LINC 2018 live case guide

Berlin

• Tuesday, January 30th: 9:19 - 9:44, Room 3 - Technical Forum

  Case 21 – Progressive bilateral carotid artery stenosis ~80% (surveillance since 2012)

  Center:

  Berlin

  Case 21 – BLN 01: male, 79 years (R-L)

  Operators:

  • Ralf Langhoff,
  • Andrea Behne

  CLINICAL DATA
  - CRF: art. hypertension, hyperlipidemia
  - PAOD with bilateral iliac stenting in 2013
  - CHD with CABG and ischemic cardiomyopathy
  - Stenting of right carotid artery 12/2107
  
  IMPORTANT ITEMS
  - Known carotid artery disease since 2012
  - Yearly DUS surveillance and since Dec. 2017 treatment was initiated by vascular surgeon
  - Vascular surgeon referred the patient for bilateral CAS
  
  DUPLEX
  PSV right 377 cm/s, left 420 cm/s
  
  PROCEDURAL STEPS
  1. Transfemoral access
  - 8F short sheath (TERUMO)
  2. Intubation of LCC
  - Berenstein 4F catheter (4F, TEMPO AQUA, CARDINAL HEALTH)
  3. Placement of guiding sheath
  - 8F CBL or Simmons 8F guiding sheath (VISTA BRITE TIP IG, CARDINAL HEALTH)
  4. Wiring with Filter Wire
  - EZ Distal EPD (BOSTON SCIENTIFIC)
  5. Predilation of left ICA
  - 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
  6. Stenting
  - 9 x 30 mm Carotid Wallstent (BOSTON SCIENTIFIC)
  7. Postdilation
  - Paladin 5 x 20 mm balloon with integrated filter protection (CONTEGO MEDICAL)
  8. Removal of guiding catheter and sheath
  9. Vessel closure
  - Angioseal 8F (TERUMO)
  

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• Tuesday, January 30th: 13:56 - 14:16, Room 5 - Global Expert Exchange

  Case 29 – Occlusion of tibioperoneal trunk left

  Center:

  Berlin

  Case 29 – BLN 03: female, 79 years (K-S)

  Operators:

  • Ralf Langhoff,
  • Andrea Behne

  CLINICAL DATA
  - PTA of left SFA & recanalisation of tibioperoneal trunk and ATA 2013
  - Stenting of left SFA 2016 (re-occlusion)
  - Stenting, scoring PTA and DEB of right SFA 2017
  
  RISK FACTORS
  - Impaired renal function CKD III
  - Hyperlipidemia, art. hypertension, diabetes mellitus
  
  PRESENT STATE
  - Severe claudication, walking distance <80 meters
  - ABI 0.5 left. 0.71 right
  
  PROCEDURAL STEPS
  1. Antegrade access
  - 5 F Terumo Destination 45 cm
  2. Crossing of the lesion
  - Advantage 0.018" wire (TERUMO) with CXI Support (COOK)
  3. PTA of TB-trunk
  - 3.0 x 40 mm balloon
  4. Stenting
  - Cr8-BTK (Alvimedica) if needed (after exchange to 0.014" wire)
  5. PTA of ATP and peroneal artery
  - 2.5 mm balloon
  6. Recanalisation of ATA and PTA
  - 2.5 mm x 200 mm balloon
  

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• Tuesday, January 30th: 15:25 - 15:45, Room 3 - Technical Forum

  Case 25 – Long SFA occlusion right leg

  Center:

  Berlin

  Case 25 – BLN 02: female, 78 years (B-P)

  Operators:

  • Ralf Langhoff,
  • M. Boral

  CLINICAL DATA
  - Severe claudication right leg
  - 12 cm long SFA occlusion
  - Recanalisation of left SFA with focal stent and DEB 11/2017
  
  RISK FACTORS
  Art hypertension, hyperlipidemia, former smoker
  
  PRESENT STATE
  - Ablatio mammae left 1997
  - ABI: 0.57 right
  
  PROCEDURAL STEPS
  1. Antegrade access 5F right common femoral
  2. Wire passage
  - 0.018" Advantage (TERUMO) with CXI 0.018" support (COOK)
  - Back-up wire: Connect 0.018" 250T (ABBOTT VASCULAR)
  3. PTA
  - Passeo 18 4 mm balloon (BIOTRONIK)
  - Passeo 18 LUX DEB 5 mm balloon (BIOTRONIK)
  4. Stenting
  - Pulsar 18 5 x 150 mm stent on demand following REACT strategy (BIOTRONIK)
  5. Manual compression
  6. If antegrade recanalisation fails retrograde access via ATA
  
  

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