After the @crfheart CTO meeting each year, I usually make practice adjustments based on the dense 2 days of content! Congratulations to this year's directors, and looking forward to next year's warmer one in Miami! @mbmcentegart @JWMoses These are my #CTO2026 take-home messages! Starting with small, quick tricks 1- A discussion on engaging septals from the PDA- Use tip injection in the PDA, engage the collateral with "Sion" (for me) rather than Suoh, then can exchange inside the collateral into Suoh given extreme tortuosity coming from the RCA side (Shunsuke Matsuno, @docjohnnyg ) 2- A nice trick by @RinfretStephane to avoid pistoning of retrograde microcatheters is to anchor with a small balloon in the donor vessel while wiring, then deflate the balloon. Gotta be careful of donor vessel injury or ischemia. 3- Utilizing a cutting balloon for tough side base/base when not able to start a knuckle. I knew about it and never tried it. Will try it in 2026 @Billlieofficial 4- TD-ADR, the concept that is tough to implement, especially with the lack of certain tools in the US! This time, I learned we can do it with 5-Fr Opticross! So I am hoping to try it in 2026 The concept depends on moving the IVUS (back and forth) to visualize a mental 3D image of the relationship between the guidewire tip and the true lumen and attempting to puncture it! That slide helps better evaluate it (@Laserrman Maoto Habara) 5-I use CTA in about 60% of my CTO PCI procedures planning (ambiguous caps, ambiguous course, prior CABG, prior failures). After this conference, knowing what's coming in terms of software ability, I think my utilization of CTA will significantly increase @ColletCarlos (1/3) #CardioX #ACCFIT

It was a great pleasure to be a part of @cvinnovations #CVI2025, learned a lot as usual and came back with multiple tips and tricks. Here are my top ones that I would apply in my next cases. 1- When freewiring the Rotawire in uncrossable lesions, a nice trick shared by @KateKearney4 is to use Finecross specifically as it centers you more within the lesion. I used whatever microcatheter I usually use (mostly TP spiral). 2- When doing laser bombing with contrast, can use 20/80 mix to create smaller bubbles and less risk of perforation. I used the 100% contrast when I did it, and looking forward to trying this trick! 3- When using high-pressure #OPN balloons, having a buddy wire is very helpful. It can help with scoring effect, maintain wire position if the balloon got stuck on the wire, and provides rapid access in case of perforation. 4-When the distal IVC is affected in chronic venous disease, avoid double-barrel venous stenting. Outcomes are better with an IVC stent with 2 extending limbs from both iliac veins. Looking forward to next year! @esbrilakis @Xlpad @shishem @psorajja #CardioX