JIM Today 2018 - Thursday - page 2

JIM today
Issue 1 
 22 February 2018
JIM Today
Publishing and Production
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Eberhard Grube, MD
Martin B. Leon, MD
Carlo Di Mario, MD
Jeffrey W. Moses, MD
Gregg W. Stone, MD
Nicolas Van Mieghem, MD
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Seung Jung Park, MD
Stephan Windecker, MD
Peter Stevenson
Rysia Burmicz
Tatum Anderson
Becky McCall
Peter Williams
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Thursday, February 22 2018
Main Hall Washington
Welcome and Opening Address Antonio
Colombo, Eberhard Grube
Chairperson: Gregg W. Stone
Co-Chairperson: Nicolas Van Mieghem
University Hospital
Commentators: Marco Barbanti, Michael
Haude, Karl Heinz Kuck, Oscar Mendiz,
Ghada Mikhail
Guest operators: Paul Hsien-Li Kao,
Marco Wainstein
Online factoids relevant to the case presented:
Lorenzo Azzalini (Coordinator), Ozan
Mehemet Demir, Damiano Regazzoli
Discussing the case
10.00 Coffee break
St. Raffaele Hospital
Commentators: Patrizia Presbitero, Gennaro
Sardella, Horst Sievert, Mohamed Ahmed
Sobhy, Goran Stankovic
Online factoids relevant to the case presented:
Lorenzo Azzalini (Coordinator), Ozan
Mehemet Demir, Damiano Regazzoli
Discussing the case
Continued on page 4
Can we roll it out for every patient?
iscussing how best to
transfer CTO knowledge
into daily practice today
is Gabriele Gasparini (Humanitas
Research Hospital, Milan, Italy),
during a session that delivers the
latest on new CTO wires, CTO
algorithms, complications, and
new techniques.
In an interview with
, Dr Gasparini explained
the relevant steps to mastering
CTO techniques, as well as the
pragmatic aspects of developing
a CTO programme.
“The world of CTO is
fascinating and exciting: pas-
sion, dedication, perseverance,
humility and commitment are
the ingredients needed to un-
dertake this journey,” he be-
gan. “As in other disciplines,
training in CTO intervention
will be accompanied by suc-
cesses and failures, excitement
and frustration.
“But it is important to
remember that appropriate
treatment of a CTO should
be a valuable opportunity for the
patient – yet still little appreciated
today – and more than a mile-
stone for the operator.”
Against this background,
Dr Gasparini set out four
distinct stages for learn-
ing CTO PCI, beginning
with the mastering of
antegrade techniques, first
antegrade wire escala-
tion and then antegrade
dissection and reentry.
Then, retrograde
techniques are initially
learned by using septal
collaterals and bypass
grafts, which are safer and
easier to cross, followed by use
of the more challenging and
risky epicardial collaterals. Thus,
the acquisition of wiring skills is a
gradual process.
“During the last five
years, dramatic advancements
have been achieved in the field
of CTO PCI, largely related to
dedicated device and technical
developments, and an increase in
operator skills,” said Dr Gasparini.
“With contemporary antegrade
and retrograde techniques,
success rates have reached a
ceiling of 90-95% in complex
CTOs, very close to the success
rates of non-occlusive CTO PCI,
but they remain in the hands of
few dedicated expert operators.
Further technical and strategic
developments in this field will cer-
tainly follow in the years to come,
but the biggest challenge is the
widespread adoption of these
techniques by larger numbers
of interventional cardiologists to
meet the needs of thousands of
patients with occluded coro-
nary arteries.”
Walsh and Hanratty (2016)
discussed the use of education
in the development of techni-
cal skills, writing that success
rates have reached over 90% in
experienced centres, accompa-
nied by falling complication
rates. Here, the authors also
emphasised that broaden-
ing abilities in more complex
anatomical subsets of
patients is key to driving up
overall success rates. They
detail the development of
a CTO programme, noting
the importance of full team
involvement and moving
away from ad hoc proce-
dures. Education plays a
central role too, rooted in an
understanding of lesion complex-
ity, techniques and safety
objectives, and yielding
from case observation and
workshops. Proctoring is
especially crucial, prefer-
ably with the proctor
able to scrub-in for the
case to move vbeyond
technically challenging
or potentially limiting
steps in the proce-
dure, and thus allow
the host physician
to gain hands-on
experience in all as-
pects of the CTO PCI,
particularly the parts
of the procedure that may
not have been reached oth-
Asked what bal-
ance should be
struck with
“Appropriate treatment
of a CTO should be a
valuable opportunity
for the patient...and
more than a milestone
for the operator.”
Gabriele Gasparini
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