Partner with us for
complex coronary cases.

A complete support hub for cardiologists, MDs, and GPs.

Designed for cardiologists, MDs, and GPs seeking support, second opinions, and collaboration in complex coronary interventions — not just a referral pathway. Whether you need a second opinion for a difficult patient, a proctoring partner for your next CTO case, or a collaborative network for ongoing complex cases, this is the right place.

Dr. Arun Kalyanasundaram is the Asia-Pacific CTO Club Director for India — the physician who sets the guidelines for CTO intervention across South and Southeast Asia. He is the definitive escalation point for complex and failed coronary cases across the subcontinent. Referrals are accepted from cardiologists and cardiac surgeons across India and internationally.

2,500+

CTO Procedures

200+

Physicians Proctored

15 Countries

Active Proctoring

30+

Publications

On this page

How to Refer

No administrative barrier.

Fastest

+91 94807 94807

Formal Report

director@ctomd.com

Speak to the Team

Phone / Call

+91 94807 94807

A WhatsApp message or email with the angiogram report and a brief clinical summary is enough to begin the referral process. No letters, no forms, no delays.

Cases Most Commonly Referred

When to send a patient our way.

Chronic Total Occlusions

Prior antegrade attempts have failed, anatomy is judged too complex for local capability, or a retrograde / ADR approach is required that the referring centre does not offer.

Complex High-Risk PCI (CHIP)

Haemodynamic support devices, intravascular imaging, or rotational atherectomy / IVL required alongside the primary intervention, or patient has been declined for surgical revascularisation.

Left Main Disease

Anatomy or patient risk profile makes percutaneous management appropriate and a highly experienced operator is required.

Multi-Vessel Disease with CTO

Combination of total occlusion and significant disease in other vessels requiring coordinated planning of sequence and haemodynamic support.

Failed Prior PCI

Stent failure, in-stent restenosis, prior strategy inappropriate for anatomy, or re-intervention required.

What to Include with the Referral

Four items to send.

Angiogram report

Required

Written report or CD image files. DICOM images preferred. Angio video via WeTransfer or MP4.

Echocardiogram with EF

Required

Current LV function assessment. Critical for CHIP and complex cases.

Clinical summary

Required

Presenting complaint, comorbidities, medications, surgical risk if assessed.

Prior intervention reports

If applicable

Previous PCI or CABG reports.

All referred patients are communicated back to the referring cardiologist with a complete procedural report and outcome summary. Long-term follow-up is managed in collaboration with the referring physician as preferred by the patient.

CTO Proctoring Programme

Transferring the technique - not just demonstrating it.

Dr. Arun Kalyanasundaram has formally proctored over 200 interventional cardiologists across 15 countries in CTO PCI and complex coronary interventions. He is an active proctor for Boston Scientific, Abbott Vascular, Asahi Intecc, and Terumo, and is the Founding Course Director of CHIP-CTO INDIA — an annual national training programme for complex coronary intervention running since 2019.

"The goal is not to demonstrate — it is to transfer. A proctor who can perform a complex procedure but cannot teach it to another operator has not completed the job."

What a Proctored Case Involves

A proctored case with Dr. Arun is structured across three distinct phases. The objective of each phase is the same: to ensure the operating cardiologist understands not just the physical steps, but the reasoning, the contingency decisions, and the specific anatomy-based choices that underpin each one.

Phase 01

Pre-Procedure Case Review

Before the case begins, Dr. Arun reviews the diagnostic angiogram with the operating cardiologist — frame by frame where needed. The discussion covers: cap morphology and entry strategy (antegrade wire selection vs ADR vs retrograde); collateral anatomy and retrograde viability; planned crossing algorithm; wire escalation sequence; contingency plans for each likely failure mode; and haemodynamic support strategy. The pre-procedure discussion is where most of the proctoring value is delivered — the case itself becomes an execution of a shared, understood plan.

Phase 02

Live Table Guidance

At the table, Dr. Arun coaches rather than takes over. The operating cardiologist performs the case; Dr. Arun provides real-time guidance on wire movement, torque application, microcatheter positioning, and escalation decisions. Where a technique is unfamiliar — ADR knuckle advancement, Stingray balloon positioning, retrograde collateral wire navigation, externalisation — Dr. Arun demonstrates the specific step and returns control to the operating cardiologist. The goal is that the operator finishes the case having performed it, not having watched it.

Phase 03

Structured Case Debrief

After the case, a structured debrief covers: what went according to plan and why; what diverged and what triggered the adjustment; specific anatomical features that drove each technique choice; the wire and device selection rationale; and what to do differently in the next case with similar anatomy. Dr. Arun provides written case notes summarising key learning points. For multi-case proctoring engagements, a cumulative feedback document is provided at the conclusion.

Founding Course Director

CHIP-CTO INDIA

CHIP-CTO INDIA is an annual national training programme in Complex High-Risk and Indicated PCI and CTO intervention, running since 2019. Dr. Arun Kalyanasundaram established and directs the course, which brings together interventional cardiologists from across India and the Asia-Pacific for live case demonstrations, structured workshops, and faculty lectures from leading international CTO operators. The programme covers the full Hybrid CTO Algorithm, haemodynamic support strategy, imaging-guided complex intervention, and challenging case review. For programme and registration enquiries, contact director@ctomd.com.

Primary Proctoring Focus — CTO PCI

Antegrade wiring technique — wire selection by cap morphology, tip load escalation sequence, torque technique, parallel wiring, knuckle wiring
Antegrade dissection re-entry (ADR) — CrossBoss advancement technique, Stingray balloon positioning and port orientation, Stingray wire puncture, and the K14 Stingray CART technique developed by Dr. Arun
Retrograde technique — collateral channel selection, Suoh 03 / SION Blue wire navigation, Caravel / Corsair microcatheter advancement, Reverse CART, guide-extension-assisted externalisation
The Hybrid CTO Algorithm — upfront case classification, strategy selection framework, escalation triggers, time and radiation management
Imaging-guided CTO stenting — entry zone confirmation, stent sizing in sub-intimal channels, post-dilation optimisation

Additional Proctoring Capability

CHIP PCI — rotablation (burr sizing, RPM management, no-reflow prevention), IVL technique, complex lesion preparation sequencing
Haemodynamic support device strategy — IABP insertion and timing, Impella positioning and monitoring, recognising when to escalate from IABP to Impella
IVUS and OCT-guided stenting — calcium arc measurement, stent sizing, MSA assessment, edge dissection identification, optimisation endpoint definition
FFR and iFR-guided lesion selection — physiological assessment in multi-vessel disease, deferred lesion decision-making
Left main PCI — Medina bifurcation classification, provisional vs planned two-stent strategy, DK Crush technique, imaging-guided sizing and optimisation

What a Proctored Case Involves

Live Case Proctoring

Dr. Arun travels to your centre and proctors cases in your catheterisation laboratory on your equipment. Single case, multi-case, or institutional programme. Available across India and to international centres.

Refer-and-Observe

Refer your complex case to Promed Hospital, Chennai. The referring cardiologist is welcome to attend and observe the procedure in the catheterisation laboratory. Full case debrief provided.

Remote Case Review

Submit your pre-procedure angiogram for a structured remote review. Dr. Arun provides a written case plan covering strategy, wire/device sequence, and contingency. A debrief call after the case is included.

Live Case Proctoring

Live case demonstrations, workshops, and didactic lectures at national and international interventional cardiology conferences. Faculty enquiries: director@ctomd.com

Countries — Active Proctoring