CTO Fundamentals.org: interaktywny kurs angioplastyki przewlekłych okluzji


Zabieg angioplastyki tętnic wieńcowych staje się pojęciem, w ramach którego tworzą się obszary podspecjalizacji. Jedna z nich poświęcona jest leczeniu przewlekłych okluzji (CTO, ang. chronic total occlusion).

Zabiegi angioplastyki, w tym wskazaniu, są uznawane za jedne najtrudniejszych, najbardziej wymagających i najdłuższych. Nic więc dziwnego, że liczba operatorów, którzy specjalizują się w CTO jest ograniczona. Tym trudniej jest młodym kardiologom inwazyjnym zdobywać rzetelną wiedzą w tym zakresie.

W tym kontekście wyjątkowo pomocny jest interaktywny kurs e-learningu CTO opracowany przez zespół ekspertów pod kierownictwem prof. Khaldoon Alaswada, MD, FSCAI, FACC, FSVM, RVT z Appleton Heart Institute.

Inicjatywa CTO Fundamentals oferuje na swojej stronie bezpłatny kurs szkoleniowy zaopatrzony w serię filmów i testów i wiedzy. Bardzo ciekawa jest również biblioteka przypadków klinicznych (wymagana jest jedynie rejestracja on-line): http://ctofundamentals.org

Tematy kursu:

1. Rationale for CTO PCI

pershad editedlecture Ashish Pershad, MD (23:57)

Learning Objectives:

  1. Recognize what the barriers are for CTO PCI adoption
  2. Identify the 5 evidence based reasons to attempt revascularization of CTO’s.
  3. Understand the use of ischemia based revascularization strategies in patients with CTO.

VIEW VIDEO – 1. Rationale for CTO PCI

2. Toolbox and Inventory Requirements for CTO-PCI

alaswad editedlecture Khaldoon Alaswad, MD (50:11)

Learning Objectives:

  1. To describe vascular access equipment and guide catheters during CTO-PCI.
  2. To describe coronary guide wires and micro catheters for CTO-PCI.
  3. To describe subintimal dissection and reentry equipment.

VIEW VIDEO – 2. Toolbox and Inventory Requirements for CTO-PCI

3. CTO PCI Procedural Planning

lembo editedlecture Nicholas Lembo, MD (42:30)

Learning Objectives:

  1. Assessment of pre-procedural angiogram with regard to CTO vessel characteristics and importance of collateral injections.
  2. Identification of pre-procedural risks and strategies to prevent contrast induced nephropathy.
  3. Operator strategies to decrease risk of radiation induced patient skin injury.

VIEW VIDEO – 3. CTO PCI Procedural Planning

4. Wire Strategy as a First Option. Properties of the Tools

burke Nicholas Burke, MD (17:31)

Learning Objectives:

  1. To understand basic guidewire characteristics and types.
  2. To understand the concept of Penetration Power and how it differs from Tip Stiffness.
  3. To understand how differing guidewire types are used in CTO PCI.

VIEW VIDEO – 4. Wire Strategy as a First Option. Properties of the Tools

5. Antegrade Dissection/Re-Entry Managing Dissections

wyman editedlecture Mike Wyman, MD (30:55)

Learning Objectives:

  1. Understand the available techniques for antegrade dissection re-entry and how they differ.
  2. Describe the basic components of the BridgePoint System and how they are used.
  3. Understand the advances in technique and how they have impacted success rates

VIEW VIDEO – 5. Antegrade Dissection/Re-Entry Managing Dissections

6. Retrograde Planning

wyman editedlecture James Spratt, MD (24:57)

Learning Objectives:

  1. To understand the indications for a primary retrograde approach
  2. To understand the particular complications associated with retrograde access and how to avoid them
  3. To understand the concept of the “interventional” collateral and how to select a collateral for retrograde access
  4. To introduce the concept of collateral dominance and understand its relevance to the retrograde approach

VIEW VIDEO – 6. Retrograde Planning

7. Retrograde Dissection Re-Entry

alaswad editedlecture Tony DeMartini, MD (25:37)

Learning Objectives:

  1. Understand the antegrade and retrograde steps in a retrograde dissection reentry approach.
  2. Appreciate the sizing for the antegrade balloon in retrograde dissection reentry.
  3. Differentiate the anatomical variables that determine an initial wire escalation or dissection reentry approach in retrograde CTO.

VIEW VIDEO – 7. Retrograde Dissection Re-Entry

8. Retrograde Externalization

grantham editedlecture J. Aaron Grantham, MD (18:12)

Learning Objectives:

  1. Discuss situations in which snaring may be needed to facilitate externalization.
  2. Describe the equipment needed and steps involved in snaring and wire externalization.
  3. Discuss the benefits of snaring and externalization.
  4. Understand the characteristics of a good externalization wire.

VIEW VIDEO – 8. Retrograde Externalization

9. Anatomic and Procedural Progress to Dictate Strategy

thompson editedlecture Craig Thompson, MD (32:52)

Learning Objectives:

  1. To understand methods for evaluating and formulating strategy for CTO PCI based on initial angiogram.
  2. To develop and understand methods for contingency strategies and procedure planning in CTO PCI.
  3. To understand a standardized algorithm for technical approaches for CTO PCI to mazimize safety, effectiveness and efficiency.

VIEW VIDEO – 9. Anatomic and Procedural Progress to Dictate Strategy

10. Transradial CTO PCI

rinfret editedlecture Stephane Rinfret, MD (40:59)

Learning Objectives:

  1. Understand the rationale for the use of the transradial approach for CTO PCI.
  2. Learn the proper equipment to use.
  3. Understand what can or cannot fit in a 6F guide.

VIEW VIDEO – 10. Transradial CTO PCI

11. Informed Consent of the CTO Patient

whitlow editedlecture Pat Whitlow, MD (25:03)

Learning Objectives:

  1. Understand the key elements required for Informed Consent.
  2. Understand the guidelines for how much detail is required for adequate Informed Consent.
  3. Understand that an allegation of “lack of informed Consent” is usually legally considered as a medical claim requiring expert testimony rather than as a civil charge of battery.

VIEW VIDEO – 11. Informed Consent of the CTO Patient

12. Complications of a CTO PCI Including Radiation Injury

brinklas editedlecture Manos Brilakis, MD (42:32)

Learning Objectives:

  1. Recognize what the barriers are for CTO PCI adoption
  2. To describe possible complications of CTO interventions
  3. To present strategies for the prevention of CTO PCI related complications
  4. To discuss and evaluate various treatment options and specialized equipment

VIEW VIDEO – 12. Complications of a CTO PCI Including Radiation Injury

13. How to Build a High Level CTO Program

karmpaliotis editedlecture Dimitri Karmpaliotis, MD (23:57)

Learning Objectives:

  1. To introduce the concept of the CTO team as an essential strategy for successful, safe and efficient CTO PCI.
  2. To discuss several important steps for the development of a successful CTO program.
  3. To discuss the economics of CTO PCI in the USA

VIEW VIDEO – 13. How to Build a High Level CTO Program



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