Datuk Dr Kumara, Consultant Cardiologist from National Heart Institute (IJN), Malaysia recently hosted a dedicated CTO workshop led by renowned interventional cardiologist Dr Lee Hsin Fu from Taiwan, showcasing real-time expertise, strategy refinement, and advanced techniques in chronic total occlusion (CTO) PCI.
This full-day educational event focused on three complex RCA (right coronary artery) CTO cases, attracting fellows, cardiologists, and interventionists eager to sharpen their skills in tackling one of interventional cardiology’s toughest challenges.
Case 1: Reverse CART Success
The first live case demonstrated the effectiveness of the reverse Controlled Antegrade and Retrograde Tracking (reverse CART) technique. Meticulous planning and precision led to successful recanalization of the RCA CTO, highlighting the importance of controlled subintimal dissection and re-entry.
Case 2: From Gaia 3rd to Retrograde Knuckle Wiring
This challenging second case began with antegrade wiring using a Gaia 3rd, which navigated to the right ventricular (RV) branch. The team then switched to a Sasuke microcatheter, but antegrade attempts failed to penetrate the hard mid-RCA CTO cap.
A direct retrograde approach was attempted but resulted in a vessel perforation. Undeterred, Dr Lee Hsin Fu adapted by employing a retrograde knuckle wire technique, followed by antegrade re-entry and reverse CART, ultimately achieving procedural success.
This case illustrated the importance of flexibility, technique mastery, and managing complications in complex CTO PCI.
Case 3: Septal Surfing to Success
In the final case, only one visible apical epicardial collateral was present — but it was not suitable for access. Despite initial failed attempts through three different selective septal branches, the team succeeded using a septal surfing technique, demonstrating creative retrograde channel navigation when conventional access options are limited.
Hands-On Learning with a Regional CTO Master
Dr Lee Hsin Fu’s live case commentary, troubleshooting insights, and dynamic teaching style offered participants valuable real-world pearls — from equipment selection to escalation strategy and bailout options. Each case reinforced different facets of contemporary CTO intervention, making it a high-impact workshop for all attendees.
Conclusion: IJN’s Commitment to Complex PCI Education
The CTO workshop at IJN with Dr Lee Hsin Fu reaffirmed the institute’s role as a regional leader in complex coronary interventions and advanced training. With growing demand for CTO PCI, such hands-on, case-based teaching is essential to elevate operator confidence and improve patient outcomes.
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