Micro-catheter selection for
antegrade and retrograde
techniques: Corsair vs Finecross
Complex PCI: Left Main and CTO summit
23-25 February, New York
Session XI: Novel Antegrade and Retrograde Techniques
Georgios Sianos, MD, PhD, FESC
AHEPA University Hospital
Thessaloniki, Greece
Disclosure Statement of Financial Interest
Within the past 12 months, I or my spouse/partner have had a financial
Interest /arrangement or affiliation with the organization(s) listed below
Affiliation/Financial Relationship:
Company
Grant/ Research Support:
Abbott Vascular
Consulting Fees/Honoraria:
Major Stock Shareholder/Equity Interest:
Royalty Income:
Ownership/Founder:
Salary:
Intellectual Property Rights:
Other Financial Benefit:
FINECROSS MG
2.6Fr.
1.8Fr.
No M-coat at distal 60cm
Outer & Inner Taper
Flexible length 13cm
0.7mm
FINECROSS MG
SUS braid
0.7mm
Gold marker length
0.7mm
CORSAIR CHANNEL DILATOR
①0.86mm (2.6Fr)
Marker coil

Tapered Soft Tip

20cm Screw Head Structure

Hydrophilic Polymer Coating

PTFE Inner Layer
②0.82mm (2.5Fr)
③0.86mm (2.6Fr)
BASELINE ANGIOGRAPHY
BIFEMORAL, JR4 6Fr – EBU4 7Fr
SB ANCHORING
FINECROSS – TREK 2.0 x 12mm
ROTATIONAL FINECROSS
ADVANCMENT
PROXIMAL OCCLUSION CROSSING
AND TIP INJECTION
FINECROSS – FILDER XT
KNUCKLE TECHNIQUE
CONFIANZA PRO 12
FAILURE TO ADNVANCE THE WIRES FURTHER
RETROGRADE ACCESS
CORSAIR - SION
X CART TECHNIQUE
RETROGRADE WIRE CROSSING AND ADVANCMENT IN
THE ANTEGRADE GC
RG WIRE TRAPPING – TREK
2.5 X 12mm
CORSAIR FAILURE TO CROSS AND
FEELING OF SPINING IN THE AIR
FINECROSS EASILY ADVANCED THROUGH THE DISTAL CUP TO THE
ANTEGRADE GC
WIRE EXTENALISATION RG3
PREDILATATION TREK NC 3.0 x 15mm
NON EXPANDED @ 30 atm
ANTEGRADE FINECROSS CROSSING AND
ROTABLATION WIRE ADVANCMENT
ROTABLATION 1.5 mm
FINAL RESULT
DIAGNOSTIC ANGIO – 3RD ATTEMPT
R RADIAL 6Fr JR4 – R FEMORAL 7 Fr EBU 4
PRIMARY RETROGRADE
TRY AND ERROR SEPTAL CROSSING
CORSAIR - SION
CORSAIR FAILURE TO BE
ADVANCED IN DISTAL RPL
After some effort the catheter
was not anymore responding to
rotation
SECOND CORSAIR ALSO FAILED
EASY FINECROSS ADVANCMENT
LESION CROSSING WITH CONFIANZA PRO 12
RETROGRADE WIRE ANDVANCED
IN THE ANDEGRADE GC
FINECROSS FAILED TO CROSS
ANCHORING IN THE ANTEGRADE
GC
TREK 2.5 x 12 mm
CROSSING AFTER PULLING BACK
THE ANTEGRADE GC WITH THE
ANCHORING AS A UNIT
PREDILATATION
TREK 2.0 x 30 mm
FINAL RESULT
AFTER 3 XIENCE STENT IMPLANTATION
DOMINANT LCX CTO – SINGLE RADIAL 7Fr EBU 4
RETROGRADE ACCESS
RG3 EXTERNALISATION
NEED A 7 Fr GC FOR SIMULTANEOUS USE OF CORSAIR
AND BALLOON
TREK 2.5 x 30 mm
DOMINANT LCX CTO – SINGLE RADIAL 6Fr EBU 4
3RD ATTEMPT
SEVERE LM DISEASE
CC2 EPICARDIAL COLLATERAL
FROM RI BRANCH
PREDILATATION TREK 3.0 x 20 mm
RETROGRADE WIRE CROSSING
CORSAIR – FILDER FC
CORSAIR EXCHANGE TO FINECROSS TO PROTECT THE COLLATERAL
AFTER RG3 WIRE EXTERNALISATION
TREK 3.0 x 30 mm
FINAL RESULT
CORSAIR
 Is bulkier and requires at least a 7 Fr GC for an additional device
use (anchoring or trapping techniques, IVUS , acutely in case of
complications……). This is very important for the efficacy and
the safety especially during the retrograde approach.
 The bigger diameter of the Corsair is an advantage for the
retrograde approach as it works as “anchor” in the septum
prohibiting the catheter from pulling back during advancement
in the CTO body retrograde. This is NOT the case in the
antegrade approach.
 Has excellent conformability with the vessel curvature
especially with small and tortuous vessels like the epicardial
collaterals and therefore potentially less prone to damage them.
 Also due to its tapering tip it has an advantage for crossing
small vessels such as epicardial and septal collateral that tend to
rupture mainly when longitudinal force is applied.
CORSAIR……
 Corsair function may be impaired when the device is used
with other devices with 7Fr GCs especially during
advancement in challenging anatomy and calcified tourtous
peripheral vessels.
 Corsair may malfunction in very calcified lesions (tip
separation, break of the screw head structure).
 It is falsely considered as an alternative device to cross the
“uncrossable” lesion especially in calcified CTOs.
 The argument that provides better back up support and wire
maneuverability due to its bulkier body is debatable
especially for the antegrade approach….
FINECROSS
 Finecross is a “simpler” microcatheter, compatible with 6Fr GC
and additional device use (anchoring, trapping techniques, IVUS
or acutely in case of complications……) making it the device of
choice (both for the antegade and retrograde apprach) for
operators that they strongly prefer the use of small CG (<7Fr) or
radial operators which is very common especially in Europe.
 It’s bradding and smaller diameter are excellent characteristics
for CTO crossing especially when combined with rotational
movement.
 When failing to be advanced ,antegrade or retrograde, is less
prone to complications ( such as trapping, breaking, tip
separation…..).
 The lack of tapering at the very tip of the Finecross makes the
catheter less eligible for crossing very small and tortuous vessels
such as the epicardial collaterals.
SUMMARY
 Both microcatheters have their advantages and limitations.
Corsair is a more complex structure and when failing is more
prone to complications (tip separation, entrapment, mesh
break).
 Both microcatheters will perform equally well in the majority
of the cases substituting each other but from the other side
they are complementary especially in the most complex CTOs.
 Microcatheter selection is an individual choice and the
selection should be combined with preferences of GC size and
shape as well as preferences in the techniques use and arterial
access.
 In my practice Finecross is the microcatheter of choice for the
antegrade approach and the Corsair of the retrograde
approach.
CTO GUIDE WIRE MILESTONES
1996
1995
Crosswire
Choice PT
1st Polymer
Covered GW
ASAHI
Miracle
1st Dedicated
CTO spring
coil GW
2008
GUIDANT
TERUMO
SCIMED
2010/11
1999
1st Nitinol
Hydrophilic
CTO Guide
Wire
2009
HT CROSS-IT XT
Tapered Tip Design
ASAHI
Confianza/Pro
Tappered
hydrophilic
wires
ASAHI
ASAHI
Fielder XT
Polymer
Covered
Tapered
Guide Wire
ABBOTT
PROGRESS
Polymer Sleeve
CTO GWi
incorporating
Penetration
Power
SION
Fielder XT-A/R
Tip
Double Coil GW
Today micro-catheter development is
lacking the wire development and this
is an important limiting factor for
further evolution of the CTO techniques
Welcome to …
›› 4th Experts "Live"
CTO Workshop 2012
September 20 - 21, 2012
London, UK
www.eurocto.eu
Course Director
Carlo Di Mario
London, UK
Co-Directors
Anthony Gershlick
Leicester, UK
David Hildick-Smith
Brighton, UK
Scientific Board
Gerald S. Werner
Darmstadt, Germany
Nicolaus Reifart
Bad Soden, Germany
Alfredo R. Galassi
Catania, Italy
Hans Bonnier
Brussels, Belgium
George Sianos
Thessaloniki, Greece
Javier Escaned
Madrid, Spain