Case 204: Manual of CTO PCI - TILT for block and deliver

A patient was referred for PCI of a RCA CTO with ambiguous proximal cap, length of approximately 60 mm and diffusely diseased distal vessel. Antegrade wiring and retrograde crossing via septals failed. Antegrade advancement knuckled of Gladius Mongo guidewire resulted in a perforation. A Guideliner was advanced over the area of perforation followed by redirection of the knuckle distally and reentry attempts with a Stingray balloon that were unsuccessful. The patient developed a pericardial effusion requiring pericardiocentesis. Attempts to deliver a PK Papyrus stent failed. While a blocking balloon was inflated in the mid RCA preventing bleeding into the pericardium, a 2nd guide catheter was used to insert a Guideliner to the mid RCA. Using the TILT (tunnel in landslide) technique, the balloon was inflated next to the Guideliner: (a) blocking blood flow to the area of perforation; and (b) increasing support for delivering the PK Papyrus stent. Using the STAR technique antegrade flow was restored to the PDA.

[@shangz0216]

Thanks for the excellent case presentation.

[@AhmedElborae]

Great lessons, and highly informative as usual, Thanks alot for sharing.

[@satheeshkumar-kj4wc]

How to free download your book of Manual of CTO intervention book Dr .Emmanouil brilakis

[@manosbrilakis]

The book is not free to download but the pci app is free and so is the information (videos and powerpoints) in pcimanual.org PCI app in Google Play: play.google.com/store/apps/details?id=com.krutsch.pcimanual&hl=en_US&gl=US&pli=1 PCI app in Apple store: apps.apple.com/us/app/pci-app/id1607148631