International Circulation: How can we judge the true or false lumen inside the CTO during the PCI procedure?

Prof. Suzuki: This is very important and a very good question， however it is very difficult to identify whether it is true or whether it is false， especially if the region is harder， this judgment of true or false is very， very difficult to make. Sometimes by the sensation of touch it is possible to tell if the region is not too smooth， this rough feeling suggests whether or not it is a false lumen. On the other hand， sometimes during a very big dissection， you do not have this rough feeling， sometimes it is smooth， and then you can judge whether it might be a true lumen. In this situation I use IVUS inside the false lumen and check whether it is true or false.

International Circulation: So in this case you rely on IVUS guidance to help to you judge?

Prof. Suzuki: Yes

International Circulation: So IVUS is very valuable in that case?

Prof. Suzuki: Yes， very valuable and useful. The next step of the procedure is IVUS guided wire crossing.

International Circulation: What is the current treatment strategy for multivessel CTO lesions?

Prof. Suzuki: CTO PCI has undergone a remarkable change because the CTO region is in front of the bare-metal stent， which is not so good， especially in terms of a high occlusion rate and high restenosis rate. But nowadays we use a much better PCI， it changes to complete revasculization by using the PCI.

International Circulation: What about in the case of asymptomatic patients with CTO lesions. How do you treat those patients without any symptoms?

Prof. Suzuki: This situation depends on the operator， however many papers suggest no CTO region compared with the CTO region. These patients have different survival rates， so we treat all CTO cases， especially viable and moveable CTO regions， but CTO regions depend on the person performing， the operator’s skill and the difficulty of the cases. For previously difficult cases the success rate is now very， very high， more than 90%.

International Circulation: How can we identify the early complications during CTO treatment?

Prof. Suzuki: That is very， very important because the CTO PCI has different set of complications， obviously， compared to the non-CTO because sometimes the stiffer wires causes penetration， so we monitor the patient after the procedure.

International Circulation: Thank you so much Dr. Suzuki. Obviously， you’ve done a lot of good work and there is a lot of great work being done in Japan， on the treatment of especially CTO. The last question is， is there any new work that you are doing? Is there any latest treatment in CTO that is happening in Japan that you are very excited about， or anything new? Is there anything that you can tell us today that you think is very new and very useful in the treatment of CTO， that you think is very important?

Prof. Suzuki: Yes， in this session we explained three or four new technologies and the new device. CTO procedures are gradually advancing in technology and devices， and improving. The CTO PCI is the final target of the PCI and I hope that all over the world CTO PCI gets a high success rate and this technology improves patient life quality and survival rates. And I think this is a very important technique.