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 CTO
Club |
| Dr. James R. Margilis, Dr. Etsuo
Tsuchikane |
Though the therapeutic outcome
of CTO-PCI has been dramatically improved in the
DES era, the success of CTO is still largely depending
upon the technique and experience of and operator.
In the CTO club of CCT 2004, Dr. James R. Margolis
and Dr. Etsuo Tsuchikane were invited as moderators,
and discussed about the current CTO-PCI practice
with national and international experts.
Dr. Reifart first presented his lecture. He classified
the levels of operator into fout stages from a behinner
to an expert. Based upon his own experiences, Dr.
Reifart recommended a beginner of the CTO-PCI to
start from a simple case to mere complex case. Dr.
Bonnier and his colleagues established a guideline
called the Catharina approach to handle the CTO-PCI.
He presented the outcome of Catharina approach in
his hospital using by emerging devices such as the
Deflectable tip and/or Safe-Cross system. The rate
of procedural success had been increased by 75%
when these devices were combined together in their
practice.
From the US, Dr. Heuser presented the result of
the Safe-Cross system. He reported the success rate
of 76% when this system was used.
Dr. Hinohara introduced the Frontrunner X39 system
in his presentation. Like a biopsy, this system
cut out the total occlusion. Because a tip of the
device is hard to control within an artery, researchers
currently consider applying the device in peripheral
artery.
Dr. Meier presented outcomes of the opened artery
based upon historical data. Most of them demonstrated
no significant effectiveness when open the artery;
however, only one study from Japan demonstrated
its positive result.
After all speakers reported their presentations,
a discussion was started regarding the current CTO-PCI
in DES era. Dr. Margolis asked about the long-term
prognosis after CTO is successfully recanalized.
“Only randomized clinical trial can be verified
the effectiveness of open artery. We should not
answer the question based upon the experience, but
based upon the evidence.” Said Dr. Katoh.
Dr. Heuser additionally answered the question that,
“Retrospective analysis is also important.
Though we have short-term evidence no one has data
on the result of long-term prognosis. It is very
important to follow these patients.” Dr. Hinohara
also agreed with these two experts. He recommended
a long-term observation for CTO patients who undergo
the DES implantation.
Before the session was closed, Dr. Katoh presented
his lecture on “IVUS guided CTO-PCI was not
an initial wiring technique. This is a bail out
strategy after guidewire unintentionally entered
into a false lumen. An operator should not perform
this technique if dissection seems not to be treatable.
“The wire should not directly be aimed at
puncturing a true lumen in distal segment, but it
is rather puncturing a plaque in re-entry point.
A success rate is lower if operator punctures it
from false lumen to true lumen,” Dr. Katoh
added.
“Further evidences are necessary to demonstrate
the effect of DES in CTO-PCI,” said Dr. Margolis
and closed the session. |
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