LINC 2019 live case guide

Berlin

• Tuesday, January 22nd: 9:26 - 9:51, Room 3 - Technical Forum

  Case 20 – Asymptomatic very high grade LICA-Stenosis in a young vascular polytrauma

  Center:

  Berlin

  Case 20 – BLN 02: male, 52 years (R-V)

  Operators:

  • Ralf Langhoff,
  • Andrea Behne

  CLINICAL DATA
  High grade bilateral ICA stenosis (left>right)
  Diabetic foot syndrom left
  Bilateral total SFA occlusions (PTA with DEB and Ultrascore 08/2018)
  Bilateral high grade CIA&EIA steosis (PTA and Stenting 08/2018
  Coronary disease (2 vessel, symptomatic)
  High grade left renal stenosis
  Left Subclavian artery high grade stenosis
  
  RISK FACTORS
  Smoker, diabetes mellitus, art. hypertension
  
  CT
  Aortic Arch Type 1, left ostial subtotal carotid artery stenosis
  
  DUPLEX
  High grade stenosis, not much calcium, straight vessel, soft plaques, high grade stenosis
  
  PROCEDURAL STEPS
  1. Transfemoral access
  - Short 8F sheath (TERUMO)
  2. Sheath placement
  - 8F MP-shape guiding catheter sheath into the left CCA (VISTA BRITE IG, CORDIS)
  3. Distal Protection
  - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
  4. Predilatation
  - 3 x 40 mm Maverick balloon (BOSTON SCIENTIFIC)
  5. Secondary protection/ stenting/ postdilatation
  - Neuroguard IEP stent 9 mm (CONTEGO MEDICAL) filter, Nitinol stent and postdilation balloon in one system
  6. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
  7. Control angiography extra – and intracranial DSA
  8. Access care
  - Angioseal 8F (TERUMO)

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• Tuesday, January 22nd: 13:30 - 15:00, Room 3 - Technical Forum

  Case 22 – CTO Left popliteal artery (11 cm length)

  Center:

  Berlin

  Case 22 – BLN 03: female, 75 years (G-J)

  Operators:

  • Ralf Langhoff,
  • David Hardung

  CLINICAL DATA
  Recanalisation of the rigt popliteal artery CTO in 11/2018,
  PTA with Sequent Please OTW and 4 Multiloc 5 x 13 mm stents.
  Deep vein thrombosis in 02/2018 with DOAK for 6 months
  
  PRESENT STATE
  ABI left 0.7, walking distance <50 mm, calf claudication,
  Duplex and Angio showed popliteal segment I CTO
  
  RISK FACTORS
  Smoking, art. hypertension
  
  PROCEDURAL STEPS
  1. Cross-over access
  - 6F Fortress 45 cm sheath (BIOTRONIK) right to left
  2. Catheter for lesion crossing
  - Navicross 0.035“ support catheter 90 cm (TERUMO)
  3. Guidewire for lesion crossing
  - Angled stiff glidewire, 260 cm (TERUMO)
  4. Lesion crossing
  5. Backup retrograde access
  - 0.018“ approach, sheathless with CXI 0.018“ support catheter (COOK)
  6. Predilation
  - 3 x 120 mm Passeo 35 balloon (BIOTRONIK)
  7. PTA
  - 5 x 120 mm Sequent Please OTW DEB (B. BRAUN)
  8. Spot Stenting
  - Multi-Loc 5 x 13 mm if needed (B. BRAUN)
  9. Postdilation if stent was necessary
  - 5 mm POBA (BIOTRONIK)
  10. Sheath removal and vessel closure

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• Tuesday, January 22nd: 15:00 - 15:30, Room 5 - Global Expert Exchange

  Case 29 – Diabetic foot syndrome with CTO of tibioperoneal trunc and distal occlusion of the ATP

  Center:

  Berlin

  Case 29 – BLN 04: male, 62 years, (J-B)

  CLINICAL DATA
  Gangrene Dig. ped. II right, persistend occlusion of right tibioperoneal trunc
  Diabetes mellitus
  Minor amputation of right foot Dig ped I ex-articulation of end-phalanx
  PTA and Supera stenting right SFA & popliteal artery 01/2019
  Impaired renal function
  TEA and Patch bilateral common femoral artery (2015)
  
  RISK FACTORS
  Hyperlipidemia (Lipidapharesis since 2016), art. hypertension
  CHD (post-MI), recanalisation of inflow was done by cross-over approach,
  wound is only slowly improving
  
  PROCEDURAL STEPS
  1. Antegrade access
  - Destination 5F sheath (45 cm) right CFA (TERUMO)
  2. Recanalisation
  - supported by CXI Supportcatheter 0.018“ (COOK) and Advantage Glidewire 0.018“ (TERUMO)
  3. PTA
  - 2 x 40 mm ballon Passeo 18 (BIOTRONIK)
  4. Recanalisation of the tibioperoneal trunc & distal ATP to the pedal arch and PTA
  5. Stenting of the tibioperoneal trunc
  - 3.0 x 31 mm Cre8 BTK dedicated DES (ALVIMEDICA)
  6. BACK-UP: transpedal-loop recanalisation of the ATP via the ATA
  - 0.014“ Corsair Microcatheter (ASAHI) and 0.014“ Advantage Wire (TERUMO)
• Tuesday, January 22nd: 16:05 - 16:30, Room 2 - Main Arena 2

  Case 17 – High-grade, progressive RICA post radiation and open surgery for parotid tumor

  Center:

  Berlin

  Case 17 – BLN 01: male, 62 years, (J-B)

  Operators:

  • Ralf Langhoff,
  • Andrea Behne

  CLINICAL DATA
  Radiation and open surgery due to parotid cancer (years ago)
  Renal insufficiency (last Creatinin level 2.3 mg/dl)
  
  DUPLEX
  High grade RICA, PSV 364 cm/sec, EDV >100 cm/sec, MDV 100 cm/sec
  
  RISK FACTORS
  Ex-nicotine, art. hypertension
  
  PRESENT STATE
  CTA and MRA not available due to impaired renal function
  
  PROCEDURAL STEPS
  1. Transfemoral access
  - Short 8F sheath (TERUMO)
  2. Placement of the guiding catheter
  - 8F MP-shape guiding catheter sheath into the right CCA (VISTA BRITE IG, CORDIS)
  3. Distal Protection
  - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
  4. Predilatation
  - 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
  5. Stenting
  - Roadsaver 8 x 25 mm Micromesh-stent (TERUMO)
  6. Postdilatation
  - 5 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
  7. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
  8. Control angiography extra – and intracranial DSA
  9. Access care
  - Angioseal 8F (TERUMO)

  View image