LINC 2016 live case guide

Bad Krozingen

• Thursday, January 28th: 8:00 - 9:00, Room 3 - Technical Forum

  Case 82 – BK 05: Recanalisation of EIA/CFA and SFA left leg

  Center:

  Bad Krozingen

  Case 82 – BK 05: male, 61 years (G-H)

  Operators:

  • Thomas Zeller,
  • Elias Noory

  CLINICAL DATA
  Calf & leg claudication left leg, calf claudication right leg about 200 m
  with progressive deterioration since a couple of weeks
  Interventional treatment of the left CFA 2007 in an external hospital
  Coronary 2-vessel disease
  PCI / DES 2009, 3/2010, 6/2010
  AMI (posterior wall) 2009
  Moderate reduction of LV function
  ABI at rest: 0.4 / 0.3, ABI after exercise: 0.2 / 0.1
  Oscillometry: reduced amplitudes right calf & ankle
  Reduced amplitudes left tigh, calf & ankle
  Duplex left leg: Occlusion of EIA & CFA (vessel diameter 11 mm!)
  Moderate to high grade stenosis of DFA
  Proximal occlusion of SFA (reperfusion distally)
  Crea/eGFR: 1.3 mg/dl / 76.3 ml/min
  
  PROCEDURAL STEPS
  1. 8F cross-over sheath right groin
  - Balkin Up&Over (COOK)
  
  2. Intraluminal passage of EIA/CFA occlusion
  - 0.018" % 0.035" Advantage GW (TERUMO)
  
  3. 8F Rotarex (STRAUB MEDICAL) if soft tissue
  - Turbohawk atherectomy (MEDTRONIC) if solid
  
  4. DEB angioplasty
  - Lutonix (C.R.BARD) if vessel size >7 mm In.Pact (MEDTRONIC)
  
  5. Lesion crossing of SFA with a 0.018" GW
  
  6. Predilatation (conventional balloon)
  
  7. DEB and spot stent on indication
  - BioMimics (VERYAN MEDICAL)
  
  8. Closure device
  - 8F Angioseal (ST JUDE)
• Thursday, January 28th: 9:46 - 10:15, Room 1 - Main Arena 1

  Case 64 – BK 01: Plaque modulation (Angiosculpt) and DCB femoro-popliteal lesions

  Center:

  Bad Krozingen

  Case 64 – BK 01: female, 59 years (R-S)

  Operators:

  • Elias Noory,
  • Peter Flügel

  CLINICAL DATA
  Claudication Rutherford 3 (<200 m) right calf
  
  RISK FACTORS
  Hypertension, diabetes mellitus, hyperlipidemia
  
  ABI AT REST
  Right: 0.6, left: 0.9
  
  DUPLEX
  Multiple high grade stenoses distal SFA and popliteal artery right leg
  
  PROCEDURAL STEPS
  1. 6F cross-over sheath from the left groin
  
  2. Crossing the lesions
  - 0.014" or 0.018" Advantage GW (TERUMO)
  
  3. Plaque modulation
  - Angiosculpt balloon catheter (SPECTRANETICS)
  
  4. Predilatation
  - 5 mm Angiosculpt catheter (SPECTRANETICS)
  
  5. Long-term (3 minutes) postdilatation
  - 5 or 6 mm Stellarex DCB (SPECTRANETICS)
  
  6. No stents if possible
• Thursday, January 28th: 10:00 - 11:30, Room 3 - Technical Forum

  Case 84 – BK 06

  Center:

  Bad Krozingen

  Case 84 – BK 06

  Operators:

  • Thomas Zeller

  New patient! Information will follow in due time. Thank you for your understanding.
• Thursday, January 28th: 13:30 - 15:00, Room 1 - Main Arena 1

  Case 70 – BK 02: male, 64 years (P-W)

  Center:

  Bad Krozingen

  Case 70 – BK 02: male, 64 years (P-W)

  Operators:

  • Thomas Zeller,
  • Elias Noory

  CLINICAL DATA
  Claudication Rutherford 3 (50m) left calf since 1 year
  Sudden onset of symptoms
  Embolic nature, source: intra cardiac thrombus as a result of an anterior wall infarction
  Oral anticoagulation
  
  RISK FACTORS
  CVRF: Nicotine, family history
  ABI: right 1.1, left 0.6
  
  DUPLEX
  Thrombotic occlusion of distal left SFA
  
  PROCEDURAL STEPS
  1. 7F antegrade sheath left CFA
  
  2. I ntraluminal lesion passage
  - 4F vertebral diagnostic catheter (CORDIS) 0.018’’ or
  - 0.014” Advantage GW (TERUMO)
  
  3. Mechanical thrombectomy
  - Rotarex 6F (STRAUB MEDICAL) or directional atherectomy
  - Silverhawk LX-M (MEDTRONIC)
  
  4. DCB angioplasty
  - I N.PACT Pacific (MEDTRONIC)
  
  5. Local lysis if indicated
  
  6. No stents!
• Thursday, January 28th: 15:21 - 15:38, Room 1 - Main Arena 1

  Case 72 – BK 03: Stent angioplasty of renal artery stenosis right side

  Center:

  Bad Krozingen

  Case 72 – BK 03: female, 64 years (M-F)

  Operators:

  • Thomas Zeller,
  • Elias Noory

  CLINICAL DATA
  Since more than 15 years known history of hypertension
  Sudden onset of symptoms of recurrent hypertensive crisis in September 2015
  Coronary 2-vessel disease
  PCI / DES LAD and Rcx 2012
  Normal LV function
  Negative stress echo up to 125 W 10/2015
  
  PRESENT STATE
  OBP: 190/80 mmHg
  ABPM: 164/81 mmHg
  Creatinine: 0.8 mg/dl
  eGFR: 80 ml/min
  
  DUPLEX
  Kidney length R/L: 119 mm/118 mm
  Acceleration time: > 70 ms/< 70 ms
  Intrarenal RI R/L: 0,74/0,81
  RA PSV- ratio R/L: 4.5/1.8
  
  PROCEDURAL STEPS
  1. 6F retrograde sheath right groin (11 cm)
  
  2. 6F IMA guiding catheter via standard 0.038" GW
  
  3. Non-selective angiography (DSA)
  
  4. Selective angiography
  
  5. Lesion crossing with a 0.014" GW (Galeo ES, BIOTRONIK)
  
  6. Direct stenting if feasible, predilatation on indication
  - Hippocampus (MEDTRONIC) or Dynamic renal (BIOTRONIK)
  
  7. Closure device
  - Femoseal (ST. JUDE)
• Thursday, January 28th: 16:30 - 18:00, Room 1 - Main Arena 1

  Case 74 – BK 04: Chronic occlusion of left SFA, popliteal and BTK arteries

  Center:

  Bad Krozingen

  Case 74 – BK 04: male, 79 years (B-H)

  Operators:

  • Thomas Zeller,
  • Elias Noory

  CLINICAL DATA
  Claudication Rutherford 3 (<50m) both legs for years
  with progressive deterioration during a the last couple of months
  ABI: right 0.3, left 0.4
  
  RISK FACTORS
  Hypertension, former smoker, hyperlipidemia
  
  DUPLEX
  Chronic bilateral SFA occlusion plus occlusion of left popliteal artery middle segment
  
  PROCEDURAL STEPS
  1. 7F cross-over Destination- sheath from the right groin (TERUMO)
  
  2. In the unlikely case of intraluminal lesion passage: Mechanical thrombectomy
  (Rotarex; STRAUB MEDICAL)
  
  3. If subintimal: predilatation with plain balloon, if result insufficient
  directional atherectomy & DCB angioplasty (TurboHawk and In.Pact DCB; MEDTRONIC)
  
  4. Stent only on indication (provisional stenting) (Supera Interwoven Nitinol-Stent; ABBOTT)
  
  5. In case of failed antegrade recanalization attempt retrograde access via left ATA

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