LINC 2013 live case guide

Hamburg

• Friday, January 25th: 8:00 - 9:30, Technical Forum

  Case 77 – Complex AAA Aorto-Iliac Obstruction

  Center:

  Hamburg

  Case 77 – HAM 06: female 73 years

  Operators:

  • Hans Krankenberg,
  • P. Burchardt

  Clinical data
  POD Rutherford 4 left side / right side 5, little lesion dig. 1 right
  RF: current smoker, arterial hypertension, Apoplex,
  DVT left side 10/2012
  
  Angio
  Occlusion of infrarenal aorta, bilateral common/external iliac arteries
  
  Duplex
  Bilateral monophasic flow CFA
  ABI: left 0.5 / right not detectable
  
  Procedural steps
  1. Transbrachial approach left side
  - 6F Flexor Check Flo Performer Introducer
  Sheath, 90 cm (COOK)
  - 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
  - 0.035" Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)
  
  2. Transbrachial recanalization bilateral with femoral wire extraction and exchange for a stiff wire
  - 0.018" V-18 control wire 300 cm (BOSTON SCIENTIFIC)
  - 0.035" Radiofocus angled + straight stiff guide wire, 260 cm (TERUMO)
  - 4 + 5F multipurpose guiding (custom made) Catheter, 125 cm (CORDIS)
  - 0.035" Supra core guide wire, 300 cm (ABBOTT)
  - Quick Cross Catheter 0.035", 135 cm (SPECTRANETICS)
  
  3. Transfemoral approach bilateral
  - Left: 7F Introducer Sheath, 23 cm (ST JUDE)
  - Right: 12F Introducer Sheath, 45 cm (COOK)
  
  4. Predilatation in kissing balloon technique
  - 4.0/120 mm Admiral Xtreme OTW Dilatation Catheter, 130 cm (MEDTRONIC)
  
  5. Stenting of the infrarenal aorta
  - CP STENT 2.8 cm (NUMED)
  - BIB Stent Placement Catheter 20mm/40mm (NUMED)
  
  6. Stenting and postdilatation in kissing-stent technique of aortic bifurcation/iliac arteries
  - 8.0/120 mm Complete SE Iliac 130 cm (Medtronic Invatec) or
  - 8.0/78 mm Scuba Peripheral CO-CR Stent 80 cmm (Medtronic Invatec)
  - Optional: ADVANTA V12 (Atrium) covered stents
• Friday, January 25th: 9:00 - 9:30, Global Expert Exchange

  Case 87 – Renal denervation using the ReCor© ultrasound balloon

  Center:

  Hamburg

  Case 87 – HAM 08: female, 75 years

  Operators:

  • Karl-Heinz Kuck,
  • Jaspers von Wedel,
  • Martin Bergmann

  Clinical data
  Dyspnea on exertion
  24h RR: mean systolic values: 182mmHg w/ peak of ~240mmHg
  Medication: Bisoprolol 1x 5mg, Torasemid 1x 10mg
  Candesartan 1x 32mg, Doxazosin 1x 2mg
  Risk factors: Hypercholesterinemia, s/p tobacco use
  Resistant hypertension for >10y
  
  Procedural steps
  1. 8F guiding catheter
  
  2. Wire distal A. renalis
  
  3. 3 ablation points with balloon 6mm, 2ATM
  
  4. 30 sec/ablation
• Friday, January 25th: 10:30 - 10:55, Main Arena 1

  Case 61

  Center:

  Hamburg

  Case 61 – HAM 01: male, 74 years

  Operators:

  • Sigrid Nikol,
  • Sven Bräunlich
• Friday, January 25th: 12:00 - 12:25, Main Arena 1

  Case 63 – Long occlusion right superficial femoral artery

  Center:

  Hamburg

  Case 63 – HAM 02: female, 60 years

  Operators:

  • Hans Krankenberg,
  • P. Burchardt

  Clinical data
  POD Rutherford 3, walking distance 50 m right calf,
  Long bilateral SFA occlusion with recanalisation/2 nitinol stents left SFA 11.12
  Failed recanalisation right SFA 12.12
  Arterial hypertension, diabetes mellitus, former smoker (40 py)
  Stroke 05/2012
  
  Procedural steps
  1. Contralateral access and placement of a cross-over sheath left groin, 5F (COOK)
  - 5F Hook Catheter (COOK)
  
  2. Bringing the patient in a prone position
  
  3. Puncture right AP under road map control
  - 6F sheath, 10 cm (St Jude Medical)
  
  4. Passage of the lesion
  - 0.035" Aquatrack angled stiff guide-wire, 180 cm (Cordis)
  - 0.035" Glidecath Catheter, straight, 65 cm (TERUMO)
  
  5. After passage of the lesion change to
  - 0.018" Steel Core, 300 cm (Abbott)
  - Optional: Outback Catheter - 0.014 Ironman, 300 cm (Cordis)
  
  6. Predilation
  - 0.035" Powerflex Pro 4 mm (Cordis)
  
  7. Stentimplantation
  - SMART (Cordis)
• Friday, January 25th: 13:45 - 14:10, Main Arena 1

  Case 64 – Renal denervation with OneShot balloon (Re – Do)

  Center:

  Hamburg

  Case 64 – HAM 03: male, 55 years

  Operators:

  • Karl-Heinz Kuck,
  • Jaspers von Wedel,
  • Martin Bergmann

  Clinical data
  55 y male w/ resistant hypertension for >10y
  s/p renal denervation w/ Simplicity© cath. 02/2012
  Systolic mean 24h RR-values remain ~148 mmHg resulting in headaches and dyspnea on exertion.
  Invasive r/o of CHD 02/2012
  Medikation: Metoprolol 2 x 100mg, Felodipin 2 x 5mg,
  Candesartan 1 x 32 mg, Urapidil 90 mg 1 x 1, Dihydralazin 2 x 12.5mg
  
  Procedural steps
  1. Analgosedation w/ Midazolam, Fentanyl, Propofol
  
  2. Right femoral access (8F, 7.500 IE Heparin)
  
  3. 8F RDC Guiding catheter (CORDIS)
  
  4. 0.014" Sion blue guidewire (ASAHI)
  
  5. OneShot™ Ballon (COVIDIEN): left 7 mm (or 2 x 6 mm?) / right 6 mm
• Friday, January 25th: 15:13 - 15:38, Main Arena 1

  Case 66 – Carotid artery stenting with cerebral embolic protection

  Center:

  Hamburg

  Case 66 – HAM 04: female, 73 years

  Operators:

  • Joachim Schofer,
  • Klaudija Bijuklic

  Clinical data
  Symptomatic 70% stenosis right ICA
  Amaurosis fugax and dyphasia
  Risk factors: hypercholesterinemia
  Medication: Clopidogrel 75 mg /die (starting 5 days prior to procedure)
  Simvastation 20mg /die
  
  Procedural steps
  1. Long sheath
  
  2. Filter protection (because of incomplete circle of Willis)
  
  3. Stenting
  
  4. Postdilatation
• Friday, January 25th: 15:15 - 16:00, Technical Forum

  Case 85 – Chronic total occlusion of right popliteal artery and trifurcation

  Center:

  Hamburg

  Case 85 – HAM 07: female

  Operators:

  • Sigrid Nikol,
  • Sven Bräunlich
• Friday, January 25th: 16:30 - 18:00, Main Arena 2

  Case 76 – Juxtarenal Aortic Aneurysm

  Center:

  Hamburg

  Case 76 – HAM 05: male, 76 years

  Operators:

  • Hans Krankenberg,
  • P. Burchardt

  Clinical data
  Asymptomatic juxtrarenal aortic aneurysm / 5.6 cm
  Y-prosthesis infrarenal aorta 1/2001
  Coronary artery disease: D1 90%
  Atrial fibrilation
  RF: Hypertension
  
  Procedural steps
  1. Transbrachial approach left side
  - 7F Flexor Check Flo Performer Introducer Sheath, 90 cm (COOK)
  - 5F Pigtail diagnostic catheter, 110 cm (CORDIS)
  - 0.035`` Radiofocus Terumo angeled soft guide wire 180 cm (TERUMO)
  
  2. Bilateral femoral surgical cut-down
  
  3. Stentgraft implantation
  - Implantation of the JOTEC E-extra fenestrated graft (JOTEC)
  - Implantation of 4 covered V12 Advanta Stents (ATRIUM) in Coeliac trunk, AMS and both renal arteries