Webinar 4 | CTO Intervention Techniques-Bifurcation Club Webinar 4

Video Transcription

Video Summary

The webinar focused on CTO intervention techniques within the Sky Bifurcation Club series, with presentations on retrograde CTO PCI, side branch preservation, calcium management, and drug-coated balloon (DCB) use.<br /><br />Dr. Anderson explained that retrograde CTO PCI remains important despite advances in antegrade and hybrid approaches. He emphasized key reasons to choose retrograde upfront: ambiguous proximal caps, distal bifurcation involvement, diffuse distal disease, failed antegrade attempts, anomalous coronaries, and flush occlusions. Case examples showed retrograde approaches helping reduce contrast and radiation, and avoiding problems such as losing side branches or getting trapped under prior stent struts.<br /><br />Dr. Alaswad discussed why side branches matter, showing that losing significant branches can worsen outcomes. He stressed evaluating the size of the subtended myocardium, not just vessel diameter, and recommended wiring important side branches early. He reviewed strategies such as dual lumen catheters, IVUS guidance, ADR, STAR, slash techniques, and retrograde approaches to preserve branches, especially when the distal cap involves a bifurcation.<br /><br />Dr. Kearney addressed CTOs with heavy calcium, noting that calcification can prevent wire or equipment delivery and complicate re-entry. She highlighted early escalation to rotational atherectomy, careful use of laser, IVL, and guide extensions, and warned about risks of cutting or orbital atherectomy in dissected or subintimal spaces.<br /><br />Dr. Sandesari presented DCB use after CTO recanalization. He described cases where DCBs were useful for long diffuse distal disease, side branches, and post-STAR healing, often reducing the need for long stent segments. He summarized early observational data suggesting DCBs are safe and effective in selected CTO cases, while acknowledging more data are needed.<br /><br />The session ended with discussion on increasing real-world DCB use and the need for further evidence.

Asset Subtitle

J. Dawn Abbott, MD, MSCAI; Khaldoon Alaswad, MD, FSCAI; Mousumi Andersen, MD; Rhian E. Davies, DO, FSCAI; Kate Kearney, MD, FSCAI; Pratik Sandesara, MD

Asset Caption

closed captions are computer-generated

Keywords

CTO intervention

retrograde CTO PCI

side branch preservation

calcium management

drug-coated balloon

antegrade approach

hybrid CTO techniques

rotational atherectomy

IVUS guidance

bifurcation lesions