spin technique. In approximately one in three cases, the catheter enters the distal true lumen, whereas in the remaining two thirds, it creates a limited dissection plane that facilitates true lumen re entry. Re entry can be achieved using the Stingray system Boston Scientific. The Stingray balloon is a flat 1 mm balloon with three exit ports that communicate with a common lumen. The distal port is used to advance the balloon into position. The other two ports, one proximal and one distal, are 1. When the balloon is inflated, it self orients so that one port is facing the true lumen and the other is facing the adventitia. The Stingray guidewire is a stiff, angled guidewire with a 0. To facilitate re entry, the Stingray wire is often exchanged for a more steerable guidewire such as the Pilot 2. Abbott Vascular after re entering the distal true lumen stick and swap technique. The Retrograde Approach. The retrograde approach to CTO crossing can significantly increase success rates, particularly in challenging lesions. A guidewire is advanced into the artery distal to the occlusion through either a bypass graft or collateral channels, followed by CTO crossing against the original direction of blood flow. Retrograde crossing is usually easier because the distal cap is softer, more frequently tapered,3. Bypass grafts. 34 and septal collaterals. Crossing the collateral is facilitated via the use of dedicated microcatheters such as the Corsair, Asahi Intecc, and Turnpike, Vascular Solutions and guidewires, such as the composite core Sion guidewire Asahi Intecc, and the soft polymer jacketed guidewires such as the Fielder FC, Asahi Intecc, and the Pilot 5. Abbott Vascular. After guidewire crossing into the distal true lumen is confirmed, the microcatheter is advanced to the distal cap, followed by CTO crossing, which is usually done using a wire escalation or dissection re entry technique. Currently, the most commonly used retrograde crossing technique is the reverse controlled antegrade and retrograde subintimal tracking reverse CART technique. The retrograde guidewire and microcatheter are then advanced into the antegrade guide catheter followed by wire externalization, which has been greatly facilitated by the recent introduction of the RG3 wire Asahi Intecc. Micro Catheter Tornus MEDICAL PRODUCTMEDICAL PRODUCTS Micro Catheter Tornus. To pagetop. Catalog Number. Nl Epub Vermeer here. Catheter Usable. LengthcmO. D. of Shaft mminchI. D. of ShaftmminchO. D. of TipmminchI. D. of TipmminchDia. Of Covered TubemminchRecommended GuidewiremminchAT2. Catalog Number. Catheter Usable. LengthcmO. D. of Distal ShaftmminchO. D. of. Proximal ShaftmminchI. D. of Distal and. Proximal Shaftmminch. O. D. of TipmminchI. D. of TipmminchDia. Of Covered. TubemminchRecommended GuidewiremminchAT3.