Leung Calvin @drcleung

ZOLUTION 3D wiring on the Asahi rotational model live at CTO Club 2026 Nagoya. Interesting to see a simple 3D technique spirals the wire tightly around the vessel center with few wire rotation — just repeat: 1) find ZOV (overlap view), 2) straighten the tip, 3) move to a secondary view (35-70° from ZOV) to confirm tip direction and advance wire until it reaches center, becoming the new ZOV (video edited in fast-forward) @ctodemon @KambisMashayek1 @realarainmd @dautov_MD @Laserrman @esbrilakis @BarberoUmberto @ungureanuclau20 @OpolskiMP @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Carl01196478 @K_DeSilva @DrJMHill @AntonisPavlidi3 @RajanRehan23

A great honor to contribute to the APCTO session at CTO Club 2026 in Nagoya — including a live model demonstration of ZOLUTION 3D wiring!

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A Simple Framework for Overlap View 3D Wiring. Happy to contribute to this work. See the short video and doi.org/10.1002/ccd.70… @ccijournal @KambisMashayek1 @realarainmd @dautov_MD @Laserrman @esbrilakis @sandeep_jalli @BarberoUmberto @ungureanuclau20 @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Carl01196478 @K_DeSilva @DrJMHill @AntonisPavlidi3 @RajanRehan23 @AishSinha1

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#ACC26 What an incredibly challenging RCT. ORBITA CTO. Simple question with amazing blinding and patient reported angina frequency based on app (much better than recall). CTO PCI DOES improve angina much more than meds in JCTO 3 or less.

Appreciate the question. Current data in coronary use very limited; wire perforation may be better tolerated, while risk spikes when it goes unnoticed and devices follow. Perhaps, in addition to controlled wire manipulation with 3D techniques, confirm distal true-lumen position before any device, and consider IVUS to ensure the wire isn’t too close to the adventitia side before any atherectomy- could be key to safety in this technique.

Excellent demonstration ARCADIA technique for Calcified Nodule in #PCI by Dr Kiwamu Sudo: doi.org/10.1016/j.jacc… And our editorial comment - Intra-Calcium Modification: New Promise for Calcified Nodule in PCI? : doi.org/10.1016/j.jacc…

The CLARP is for retrograde wire only. It will be useful for operators that wish not to think of the mental picture every time. For antegrade wire it will be just like using the JR4 guide . Great point ! Personally I image the cross section, looking from the shaft of wire toward the tip (which work for both antegrade and retrograde ) to determine the wire rotation direction.

Definitely agree. When retrograde wire created large subintimal or periwire space, retrograde wire control is lost and any attempt for directed reverse cart will be difficult without wire control and penetration. This 3d reverse cart will work best when retrograde wire peri-wire space still preserved . Rotate wire only once to direct a high penetration wire and first attempt puncture for highest success.

Directed Reverse CART is the perfect scenario to apply the OVERLAP VIEW #3Dwiring concept in #CTO. Point retrograde wire tip precisely at balloon with a single wire rotation! (3D reverse CART) see more at @AsiaInterv : doi.org/10.4244/AIJ-D-… @KambisMashayek1 @realarainmd @dautov_MD @Laserrman @esbrilakis @sandeep_jalli @BarberoUmberto @ungureanuclau20 @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Carl01196478 @K_DeSilva @DrJMHill @AntonisPavlidi3 @RajanRehan23 @AishSinha1

Presenting our new methods of bifurcation stenting in TCT 2025: IM-CRUSH ✅7F guide compatible with Altaview ✅real time IVUS guidance ✅minimal protrusion into LM carina ✅adequate ostial coverage #bifurcationstenting #pci #imcrush #Tct2025 @drcleung

@Laserrman @KambisMashayek1 @realarainmd I am looking forward to that ! Thank you so much

Grateful to present this angio3D wiring in #EUROACTOS meeting this year, and good to hear many interested that email me for the ppt. See this video showing how to rotate fluoroscopy to find the overlap view quickly! doi.org/10.1016/j.jacc… @KambisMashayek1 @realarainmd @sandeep_jalli @BarberoUmberto @SasseMark @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Laserrman @dautov_MD @GwendolynY23762

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RCA #CTO #HDR Pilot200→#HDR→non tip XT→#HDR→sionblack Careful analysis of #stains observed during #HDR and passive injection is critically important. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

3D Wiring Demystified. Or, I think I get it! Thanks to the links and diagrams sent or suggested by @Laserrman and @evandrofilhobr, and the videos by @CtoDemon and Sensei Okamura, I think I get it! I should also credit @DrPravinKGoel and @drcleung for their well written papers and videos! 🙏🏼 Let me consolidate my ideas and I will get back to you! Not today, but soon.

Euro CTO CLUB @CtoEuro with @KambisMashayek1 ,@AgostoniPF , @drcleung, Chan YH & Jo Dens.

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Grateful to join the CTO Club in Nagoya, Japan, and participate in the APCTO club live case session. An incredible experience learning from CTO experts around the world!

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@drcleung @MichaelChiangCS An improved way for minimal stent protrusion in doing bifurcation stenting- Real-time IVUS guided minimal crush (IM-CRUSH) - 7F guide compatible (Altaview, Terumo ) -only minimal SB stent protrusion, subsequent delivery of crush balloon is smooth

Journal of Invasive Cardiology @InvasiveCardiol

a year ago

🆕 in Early View: Real-Time IVUS-Guided Minimal CRUSH for Bifurcation Stenting: The IM-CRUSH Technique ▶️hubs.ly/Q03j3PNJ0 @RonnieCB_Ho @drcleung @DLBHATTMD #cardioTwitter #cardioX #cardiology #interventionalcardiology

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🆕 in Early View: Real-Time IVUS-Guided Minimal CRUSH for Bifurcation Stenting: The IM-CRUSH Technique ▶️hubs.ly/Q03j3PNJ0 @RonnieCB_Ho @drcleung @DLBHATTMD #cardioTwitter #cardioX #cardiology #interventionalcardiology

This year I am late in #my_4_slides on my most important takeaways from #CTO2025 Lots of great stuff and I will start with the intriguing #CTO #PCI techniques I will try in 2025. 1-HDR presentation by @realarainmd He explains it perfectly, his cases on X are enjoyable. In a very simple way 1-Stick the cap (a few mm) 2-Advance MC- pull wire while dripping contrast (prevent air trapping in the MC) 3-Inject slowly <0.5 cc 4-Analyze and decide next steps If intraplaque staining, nontip Fielder XT. If extraplaque, move down your algorithm (stick again or use other techniques) #cardioX #accfit

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