LINC 2018 live case guide

Bad Krozingen

• Wednesday, January 31st: 16:52 - 17:15, Room 1 - Main Arena 1

  Case 36 – CFA directional atherectomy with additional DCB angioplasty

  Center:

  Bad Krozingen

  Case 36 – BK 01: female, 64 years (B-R)

  Operators:

  • Aljoscha Rastan

  CLINICAL DATA
  - Claudication Rutherford-Becker class 3
  - DCB angioplasty and stenting of the left popliteal artery 2014
  - Stenting of the right CIA and CIE 2017
  
  RISK FACTORS
  Hypertension, tobacco use, diabetes, hypercholesterolemia
  
  PRESENT STATE
  - ABI at rest: 0.7
  - Duplex ultrasound/angiography: 80% stenosis of the left CFA
  
  PROCEDURAL STEPS
  1. Femoral access (cross-over)
  - 0.035" wire (TERUMO)
  - 7/8F 45 cm sheath (COOK)
  2. Directional atherectomy
  - 0.0014" wire (TERUMO)
  - Spider filter (MEDTRONIC)
  - TurboHawk/ HawkOne (MEDTRONIC)
  3. Post-dilatation
  - DCB (MEDTRONIC)
  4. Stenting on indication
  

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• Thursday, February 1st: 8:00 - 9:30, Room 3 - Technical Forum

  Case 74 – Recanalisation of a chronic CIA CTO and stenting of bilateral IIA stenoses

  Center:

  Bad Krozingen

  Case 74 – BK 03: male, 62 years (FG)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IIb, Rutherford 3
  - Recanalisation right SFA and proximal popliteal artery 12/2017
  - Recanalisation right popliteal and posterior tibial arteries 06/2014
  - Persistant CTO left CIA and bilateral IIA stenoses
  
  RISK FACTORS
  Smoking, hypertension, diabetes mellitus, hypercholesterolemia
  
  PRESENT STATE
  - Buttock, thigh and calf claudicatio left side
  - ABI: 0.8 / 0.4
  - MRA 2014: CTO of left CIA, high grade stenosis of bilateral IIA
  
  PROCEDURAL STEPS
  1. Bilateral retrograde femoral access
  - Right side 45 cm, left side 11 cm
  2. First crossing approach from contralateral side
  - 6F IMA- or 5 F SOS-catheter
  3. Additional retrograde crossing attempt in order to avoid impacting the left IIA origin (CART technique)
  4. Predilatation of left CIA
  5. Stent implantation left CIA
  6. Stent implantation left IIA (right side on indication)
  - Promus Stent (BOSTON SCIENTIFIC)
  

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• Thursday, February 1st: 9:30 - 11:00, Room 3 - Technical Forum

  Case 76 – Combined antegrade and retrograde recanalisation attempt of chronic calcified PTA & ATA occlusions left leg

  Center:

  Bad Krozingen

  Case 76 – BK 04: female, 81 years (G-E)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IV, Rutherford 5 left leg
  - Chronic bilateral venous insufficiency
  - Intermittant atrial fibrillation
  - Unsuccessful recanalisation attempt of left PTA and ATA 04/2017
  - Chronic kidney diseases NKF III - IV (GFR 23–35 ml/min)
  
  RISK FACTORS
  Diabetes mellitus, obesity
  
  PROCEDURAL STEPS
  1. Left antegrade femoral access, 6F
  2. 5F STR guiding catheter (CORDIS)
  3. Balloon guided antegrade crossing attempt
  - 0.014'' Advantage wire (TERUMO) or 0.014'' Victory 14 wire (BSC)
  4. Predilatation on indication
  5. Optional atherectomy
  - Rotablator (BSC)
  6. Drug coated balloon angioplasty
  - Lotus (Acotec)
  7. Stenting on indication
  

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• Thursday, February 1st: 11:59 - 12:24, Room 1 - Main Arena 1

  Case 60 – In-Stent reocclusion right SFA

  Center:

  Bad Krozingen

  Case 60 – BK 02: male, 53 years (M-P)

  Operators:

  • Elias Noory

  CLINICAL DATA
  - PAOD Rutherford 3
  - Severe claudication right calf, walking capacity 50 meters
  - Recanalisation, rtPA-thrombolysis and stent implantation right prox-dist SFA 04/2011
  - Recanalisation and stent implantation right distal SFA 11/2004
  - Fogarty thrombectomy right distal SFA 2004
  - Testicular cancer, semicastratio and radio-chemotherapy 2003-2004
  - ABI: right 0.6 after excercise test 0.4
  
  RISK FACTORS
  Nicotine abuse (25 PY) to 2006, hypercholertinemia
  
  DUPLEX
  Long instent reocclusion of right SFA
  
  PROCEDURAL STEPS
  1. Left femoral retrograde and cross over approach
  - 6F 45 cm sheath
  2. 0.035" or 0.018" Terumo GW, supported by vertebral catheter, 5F
  3. Rotarex thrombectomy
  - 6F (STRAUB MEDICAL)
  4. Predilatation on indication (Cutting balloon)
  5. Drug-coated balloon angioplasty
  

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• Thursday, February 1st: 13:30 - 17:00, Room 3 - Technical Forum

  Case 83 – Combined antegrade and retrograde recanalisation left CIA, EIA, CFA and SFA

  Center:

  Bad Krozingen

  Case 83 – BK 05: male, 71 years (S-W)

  Operators:

  • Thomas Zeller

  CLINICAL DATA
  - PAOD Fontaine IIb/ Rutherford 3
  - Recanalisation right EIA, CFA & DFA with persistant SFA occlusion 11/2017
  - Infrarenal AAA
  - ABI: 0.6/ 0.4
  
  RISK FACTORS
  Hypertension, ex-smoker, hypercholesterolemia
  
  MRA
  Occlusion of left CIA, EIA, CFA and SFA
  
  PROCEDURAL STEPS
  1. Retrograde right femoral access (45 cm sheath)
  2. Retrograde puncture distal left SFA
  3. Primarily retrograde recanalisation attempt
  - 0.018'' or 0.035'' Glidewire (TERUMO)
  4. Stenting of iliac vessels
  5. DCB angioplasty of femoral arteries with stenting on indication
  - BioMimics (Veryan) or Supera (ABBOTT VASCULAR)
  
  

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• Thursday, February 1st: 16:44 - 17:12, Room 1 - Main Arena 1

  Case 66 – Combined antegrade and retrograde recanalisation right popliteal artery

  Center:

  Bad Krozingen

  Case 66 – BK 06: male, 64 years (T-B)

  Operators:

  • Aljoscha Rastan

  CLINICAL DATA
  - Claudication Rutherford-Becker 3
  - Unsuccessful recanalisation right popliteal artery with perforation 12/2017
  
  RISK FACTORS
  Hypertension, tobacco use, hypercholesterolemia
  
  PRESENT STATE
  - ABI: 0.3
  - Duplex ultrasound/ angiography: Occlusion of the right popliteal artery
  
  PROCEDURAL STEPS
  1. Femoral access (cross-over)
  - 0.035" wire (TERUMO)
  - 6F 45 cm sheath (COOK)
  2. Retrograde puncture ATA vs. ATP
  3. Recanalisation attempt
  - 0.018" wire (BOSTON SCIENTIFIC, TERUMO)
  - 3 x 40 mm balloon (BOSTON SCIENTIFIC)
  4. Pre-dilatation
  - DCB vs. POBA (MEDTRONIC, BOSTON SCIENTIFIC)
  5. Stenting on indication
  - Supera (ABBOTT)
  

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