Use of Crusade in CTO

Posted By in Intervention

Micro-catheters

  • In CTO procedures, micro-catheters are invaluable tools
  • Current single lumen catheters such as Corsair and Caravel both by Asahi have advanced the procedure by leaps and bounds
  • The double lumen catheter ‘Crusade’ by Kaneka is also useful for crossing CTO
  • A particularly useful situation is when the CTO stump is at a bifurcation
  • It is also very useful as a tool for parallel wiring

Crusade catheter

  • This is a double lumen catheter manufactured by Kaneka
  • The detail can be obtained at this link
  • It has a lumen that runs the length of the catheter and exits at a side port near the tip
  • A second exit at the tip is of a monorail type

Wire behavior at CTO proximal cap even with support of single lumen micro-catheter

This patient has double CTO’s

  • This AP cranial angiogram shows the LAD CTO with the diagonal bifurcation at the proximal CTO site
  • The second CTO is at the Left Circumflex artery/li>

1 AP cran

  • In this view, the LAD is overlapped with the circumflex
  • This is not a good view to proceed with the procedure

2 LAD wrong entr

  • With more cranial placement of the plate, the LAD CTO site can now be seen clearly
  • Proper angulation of the X-ray tube is one secret of success

3 Steep cran

  • Placing a Runthrough wire in the Diagonal branch, the Crusade is brought down as close as possible to the CTO cap
  • A Gaia 2nd is then able to attain enough support to enter the proximal cap without being deflected or prolapsed

4 Crusade again

  • After stent placement, the LAD is successfully opened

5 Final LAD cran

This is a case of very proximal RCA CTO

  • The CTO starts at the origin of the acute marginal branch
  • To provide adequate support, one can place a small 1.5mm balloon in the marginal branch as anchor
  • Conversely, one can also use a Crusade

6 Base LAO

  • With a Runthrough wire in the acute marginal branch, a Crusade was brought down
  • A Gaia 2nd exited the side port close to the proximal cap of the CTO
  • It was possible to penetrate the cap this way

7 Crusade

After successful crossing and stenting, the RCA is treated

8 Final LAO RCA

Bifurcation and parallel wiring

  • The Crusade is also useful tool for parallel wiring or when a bifurcation is present at the CTO distal site
  • This patient has a mRCA CTO
  • At the exit site is a bifurcation to RPL and PDA

9 Base LAO

These 2 sequential still frames shows the start of CTO and the distal bifurcation

 

 
At the 1st attempt the Gaia 2nd could not enter distal true lumen but came very close

10 Bring down Gaia on Crusade

Leaving the Gaia 2nd in the current position, a Conquest Pro 12 (Confienza) was passed down and exited the side port of the Crusade

11 Gaia not in CP12 waiting

Using the Conquest Pro as a parallel wire, it entered the PDA branch

12 CP12 is in

Now the Gaia 2nd can be used to enter the RPL branch
Once both wires are verified to be in lumen, the Crusade was hydro-planed out and the vessel ballooned

13 Both in

Finally after stenting, the RCA is successfully treated

14 Final

CONCLUSION

  • Double lumen catheter is quite a recent addition to the armamentarium of the interventionist
  • There is still scope for creative use of this device other than what I have described
  • I would love to hear from anyone who has new ways of using this device
  • We may start off a discussion on our Facebook page
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