IMDS

Almost for 20 years TOBI has been on the frontline of complex PCI education. Please have a look at our latest portfolio additions the FlowGuide and GuidionShort present at the booth of our partner Biotronik. They can also tel you how to best use the ReCross in CTO PCI.   Did you know that as well the ReCross as the NHancer Rx can be used in a 6F guiding catheter. These are the only 6F compatible dual lumen catheters available in the market. Insider tip: Use the TrapIt as trapping balloon. The balloon on the wire design in combination with the 2F profile and no coating design on the balloon make it easy to insert, reliable to trap and very safe as when the TrapIt is match with your guiding catheter length (e.g. 100 cm guide with the TrapIt 100) it cannot exit into the coronaries.   We are moving the boundaries of PCI treatment with unique & effective procedural devices.   #Biotronik #IMDS #ReCross

FlowGuide -Designed for the Transradial approach Device interaction upon insertion into a guide extension catheter is a common issue. It’s often related to subclavian angulation combined with conventional guide extension catheter design.   The FlowGuide has a 15 centimeter distal shaft which results that the transition of proximal to distal shaft will be mostly in the relative straight part of the ascending aorta.   When the first guide extension catheter came to the market the dominant access point was the femoral approach. With a guide extension catheter length of 25 cm the transition of proximal to distal shaft was positioned in the descending aorta. With the progression of PCI treatment in the past 15 years nowadays the transradial approach is the preferred access point for most procedures causing increased potential of difficulties of device introduction at the transition with conventional designed guide extension catheters.   The FlowGuide is optimized to the current state of the art of predominant transradial access. The GuideZone at the transition also supports optimal use with femoral access.   The short distal shaft length furthermore facilitate the ability to exchange Over The Wire devices as trapping inside the guiding catheter is possible.   The 9 perfusion holes in the distal shaft support an FFR > 0.6.   FlowGuide is addressing the need for state of the art devices for optimal and safe PCI treatment ·        Reducing the risk of pressure dampening ·        Designed for transradial and femoral approach ·        Support combined use with OTW devices ·        True distal end visibility ·        Convenient device deliverability to target   Defining the next step of the state of the art treatment is what we call PCI with a PLUS

An unspoken unmet need with the use of Guide Extension catheters in PCI treatment is that sufficient blood supply is maintained during the procedure.   With conventional guide extension flow to side branches and the distal main vessel is significantly reduced causing pressure dampening. Pressure dampening is undesired, results in unnecessary stress, more proximal alignment of the guide extension despite this is sub optimal and potentially can cause procedural complications.   The FlowGuide with 9 very small perfusion holes is designed to maintain the FFR> 0.6. In opposite to conventional guide extension catheters the perfusion flow is increased instead of reduced when the FlowGuide is deeper intubated. This is while more perfusion holes are exiting from the guiding catheter.   Did you now that the marker of conventional guide extension catheter is not the true distal end but two millimeter more proximal? If you align your stent with the marker of these guide extension catheter you inflate the proximal part of the stent insight the guide extension. The IMDS guide extension catheter are uniquely designed with a true leading edge radiopaque marker so you can securely align your stent with the FlowGuide/ Guidion marker.   Addressing the unspoken unmet needs is what we call PCI with a PLUS

PCI is performed to improve an as compete as possible coronary perfusion. During the PCI procedure devices are inserted into the coronary to support the revascularization. Guide extension catheters are among the largest bore devices been inserted in a PCI procedure and often pressure dampening is observed even to the point of procedure induced ischemia which is not desired.   Pressure dampening while using a Guide extension can now be prevented by using the FlowGuide. Nine very small perfusions holes in the distal shaft are designed to keep the FFR > 0.7. By having the perfusion holes covering a distal shaft length of 4 cm blood can enter and exit and so provide the required perfusion.   In the video the very small perfusion holes of the FlowGuide are visible (spots where blood with the heart beat is exiting) and demonstrate that when pressure difference is present (e.g. when the distal vessel is occluded by the Guide extension) the FlowGuide will facilitate perfusion of blood.   FlowGuide, PCI with a Plus

An everyday challenge to wire an angulated diseased side branch. On angio it often looks straightforward but guidewires will follow the path of least resistance.   ShapeIt resolve these everyday challenges. Due to 1:1 torque response the tip of the ShapeIt can be steered toward the target vessel by gentle proximal shaft rotation. Strong shape retention will guide the wire into the target vessel. If the distal shape is not optimal for the anatomy the ShapeIt can be easily retrieved due to the rapid exchange design, the distal section can be (re-)shaped conform your needs and the ShapeIt it reinserted and steered with the modified shape towards your target.   The majority of your bifurcation wiring challenges will be a memory of the past. (Sub-) total occluded bifurcations are recommended to be approached with the ReCross. The dual lumen OTW structure provide great stability and control needed for the puncture. If the first wire goes subintimal the second OTW lumen can be used to re-puncture. Remind to use a stiffer wire (e.g. Gaia 2) than the first wire which went subintimal. The first wire in the subintimal space is your landmark of the vessel wall increasing the visualization to target a luminal puncture.

Shape the outcome of your PCI   Over 25 years many support devices have been offered to solve wiring of complex (jailed) bifurcations. Dual lumen micro catheters like the NHancer Rx have proven highly relevant and effective but require a learning curve and have certain limitations like ability to steer the side port to the required direction.   ShapeIt is designed for use in every day PCI complexity   Rapid Exchange - in and out without the need for trapping Shape and handle like a guidewire - shape the distal end conform your needs High shape retention - a stable shape providing the required guidewire direction backup 1:1 torque - direct and stable control of the bend towards the target side branch Being among the smallest profile catheters allowing effective following the guidewire into the side branch to allow distal engagement of the guidewire   ShapeIt, PCI with a plus.   Many thanks to Dr. Gregor Leibundgut, Dr. Roberto Garbo and Dr. Emmanouil (Manos) Brilakis who have been instrumental for the development of this unique procedural tool. About IMDS Strong clinical knowledge and physician partnerships, true innovation and cutting edge technology result in easy to use proven effective medical devices like the ReCross, FlowGuide, TrapIt, Micro Rx, NHancer Rx and now also the ShapeIt.   IMDS - moving the boundaries of vascular treatment

Professional educators know that when you can add a smile to teaching the engagement and learning is improved! SwissCTO&CHIP did it again. First time that a live in-vitro experiment was part of a congress. In the egg experiment where elegant displacement won from brute force. Nobody could argue different in this debate beside that high pressure balloons of course have a relevant place in the treatment calcium under the right circumstances.   What should you choose as front line support catheter? A single lumen which has a small crossing profile but limiting options of guidewire based CTO crossing or the ReCross with high versatility in wire based dual access/ CTO crossing and subintimal guidewire redirection. In several live cases the different options where demonstrate and of course discussed on pros and cons.   Last but not least FlowGuide demonstrated that minimum to none pressure dampening is possible when you use the FlowGuide in PCI treatment and so reducing the risk of procedural induced ischemia and furthermore reducing stress & rush, the basis for mistakes. The short distal shaft length furthermore facilitate ability for OTW device exchange.   The Swiss CTO&CHIP song eliminated all debate between the experts (at least for the night), never thought to hear over 100 cardiologist singing together!!   Fantastic job Gregor Leibundgut & Daniel Weilenmann can’t wait for the 2025 meeting!

Summertime is over. Time for new inspiration.   Meet the GuidionShort next week in Basel during the Swiss CTO&CHIP meeting. GuidionShort is designed for CTO&CHIP procedures as OTW devices can be easily be exchanged/ removed with the TrapIt trapping balloon or other trapping devices.   Meet us at our Biotronik partner booth to have a personal feel and touch of this new tool for CTO&CHIP!

Navigate all levels of complexity in a safe and effective manor is what we are comitted to. Continious education is essential with emerging technolgy and techniques. Great to work with the Biotronik team providing the cath labs with proffesional support.

Nice case demonstration that the FlowGuide is making a clinical relevant difference with nine perfusion holes and 15 cm distal shaft length optimizing use in the transradial approach.