Posted in Cardiology -Interventional -PCI, Cardiology-Coronary artery disese, cath lab tips and tricks, cto chronic total occlusion, PCI PTCA Hardware, tagged chronic total occlusion, cto, tips and tricks on February 28, 2013| Leave a Comment »
Japanese are the pioneers in CTO reopening .(I understand they do less CABG surgeries for religious reasons ) CTO is the ultimate test for cardiologist patience . it may take hours to open up a CTO (or even to abandon it .) Here is a success prediction tool from Japan .
Source courtesy : JACC: Cardiovascular Interventions Volume 4, Issue 2, February 2011
Reference
http://www.sciencedirect.com/science/article/pii/S193687981000912X
Posted in cardiology- coronary care, Cardiology-Coronary artery disese, cath lab tips and tricks, cto chronic total occlusion, Hardware techniques tips, tagged chronic total occlusion, cto, fielder xt, pci for cto, retrograde cto crossing, success in cto pci, tips and tricks on February 27, 2013| Leave a Comment »
Answer :
While each one of the above factor appears very much important morphology of the lesion is the clear winner ( Which includes , the content of the lesion , hardness , micro channels , thickness of the proximal and distal caps, the length and tortuosity of the CTO ( which is invisible ) the collateral status will ultimately determine the success)
It is becoming increasingly clear cardiologist expertise is getting less and less important .
Finally , it must be told to our younger generation of cardiologists , crossing a CTO and deploying a stent is not synonymous with success .It should result in long term sustained distal flow and make a significant impact on the patients symptoms (If at all any !) and survival.
Posted in Cardiology - Clinical, Cardiology -Interventional -PCI, tagged complications of coronary stenting, coronary stenting, edge lesion, exit block in cath lab, geographical miss, plaque stent dissociation, stent lesion mismatch, tips and tricks on July 21, 2011| Leave a Comment »
Landing an aircraft is a high precision job. A pilot and co pilot with the help of air traffic control must do this job meticulously every time .They are not afford to make any mistake .Number of lives are at stake.
In cath lab something similar happens every day although a single life is at stake ! We call this coronary stent landing . If it lands wrongly it is referred to as geographical miss , a descriptive terminology for a poorly deployed coronary stent ! ( In strict terms it should be called as failed PCI !)
But there are few vital differences between the two . . .
If an aircraft overshoots the runway it is visible to every body and it becomes a national news next day !
If you deploy a stent away from a lesion it is usually a silent event . Only a few alert fellows and staffs know it ! Patient often gets discharged next day (of course after paying the bills ) and the consequence is often delayed by weeks or months when he comes back knocking the ER doors with an ACS !
Final message
The stent -plaque dissociation is much more common than we perceive , for the simple reason cardiologists have learnt to accept luminal shadows as surrogate markers for plaques . ( Coronary blindness !)
It is imperative to apply all our senses properly in the cath lab , like our pilots do while they land . Be prepared for turbulent weather which is common in cath lab as well !
http://www.sciencedirect.com/science/article/pii/S0735109701011123
Dr.S.Venkatesan MD 