LINC 2018 live case guide

Cotignola

• Tuesday, January 30th: 9:47 - 10:10, Room 2 - Main Arena 2

  Case 12 – Right common iliac occlusion in a patient with severe aortic carrefour disease

  Center:

  Cotignola

  Case 12 – COT 02: male, 70 years (P-P)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  - Known vascular history with previous LICA PTA in 2015
  - No history of chest pain, referred progressively deteriorating symptoms of claudication from October '17, now severely impairing his quality of life
  
  RISK FACTORS
  - Hypertension, previous history of smoking, hypercholesterolemia
  - Severe claudication (20 mt), erectile dysfunction
  - pronounced flow demodulation in both common femoral arteries
  
  PROCEDURAL STEPS
  1. Radial access for angiographic evaluation
  2 . Bilateral femoral access
  3. Right common iliac artery lesion crossing
  - 0.018'' 300 cm wire or Terumo soft 0,035'' hydrophilic wire
  4. Kissing stenting with balloon-expandable stents
  - Assurant-Cobalt stents (MEDTRONIC)
  5. Postdilation as required
  

  View image
• Tuesday, January 30th: 11:50 - 12:16, Room 3 - Technical Forum

  Case 22 – Symptomatic left internal carotid disease in a 79-year old woman

  Center:

  Cotignola

  Case 22 – COT 03: female, 79 years (D-P)

  Operators:

  • Antonio Micari,
  • Fausto Castriota

  CLINICAL DATA
  - In November '17 major stroke with right-sided hemiparesis
  - Progressive full recovery in the subsequent 30 days
  
  RISK FACTORS
  - Hypertension, hypercholesterolemia
  - Asymptomatic (recent stroke)
  
  DUPLEX
  Left internal carotid tight disease with soft/ mixed plaque determining significant flow acceleration
  
  PROCEDURAL STEPS
  1. Femoral access
  2. Proximal protection
  - MOMA 9F (MEDTRONIC)
  3. Lesion crossing with 0.014'' wire
  4. Direct stenting
  - 'Double mesh' stent C-Guard (INSPIRE MD)
  5. Postdilation
  - 5.0 mm Maverick XL balloon (BOSTON SCIENTIFIC)
  6. Debris aspiration (if any)
  

  View image
• Tuesday, January 30th: 14:25 - 14:45, Room 1 - Main Arena 1

  Case 06 – Severely calcified left SFA restenosis

  Center:

  Cotignola

  Case 06 – COT 01: male, 66 years (A-V)

  Operators:

  • Antonio Micari,
  • Fausto Castriota

  CLINICAL DATA
  - Previous left SFA PTA (plain balloon) for severe claudication in February 2017
  (final angio attached).
  - Asymptomatic till mid November when he started complaining left leg pain for walking distances > 200 mt (very active lifestyle)
  
  RISK FACTORS
  - Hypertension
  - Severe claudication (walking distance 200 mt)
  
  DUPLEX
  Evidence of proximal SFA occlusion with flow demodulation in popliteal artery
  1. Right femoral access
  2. Cross-over approach
  - Terumo Destination 6F 45 cm long sheath
  3. Lesion crossing
  - 0.018'' wire, 0.035'' hydrophilic wire (TERUMO)
  4. Atherectomy for lesion preparation
  - HawkOne System (MEDTRONIC)
  5. Balloon dilatation
  - 5.0 and 6.0 mm In.Pact Admiral drug-eluting balloons (MEDTRONIC)
  6. Further postdilatation with long balloons, if needed
  

  View image
• Tuesday, January 30th: 16:30 - 18:00, Room 3 - Technical Forum

  Case 28 – Symptomatic left internal carotid artery disease in a 68-year old high-risk patient

  Center:

  Cotignola

  Case 28 – COT 04: male, 68 years (A-S)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  - Known history of dilated cardiomyopathy (EF 35%).
  - Severe COPD.
  - Previous PTA to RICA in 2016.
  - In November 2017 sudden onset of right-sided hemyparesis with dysartria, full recovery after 24 hours.
  
  RISK FACTORS
  - Hypertension
  - Currently asymptomatic (previous stroke in Novmber 2017)
  
  DUPLEX
  Severe LICA disease (fibro-calcific disease)
  
  PROCEDURAL STEPS
  1. Femoral access
  2. Proximal protection
  - MoMa proximal protection system (MEDTRONIC)
  3. Direct stenting with 'closed-cell' stent
  - Carotid Wallstent (BOSTON SCIENTIFIC)
  4. Postdilatation
  - 5.0 mm Maverick XL balloon (BOSTON SCIENTIFIC)
  5. Debris aspiration (if any)
  

  View image