Jeffrey M. Chua, MD

Jeffrey M. Chua, MD ❤️ Healthy Heart. High success rates. Patient-focused.

Healthy Life
Your heart deserves the best care — & latest treatments

Specialist in:
✔️ Advanced Angioplasty
✔️ Complex PCI & CTO Procedures
✔️ Intravascular Imaging - IVUS, OCT

🩺 Cutting-edge care.

25/04/2026

Reverse CART, reimagined.

When the ostial CTO of an LAD refuses to yield, strategy becomes everything.

Use of a guide extension catheter during Reverse CART for an ostial LAD CTO via the retrograde approach provides critical benefits by:

✔️ Enhanced back-up support and device delivery.
✔️ Precise proximal vessel re-entry by creating an open target lumen and reducing subintimal hematoma which can otherwise make true lumen re-entry difficult.
✔️ Protection of the Left Main and LCX artery by ensuring the re-entry connection is distal to the bifurcation and within the LAD, preventing hazardous extension of subintimal space created by guidewire manipulations and balloon inflations.
✔️ Efficient wire externalization by securing an easier Tip-in technique and facilitating a “Capture” technique when the retrograde microcatheter cannot reach the antegrade guide-catheter.
✔️ Increased procedural success by providing versatility during challenging connection attempts.

22/04/2026

When balloons won’t cross… and won’t dilate. That’s when strategy wins.

A challenging CTO PCI case with:
▪️ Balloon-uncrossable CTO segment
▪️ Balloon-undilatable proximal vessel

Two problems. One solution mindset.

🔧 Stepwise strategy:
• Halfway Rotablation to modify the resistant proximal cap and create a workable pathway
• Guide extension “Tunnel in Landslide Technique” (TILT) to improve support and deliver devices across the uncrossable segment

💡 Key takeaway:
Complex CTOs are rarely solved by force—they are solved by understanding the limitation and adapting the technique.
When balloons fail, plaque modification + support augmentation can turn an “impossible” lesion into a successful revascularization.

21/04/2026

Reverse CART in CTO PCI: Evolution of Strategy, Precision of Ex*****on

Not all Reverse CART techniques are created equal. Each evolution reflects our pursuit of safer, more controlled, and more predictable CTO crossing.

🔹 Conventional Reverse CART
The classic approach.
Antegrade balloon creates a subintimal space → retrograde wire navigates into it.
✔️ Effective
❗ Less controlled, larger dissections, higher risk of losing vessel architecture

🔹 Contemporary Reverse CART
A shift toward precision.
Smaller antegrade balloons + targeted retrograde wiring
✔️ Controlled dissection
✔️ Better wire alignment
✔️ Reduced vessel trauma

🔹 Extended Reverse CART
Taking it further when needed.
Expanding a subintimal space intentionally beyond the CTO segment to facilitate connection
✔️ Useful in complex anatomy or resistant CTOs
❗ Requires experience to avoid excessive dissection

21/04/2026

3 CTOs. 3 Challenges. 3 Different Strategies. One Goal: Revascularization.

Success in CTO PCI is not about one “best” technique — it’s about choosing the right strategy for the right lesion, and knowing when to pivot.

Grateful for the team effort and the continuous evolution of techniques that make these once “impossible” cases achievable.

21/04/2026

Complex CTO. Unusual Anatomy. Precise Strategy.

A CTO with an anomalous vessel origin and an ambiguous proximal cap - where the true entry point is uncertain and antegrade wiring can be risky.

💡 Strategy matters.
Primary retrograde approach was performed, navigating through collateral channels to reach the distal true lumen, allowing safer and more controlled crossing of the occlusion.

Every CTO is different. The right strategy makes all the difference.

20/04/2026

A CTO with a blunt proximal cap means:
❌ No visible starting point
❌ High risk of going outside the vessel
❌ Lower success with standard wiring

IVUS-guided wiring enable us to:
🔹 Identify the true vessel path
🔹 Guide precise wire entry
🔹 Successfully cross the occlusion

Advanced imaging + proper technique
= Higher success in difficult CTO cases

01/04/2026

April Fools?

Coronary perforation doesn’t joke.

No warning. No punchline. No second chances

Just contrast extravasation…
and a room that either goes into silence or chaos real fast.

Experienced operators act and execute without hesitation

Because in the cathlab,
nothing is ever a joke.

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Ortigas Avenue
Pasig
1800

Opening Hours

Monday 12pm - 4pm
Wednesday 12pm - 4pm
Friday 12pm - 4pm

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