We at the Asia Pacific Chronic Total Occlusion (APCTO) club, provide this review to address the gap between reverse controlled antegrade and retrograde subintimal tracking (CART) and antegrade wire access. This case illustrates a novel approach to completing wire externalization and provides a further indication for the role of the Guideliner™ catheter in treating CTOs. Wire externalization was then completed and the RCA was subsequently stented with a good final angiographic result. To solve this a Guideliner™ catheter was passed on the antegrade wire and successfully advanced over and 'captured' the retrograde micro-catheter. After performing reverse controlled anterograde and retrograde sub-intimal tracking (CART), the retrograde micro-catheter was only able to reach the mid RCA. The retrograde limb involved a saphenous vein graft to the native circumflex artery, which in turn provided collateral channels to the distal RCA. We report such a case where retrograde intervention was used to treat a right coronary artery (RCA) CTO in a patient with stable angina. Despite this there are occasions where the micro-catheter is unable to reach the anterograde guide catheter, due to long collateral channels particularly when the retrograde limb involves a bypass graft. ![]() In the retrograde approach, wire externalization through the antegrade guide catheter often requires the use of a short donor guide catheter and a long (> 150 cm) micro-catheter. The changes will also require the development of new skills, knowledge and approaches from those in the building industry including developers, designers and architects, builders, project managers, certifiers and building operators.The hybrid approach to percutaneous treatment of chronic total occlusion (CTO) of coronary arteries requires both antegrade and retrograde skillsets. ![]() They will also help in creating a more sustainable built environment capable of responding to our changing circumstances and family and community needs.Īll of us will benefit from these changes as our individual needs change over time. These changes will improve the opportunities for people with disability to participate in and contribute to the economic, cultural, social and political life of our community as equal citizens. The introduction of the Premises Standards will lead to widespread and important improvements in the accessibility and safety of all new and upgraded public buildings in Australia. to give certainty to building certifiers, developers and managers that if the Standards are complied with they cannot be subject to a successful complaint under the DDA in relation to those maters covered by the Premises Standards.to ensure that dignified, equitable, cost-effective and reasonably achievable access to buildings, and facilities and services within buildings, is provided for people with disability, and.The purpose of the Premises Standards (and corresponding changes to the Building Code of Australia and state and territory building law) is: ![]() The Australian Human Rights Commission has issued Guidelines on the application of the Premises Standards to assist in their implementation. Any application for a building approval for a new building or upgrade of an existing building on or after that date will trigger the application of the Premises Standards. The Disability (Access to Premises - buildings) Standards 2010 (the Premises Standards) commence on. ![]() Guidelines on application of the Premises Standards
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