CTO PCI Simplified: Dr. Robert Riley’s Step-by-Step IVUS Sighted ADR Technique with Dr. Chris Brown

ADR (Antegrade Dissection and Re-Entry) has historically been viewed as unpredictable — but with a structured, IVUS-sighted approach, it becomes one of the most consistent and controllable CTO PCI techniques.In this detailed case walkthrough, Dr. Robert Riley demonstrates how he performs an IVUS-Sighted ADR workflow during a complex RCA CTO. He explains how to select landing zones, create a controlled knuckle, prevent hematoma formation, orient the Stingray system correctly, and re-enter the true lumen with precision.Topics you’ll learn:When ADR is the correct strategy for a long CTOIdentifying a clean distal landing zone using IVUSHow to form a stable knuckle with the Pilot 200The purpose of de-escalating to Mongo for safer advancementHematoma prevention with guide extension supportHow retrograde angiography guides Stingray orientationVacuum decompression (“straw technique”) for clearing the subintimal spaceStick-and-drive vs stick-and-swap re-entry patternsUsing IVUS to confirm true lumen passage and guide stent sizeAvoiding the most common ADR failure modesThis is a foundational training for operators refining modern ADR technique with IVUS guidance.Chapters:00:00 – Why ADR still matters in modern CTO PCI 01:00 – When ADR is favored over wire escalation 02:00 – Identifying the distal landing zone with IVUS 03:30 – RCA CTO setup and planning 05:30 – Bifemoral access and guide selection 06:30 – Creating a knuckle with the Pilot 200 08:30 – De-escalating the knuckle and reducing subintimal trauma 10:30 – Guide extension support and pressure control 11:30 – Stingray preparation and system orientation 12:30 – Selecting the correct projection angle 14:00 – Retrograde angiography for confirmation 15:00 – Vacuum decompression (“straw technique”) 17:00 – Stick-and-swap method to regain the true lumen 19:00 – IVUS confirmation and how to size stents correctly 21:00 – Final angiographic review and procedural takeaways🔔 Subscribe for more insights from interventional experts and real-world program builders.📱 Download the app: https://apps.apple.com/app/apple-store/id1586692687📺 Follow us on YouTube: https://www.youtube.com/channel/UCfrLYhAhliQ2ZvXinkDCZvA#CTO #ADR #IVUS #InterventionalCardiology #ComplexPCI #Stingray #Pilot200 #MongoWire #CathLab #MurmurMD