Experts "Live" CTO Workshop 2015 Septemper, 18th – 19th , 2014 in Istanbul, Turkey

1. Bifurcation in the steting of
CTO setting
Omer Goktekin, MD
Bezmialem Vakif University
Istanbul, Turkey
EuroCTO 20015, Istanbul

2. • CTOs often have side branches at the proximal
or distal cap
• Treating CTOs with a bifurcation can be
challenging
• Could result in recanalization of only one of
the branches
• It may cause periprocedural myocardial
infarction
• Resulting in incomplete revascularization

3. • Bifurcation at distal cap is especially a
challenge during antegrade approach
• Retrograde approach may help to save both
branches but not guaranteed
• Bifurcation at proximal cap is a challenge
during retrograde approach
• Reverse CART technique may help to save
both branches but not guaranteed

4. We should make sure that we are working on
the true-true lumen

9. Additional tools may require to deal
with CTO related bifurcation
IMDS Vascular Solutions
Double Lumen Catheters
Terumo

10. CTO on CX-OM bifurcation

11. Pilot 50 in Fine Cross Micro cath

14. Twinpass
catheter

16. Techniques for bifurcation related CTO
When dissected in two vessel

17. Guidewire at subintima

18. Adequate angulation for
STAR technique

20. Mini Crush is the optimum technique to
retain both vessels

21. Final result

22. Retrograde approach may not always
save the branch

27. Bifurcation related CTO
Which technique: Cullotte vs Minicrush

31. 1 month later
Final result of the first
attmeption

32. Final result of the
second attempt
1 yr follow-up

33. Importance of Micro cath tip injection
in Bifurcation CTO

35. Miracle 6 gr in Corsair

39. 3.0X18 mm
Absorb

44. After 2 BVS

45. Branch occlusion may result periop MI

56. Retrograd approch may cause lost of
Branch in proximal cap bifurcation

67. Guidezilla
Guideliner

74. After 2 DES (bifurcation) and 2 Absorb