LINC 2013 live case guide

Berlin

• Thursday, January 24th: 8:15 - 8:40, Main Arena 1

  Case 24 – Occlusion of the popliteal artery and all proximal BTK arteries

  Center:

  Berlin

  Case 24 – BLN 01: female, 77 years (D-R)

  Operators:

  • Ralf Langhoff,
  • Jens Stegemann

  Clinical data
  PAOD Rutherford 5, minor tissue loss on the right foot,
  walking capacity 20m and rest pain at night
  Bilateral diabetic foot syndrome
  Recanalization of the left popliteal artery 12/2012,
  Diabetes mellitus (IDDM, HbA1c >8,5), art. hypertension
  Renal insufficiency (CKD III), CAD, atrial fibrillation with oral anticoagulation
  
  Procedural steps
  1. Antegrade access
  - 45 cm 6 F braided sheath (TERUMO)
  
  2. Lesion passage into the posterior tibial artery
  - Truepath CTO Device (BOSTON SCIENTIFIC)
  - Add on wires: Victory 0,014/0,018 and V18 control (BOSTON SCIENTIFIC)
  - Add on Support: Rubicon Catheter (BOSTON SCIENTIFIC) and angled CXI support catheter (COOK)
  
  3. PTA
  - 3 mm resp. 4 mm Coyote balloon (BOSTON SCIENTIFIC)
  
  4. Stenting on indication
  - Promus Element Plus BTK (BOSTON SCIENTIFIC)
• Thursday, January 24th: 9:45 - 10:10, Main Arena 2

  Case 38 – Long occlusion of the right ATA

  Center:

  Berlin

  Case 38 – BLN 02: male, 56 years (L-M)

  Operators:

  • Ralf Langhoff,
  • Helgar Petrov

  Clinical data
  PAOD Rutherford 5 impaired wound healing and minor tissue loss right foot after amputation D1 11/2012
  Recanalisation of the right SFA and right TPT
  Diabetes mellitus with diabetic foot syndrome
  Renal insufficiency (CKD III)
  Left ventricular dysfunction, oral anticoagulation
  Current smoker, stroke in the past
  
  Procedural steps
  1. Right antegrade access
  - 4F Fortress 45 cm Sheath (BIOTRONIK)
  
  2. Passing the lesion
  - XT-14 or a Cruiser-18 guide wire (BIOTRONIK)
  
  3. Predilation
  - 2mm Passeo-14 or Passeo-18 (BIOTRONIK)
  
  4. PTA
  - Passeo-18 Lux drug coated balloon 2.5 mm (BIOTRONIK)
  
  5. Stenting on indication
  - Orsiro 3 x 40 mm coronary DES or Pulsar-18 self-epxanding stent system (BIOTRONIK)
  
  6. Prepare for a retrograde pedal access via ATA as a backup option
• Thursday, January 24th: 11:05 - 11:30, Global Expert Exchange

  Case 55 – High grade symptomatic left ICA stenosis

  Center:

  Berlin

  Case 55 – BLN 03: male, 60 years (H-W)

  Operators:

  • Ralf Langhoff,
  • Brigitte Bäsell

  Clinical data
  2nd transient blindness in 2012 left eye
  Bilateral ICA Stenosis L>R, PSV ICA left >300cm/s, EDV 90 cm/sec
  CAD with stenting left main 12/2012
  PAOD with bilateral EIA stenosis
  Arterial hypertension, former smoker (till 12/2012), hyperlipidemia
  
  Premedication
  Aspirin 100 mg, Clopidogrel 75 mg since 12/2012, Simvastatin 40 mg
  Ramipril 5 mg and HCT 12,5 mg
  
  Procedural steps
  1. Femoral access right groin
  
  2. Stenting of the right EIA
  (Dynamic Balloon-Expandable Stent System 7 x 38 mm, BIOTRONIK)
  
  3. 260 cm stiff angeled Radiofocus guide wire (TERUMO)
  
  4. Weinberg Catheter for left CCA (COOK)
  
  5. Vista Brite Tip IG Guiding Catheter 8F MP Shape (CORDIS)
  
  6. Filterwire EZ Protection System (BOSTON SCIENTIFIC)
  
  7. 9/30 mm Wallstent (BOSTON SCIENTIFIC)
  
  8. PTA with 5 x 30 mm Sterling Balloon Dilatation Catheter (BOSTON SCIENTIFIC)