LINC 2019 live case guide

Conference day 1

• 8:14 - 8:45, Room 1 - Main Arena 1

  Case 01 – Calcified SFA-occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 01 – LEI 01: male, 75 years (M-K)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right calf, walking capacity 100 meters,
  ABI right 0.54, Rutherford class 3
  PTA both EIA 10/2014 and left SFA 12/2014
  CAD, AMI 02/2014
  Mild renal impairment
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, former smoker
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - 0.035“ SupraCore guidewire 190 cm (ABBOTT)
  - 7F 40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage
  - Command 18 and Armada 18 balloon (ABBOTT) or
  - 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO)
  3. In case of failure to pass the CTO
  - GoBackTM Crossing Catheter (Upstream Peripheral)
  4. PTA
  - 4.0 – 6.0 mm Armada 35 balloon (ABBOTT)
  - Conquest high pressure balloon on indication (BARD)
  5. Stenting
  - 5.0 or 6.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

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• 8:50 - 9:10, Room 2 - Main Arena 2

  Case 09 – Woven nitinol stent for chronic total occlusion of common femoral vein

  Center:

  Zürich

  Case 09 – ZUE 01: male, 39 years (FJ-C)

  Operators:

  • Nils Kucher,
  • Dai-Do Do

  CLINICAL DATA
  Severe post-thrombotic syndrome right leg
  History of provoked deep venous thrombosis left leg 2009
  
  PRESENT STATE
  Villalta score: 12 points
  Hetercygote Faktor-V Leiden mutation
  
  DUPLEX
  Right leg: chronic thrombosis of common femoral and femoral vein
  Patent iliac veins
  
  PROCEDURAL STEPS
  1. Analgosedation propofol, fentanyl; ultrasound-guided access: of the size and location of metastases.
  2. Lesion examination with selective venography in two orthogonal views, deep femoral vein imaging using balloon occlusion venography of common femoral vein, provisional IVUS
  3. Passage of femoral vein occlusion using stiff angled glidewire 0.035“, Astato 0.018“ 30 g tip load, angled 0.035“ CXI support catheter
  4. Balloon angioplasty up to 12 mm high pressure of common femoral vein, provisional cutting ballon up to 8 mm
  5. Placement of Blueflow stent (14 x 100 mm or 14 x 150 mm) likely from the jugular approach
  6. Postdilatation high pressure of Blueflow up to 14 mm (ATLAS GOLD, BARD)
  7. Final venograms and assessment of peak flow velocity in common femoral vein by Duplex sonography

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• 9:06 - 9:30, Room 1 - Main Arena 1

  Case 02 – Calcified CTO of the left distal SFA and left popliteal artery

  Center:

  Leipzig, Dept. of Angiology

  Case 02 – LEI 02: male, 73 years (W-H)

  Operators:

  • Sven Bräunlich,
  • Axel Fischer

  CLINICAL DATA
  PAOD Rutherford III left, painfree walking distance 100 m, ABI left: 0,5
  CAD, ICM (EF 32%), AMI 2014 and 12/2018, CABG 2014, PTCA 12/18
  Renal impairment
  
  RISK FACTORS
  Arterial hypertension, diabetes mellitus type 2 with angio- and neuropathy, hyperlipidemia
  
  PROCEDURAL STEPS
  1. Right groin retrograde and cross-over approach
  - 0.035“ SupraCore guidewire 190 cm (ABBOTT)
  - 7F 40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage and PTA
  - Command 18 and Armada 18 balloon (ABBOTT) or
  - 0.035“ Radiofocus soft angled guidewire, 260 cm (TERUMO) and
  4.0/120 mm Armada 35 balloon (ABBOTT)
  - 5.0/40 mm Armada 35 balloon (ABBOTT)
  3. Stenting
  - 5.0/150 mm Supera Interwoven Selfexpanding Nitinol stent (ABBOTT)

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• 9:10 - 9:30, Room 2 - Main Arena 2

  Case 10 – Live case from Galway

  Center:

  Galway

  Case 10 – Live case from Galway

  Information will follow in due time. Thank you for your understanding.
• 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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• 9:48 - 10:15, Room 2 - Main Arena 2

  Case 11 – TASC D calcified iliac occlusion right

  Center:

  Leipzig, Dept. of Angiology

  Case 11 – LEI 06: male, 59 years (L-G)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  Severe claudication right, walking-capacity 50-100 meters
  Rutherford class 3, ABI right 0.46
  COPD
  
  RISK FACTORS
  Arterial hypertension, hyperlipidemia, strong smoker (50PY)
  
  PROCEDURAL STEPS
  1. Right femoral access
  - 7F 25 cm Radiofocus Introducer (TERUMO)
  - 0.035“ SupraCore guidewire 300 cm (ABBOTT)
  Left brachial approach:
  - 6F 90 cm Check-Flo Performer (COOK)
  2. Antegrade and retrograde guidewire passage
  brachial:
  - 5F Judkins Right diagnostic catheter 125 cm (CORDIS/CARDINAL HEALTH)
  from femoral:
  - 5F Multipurpose diagnostic catheter 80 cm (CORDIS/CARDINAL HEALTH)
  - 0.035“ stiff angled glidewire, 260 cm (TERUMO)
  3. Predilatation and stenting of the aorto-iliac bifurcation
  - Ultraverse or Dorado balloon (BARD)
  - LifeStream covered stent 8/58 mm bilateral common iliac arteries in kissing-technique (BARD)
  - Covera Plus vascular covered stent for the external iliac artery (BARD)

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• 10:35 - 10:55, Room 1 - Main Arena 1

  Case 03 – Occlusion of the right SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 03 – LEI 03: male, 74 years (P-V)

  Operators:

  • Sven Bräunlich,
  • Manuela Matschuck

  CLINICAL DATA
  PAOD Rutherford 3, walking capacity 100 m, ABI right 0.55, left 0.6
  Failed recanalisation attempt of the right SFA 08/12 elsewhere
  Renal impairment grade 2
  
  RISK FACTORS
  Aterial hypertension, former nicotine abuse (20PY), hyperlipidemia
  
  PROCEDURAL STEPS
  1. Left groin and cross-over approach
  - Judkins Right 5F diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0,035“ SupraCore guidewire 30 cm (ABBOTT)
  - 6F 40 cm Balkin Up&Over sheath (COOK)
  2. Guidewire passage of the occlusion
  - 0.035“ Halfstiff TERUMO 260 cm (TERUMO)
  - 0.035“ QuickCross support catheter, 135 cm (PHILIPS)
  3. PTA with scoring ballon
  - 4/40 mm AngioSculpt PTA scoring balloon (PHILIPS)
  4. PTA with DCBs
  - Stellarex 5.0/120 mm DCBs (PHILIPS)

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• 10:57 - 11:22, Room 3 - Technical Forum

  Case 21 – Symptomatic left carotid artery disease in a patient with coronary artery disease

  Center:

  Bergamo

  Case 21 – BG 02: male, 64 years (D-V)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  Stable angina during the last 12 months, 1 hospital admission for TIA (transient dysartria) 1 month ago
  
  RISK FACTORS
  Hypertension, hypercholesterolemia
  
  DUPLEX
  Critical LICA stenosis with evidence of a ‚soft‘ plaque
  
  PROCEDURAL STEPS
  1. Femoral access
  2. Selective angiography
  3. Cerebral protection
  - MOMA 9F (MEDTRONIC) positioning
  4. Stenting
  - C-Guard (Inspire MD)
  5. Postdilatation
  - 5,0/20 mm balloon (BOSTON SCIENTIFIC )
  6. Femoral access haemostasis

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• 11:10 - 11:25, Room 2 - Main Arena 2

  Case 12 – Endovascular Y-reconstruction of chronic total occlusion of infrarenal inferior vena cava and iliofemoral veins

  Center:

  Zürich

  Case 12 – ZUE 02: male, 24 years, (F-A)

  Operators:

  • Nils Kucher,
  • Dai-Do Do

  CLINICAL DATA
  Massive descending bilateral iliofemoral DVT in September 2018 including the infrarenal IVC diagnosed late
  and treated conservatively, ongoing shortness of breath, ongoing severe spinal and biliateral leg claudication,
  limited physical performance since childhood
  
  PRESENT STATE
  Villata score: 6 points;
  Spiroergometry: limited oxygen uptake during exercise due to impaired venous return
  
  CT VENOGRAPHY
  Obtained 4 weeks after onset of symptoms:
  - chronic total occlusion of perirenal inferior vena cava with descending DVT into both iliac and common femoral veins
  - acygos collaterals
  
  DUPLEX
  Preserved leg inflow veins
  
  PROCEDURAL STEPS
  1. General anaesthesia, ultrasound-guided access bilateral femoral veins (below occlusion) and possibly right jugular vein (10F)
  2. Passage of occlusion of vena cava and iliac veins stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load
  3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
  4. High pressure balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
  5. Stenting of IVC with 20 mm Venovo stent (BARD) with high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
  6. Y-reconstruction of iliac confluens using Venovo (BARD) 14 mm kissing stents
  7. Kissing balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
  8. Stent extension to both common femoral veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
  9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography

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• 11:25 - 11:40, Room 2 - Main Arena 2

  Case 13 – Live case from Galway

  Center:

  Galway

  Case 13 – Live case from Galway

  Operators:

  • Gerard O'Sullivan,
  • M. Mullin

  Information will follow in due time. Thank you for your understanding.

  View image
• 11:25 - 11:40, Room 2 - Main Arena 2

  Case 13 – Live case from Galway

  Center:

  Galway

  Case 13 – Live case from Galway

  Information will follow in due time. Thank you for your understanding.
• 12:10 - 12:20, Room 2 - Main Arena 2

  Case 14 – Endovascular Y-reconstruction of chronic total occlusion of entire suprarenal and infrarenal inferior vena cava and iliac veins

  Center:

  Zürich

  Case 14 – ZUE 03: male, 46 years (W-C)

  Operators:

  • Nils Kucher,
  • Dai-Do Do

  CLINICAL DATA
  Limited physical performance
  History of acute venous thrombosis right common iliac vein (2013)
  Several catheterizations as newborn
  
  IMPORTANT ITEMS
  MR-venography: atresia of entire inferior vena cava starting from the liver veins, bilateral common iliac vein occlusion, prominent collateral veins (vena azygos and lumbar veins)
  Spiroergometry: limited oxygen uptake during exercise due to impaired venous return (60% of norm)
  Villalta score: 9 points
  
  DUPLEX
  patent common femoral veins
  
  PROCEDURAL STEPS
  1. General anaesthesia, Ultrasound-guided access:
  right and left common femoral veins and possibly right jugular veins (10F)
  2. Passage of occlusion of vena cava and iliac veins using stiff angled glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load, angled CXI 0.035“ support catheter
  3. Lesion examination by selective venograpy two planes, intra-occlusion venography and provisional IVUS
  4. High pressure Balloon angioplasty up to 20 mm in vena cava, up to 14 mm iliac veins
  5. Stenting of IVC with two overlapping 20 mm Venovo (BARD) stents and high pressure postdilation up to 20 mm (ATLAS GOLD, BARD)
  6. Y-reconstruction of iliac confluens using Venovo 14 mm kissing stents (BARD)
  7. Kissing Balloon postdilation of iliac confluens with 14 mm ATLAS GOLD balloons (BARD)
  8. Possibly stent extensions to both external iliac veins using Venovo 14 mm stents (BARD) with postdilation up to 14 mm high pressure
  9. Final venograms and assessment of peak flow velocity in both common femoral veins by Duplex sonography

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• 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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• 13:30 - 15:00, Room 3 - Technical Forum

  Case 23 – Long calcified SFA-occlusion left

  Center:

  Leipzig, Dept. of Angiology

  Case 23 – LEI 07: male, 61 years (R-F)

  Operators:

  • Sven Bräunlich,
  • Andrej Schmidt

  CLINICAL DATA
  Severe claudication left calf, walking capacity 50 meters, ABI left 0.62
  Femoro-popliteal bypass right 2012, thrombendatherectomy left groin 01/2019
  CEA left 11/2012 and right 12/16, CAD, AMI 1997
  
  RISK FACTORS
  Art. hypertension, diabetes mellitus type 2, nicotine abuse (80PY), hyperlipidemia
  
  PROCEDURAL STEPS
  1. Right groin and cross-over access
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035“ angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035“ SupraCore guidewire, 190 cm (ABBOTT)
  - 7F Balkin Up&Over sheath, 40 cm (COOK)
  2. Antegrade guidewire-passage
  In case of failure from antegrade:
  Retrograde GW-passage via proximal ATA
  - 21 Gauge 9cm needle (B.BRAUN)
  - 0.018” V-18 Control GW, 300cm (BOSTON SCIENTIFIC)
  - 0.018” CXC Support-Catheter, 90cm (COOK)
  3. In case of failure to pass the guidewire
  - retrograde approach via distal SFA or GoBackTM Crossing Catheter (Upstream Peripheral) from antegrade
  4. Tumescent anesthesia of the SFA
  - Bullfrog-Device (MERCATOR)
  5. PTA/ vessel preparation
  - Sterling 5/100 mm balloon (BOSTON SCIENTIFIC)
  - Conquest High pressure balloon on indication (BARD)
  6. Differential stenting
  - Eluvia DES in case of minor recoil (BOSTON SCIENTIFIC)
  - Supera Interwoven Nitinol-Stent in case of severe recoil (ABBOTT)

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• 13:30 - 14:00, Room 5 - Global Expert Exchange

  Case 28 - Live case from Bergamo

  Center:

  Bergamo

  Case 28 - Live case from Bergamo

  Operators:

  • Antonio Micari,
  • Fausto Castriota

  Information will follow in due time. Thank you for your understanding.
• 13:38 - 14:02, Room 1 - Main Arena 1

  Case 04 – Chronic total occlusion left SFA

  Center:

  Leipzig, Dept. of Angiology

  Case 04 – LEI 04: female, 76 years (M-R)

  Operators:

  • Matthias Ulrich,
  • Manuela Matschuck

  CLINICAL DATA
  Severe claudication both calves, walking capacity 20 meters
  Obesitiy, renal impairment G3, ICM, mycardial infarction 2009
  ABI right: 0.53 and left: 0.64
  
  RISK FACTORS
  Arterial hypertension, former smoker
  
  ANGIOGRAPHY
  11/2018: long SFA-occlusions both sides, moderate calcification
  
  PROCEDURAL STEPS
  1. Left groin retrograde and cross-over approach
  - IMA-diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
  - 0.035“ angled soft Radiofocus guidewire, 190 cm (TERUMO)
  - 0.035“ SupraCore guidewire, 190 cm (ABBOOTT)
  - 6F Balkin Up&Over sheath, 40 cm (COOK)
  2. Passage of the occlusion of the right SFA
  - 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035“ TrailBlazer support catheter, 135 cm (MEDTRONIC)
  - Exchange to 0.018“ SteelCore guidewire (ABBOTT)
  3. PTA with DCBs
  - 5.0 mm Chocolate balloon (MEDTRONIC)
  - 6.0/120 mm In.Pact Pacific DCB (MEDTRONIC)
  4. Stenting on indication
  - Complete Selfexpanding Nitinol stent (MEDTRONIC)

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• 13:47 - 14:07, Room 2 - Main Arena 2

  Case 15 – Live case from Galway

  Center:

  Galway

  Case 15 – Live case from Galway

  Information will follow in due time. Thank you for your understanding.
• 14:18 - 14:42, Room 1 - Main Arena 1

  Case 05 – Severe diffuse left SFA disease with distal occlusion

  Center:

  New York

  Case 05 – NY 01: female, 75 years, (S-C)

  Operators:

  • Prakash Krishnan,
  • Vishal Kapur

  CLINICAL DATA
  Left leg claudication x 6 months (< 3 blocks)
  Failed exercise therapy and a trial of Cilostazol
  ABI (R/L) 0.92/0.71
  
  RISK FACTORS
  Type 2 DM, HTN, dyslipidemia
  
  DUPLEX
  Suggestive of distal left SFA occlusion
  
  PROCEDURAL STEPS
  1. Right CFA access
  - Micropuncture sheath (COOK)
  2. Access sheath
  - 6F 45 cm crossover Destination sheath (TERUMO)
  3. Antegrade lesion crossing
  - 0.035“ stiff angled glidewire (TERUMO)
  4. Embolic protection
  - Emboshield Nav 6 (4-7) filter deployment (ABBOTT)
  5. Ultrasound
  - Vision PV 0.14 intravascular ultrasound (PHILIPS)
  6. Atherectomy
  - Directional atherectomy, Hawk M (MEDTRONIC)
  7. Angioplasty
  - Drug coated balloon angioplasty IN.PACT Admiral balloon (MEDTRONIC)
  8. Stenting
  - Stent scaffold for severe flow limiting dissection

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• 15:00 - 16:30, Room 3 - Technical Forum

  Case 24 – Chronic occlusion of the abdominal aorta and aortic bifurcation, Leriche-Syndrome

  Center:

  Leipzig, Dept. of Angiology

  Case 24 – LEI 08: male, 46 years (A-G)

  Operators:

  • Andrej Schmidt,
  • Matthias Ulrich

  CLINICAL DATA
  PAOD Rutherford 3 bilateral, ABI bilateral 0.5
  Absolute walking-capacity 100 meters, weakness both thighs/calves
  
  RISK FACTORS
  Art. hypertension, nicotine abuse (30PY)
  
  PROCEDURAL STEPS
  1. Transbrachial approach
  - 6F 90 cm Check-Flo performer sheath (COOK)
  - 5F 125 cm diagnostic Judkins Right catheter (CORDIS/CARDINAL HEALTH)
  - SupraCore 300 cm 0.035“ guidewire (ABBOTT)
  2. Passage of the occlusions
  - Stiff angled 0,035“ guidewire, 260 cm (TERUMO)
  - Together with 5F-125 cm Judkins Right catheter
  3. Bilateral groin access
  - 7F 10 cm Radiofocus sheath (TERUMO)
  - Snaring of the antegrade guidewire from above into the groin-sheath or
  - Into 6F-Judkins-Right guiding catheter (CORDIS) inserted from below
  4. PTA/thrombectomy via the groin access bilateral
  - Rotarex 10F thrombectomy (STRAUB MEDICAL)
  - SupraCore 300 cm 0,035“ guidewire (ABBOTT)
  - Admiral balloon 6.0/120 mm bilateral (MEDTRONIC)
  5. Implantation of covered stents
  - VBX covered stents for both renal arteries (GORE)
  - VBX covered stents bilateral in kissing technique (GORE)

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• 15:00 - 16:30, Room 3 - Technical Forum

  Case 25 – Live case from New York

  Center:

  New York

  Case 25 – Live case from New York

  Information will follow in due time. Thank you for your understanding.
• 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)
• 15:20 - 15:45, Room 2 - Main Arena 2

  Case 16 – Rapidly progressing right carotid artery disease in a 55-yrs old patient

  Center:

  Bergamo

  Case 16 – BG 01: female, 55 years (C-C)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  CVRFs: hypertension, hypercholesterolemia
  Unstable angina treated with PCI to LAD (DES) in December 2018 (need for 12-month double antiplatelet therapy)
  
  DUPLEX
  Critical RICA stenosis (NASCET 80%) with evidence of a ‚soft‘ fast-growing plaque (40% at Duplex scan performed in January 2018)
  
  PROCEDURAL STEPS
  1. Femoral access
  2. Selective angiography
  3. Cerebral protection
  - MOMA 9F (MEDTRONIC) positioning
  4. Stenting
  - Roadsaver (TERUMO) stent
  5. Postdilatation
  - 5,0/20 mm balloon (BOSTON SCIENTIFIC)
  6. Femoral access haemostasis

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• 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)

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• 16:30 - 18:00, Room 2 - Main Arena 2

  Case 18 – Oblique hybrid stent placement for postthrombotic May Thurner Syndrome

  Center:

  Zürich

  Case 18 – ZUE 04: female, 29 years, (H-D)

  Operators:

  • Nils Kucher,
  • Dai-Do Do

  CLINICAL DATA
  History of acute iliac vein thrombosis (left) during complicated gemini-pregnancy in 23rd week of gestation
  treated with enoxaparin 1 mg/kg twice daily (in August 2018), caeserian section for twins in October 2018;
  currently breastfeeding and still treated with enoxaparin but severe venous claudication with leg swelling and venous claudication.
  
  DUPLEX
  Postthrombotic changes of common femoral veins, May Thurner anatomy with compressed left common
  ilica vein, preserved leg inflow veins
  
  ULTRASOUND
  Post-thrombotic changes left iliac and common femoral veins
  Linear flow pattern left external iliac vein
  Left common iliac vein compressed down to 2 mm (May-Thurner anatomy)
  
  PROCEDURAL STEPS
  1. Ultrasound-assisted access left femoral vein (10F), analogosedation propofol, fentanyl
  2. Passage of iliac veins with stiff angeld glidewire 0.035“, Astato 0.018“ CTO wire with 30 g tip load,
  4F Berenstein catheter or angled CXI 0.035“ support catheter
  3. Selective venograpy two planes, intra-occlusion venography, deep femoral vein imaging using
  balloon occlusion venography of common femoral vein and provisional IVUS
  4. Balloon angioplasty up to 14 mm (ATLAS GOLD, BARD)
  5. Left iliac vein stenting (SINUS obliquus 14 x 150 mm, OPTIMED)
  6. Provisional stent extension to common femoral vein (SINUS XL Flex 14 mm, OPTIMED)
  7. Postdilation high pressure up to 14 mm (ATLAS GOLD, BARD)
  8. Postdilation high pressure up to 14 mm (ATLAS GOLD, BARD)
  9. Final venograms and assessment of peak flow velocity in common femoral vein by Duplex sonography

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• 16:30 - 18:00, Room 2 - Main Arena 2

  Case 19 – Live case from Galway

  Center:

  Galway

  Case 19 – Live case from Galway

  Information will follow in due time. Thank you for your understanding.
• 16:30 - 18:00, Room 3 - Technical Forum

  Case 26 - Symptomatic left subclavian artery stenosis

  Center:

  Bergamo

  Case 26 – BG 03: female, 78 years (N-S)

  Operators:

  • Antonio Micari,
  • Fausto Castriota

  PRESENT STATE
  During the last 3 months she referred effort left arm pain (while doing homework).
  One week ago 1 episode of marked dizziness while climbing stairs.
  Duplex showed critical left subclavian artery stenosis (then confirmed by angio)
  
  RISK FACTORS
  Hypertension, hypercholesterolemia
  Known history of CAD (previous PCI to LM-LAD and RCA)
  
  PROCEDURAL STEPS
  1. Femoral access
  2. Left radial access
  3. Lesion crossing
  - 0.018‘‘ wire
  4. Lesion predilation
  - cutting balloon (WOLVERINE, BOSTON SCIENTIFIC) and drug-coated balloon (RANGER, BOSTON SCIENTIFIC)
  5. Stenting
  - Innova self-expanding stent (BOSTON SCIENTIFIC)
  6. Postdilatation

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• 16:30 - 18:00, Room 3 - Technical Forum

  Case 27 – Restenosis of the left common carotid artery after TEA

  Center:

  Leipzig, Dept. of Angiology

  Case 27 – LEI 09: female, 56 years (L-K)

  Operators:

  • Andrej Schmidt,
  • Sven Bräunlich

  CLINICAL DATA
  Asymptomatic highgrade stenosis of the the common carotid artery left, dizziness
  M. Hodgkin 1984 with cervical radiation
  CEA right 09/16 and CEA of left common carotid artery 05/17
  
  RISK FACTORS
  Art. hypertension, hyperlipidemia, former smoker
  
  DUPLEX
  4.8 m/sec. Left distal common carotid artery
  
  PROCEDURAL STEPS
  1. Right groin access
  - 5F Judkins Right diagnostic catheter (CORDIS/CARDINAL HEALTH)
  - 0.015“ SupraCore guidewire (ABBOTT)
  - 7F 90cm Check Flo Performer sheath (COOK)
  2. Cerebral protection
  - Filter-wire EZ (BOSTON SCIENTIFIC)
  3. Predilatation and Stenting
  - 3.5/20 mm MiniTrek Monorail balloon (ABBOTT)
  - 8/30 mm CGuard stent (InspireMD)

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• 16:36 - 17:02, Room 1 - Main Arena 1

  Case 07 – Chronic CTO left SFA, CLI

  Center:

  Leipzig, Dept. of Angiology

  Case 07 – LEI 05: male, 64 years (P-W)

  Operators:

  • Sven Bräunlich,
  • Matthias Ulrich

  CLINICAL DATA
  Critical limb ischemia left, ulceration dig 4, Rutherford class 5
  Severe claudication left calf, walking capacity 50–100 meters,
  PTA/stenting left EIA 11/2018
  ABI left: 0.45
  
  RISK FACTORS
  Diabetes mellitus type 2, arterial hypertension, former smoker
  
  PROCEDURAL STEPS
  1. Right femoral access and cross-over approach
  - 6F 45 cm cross-over sheath Fortress (BIOTRONIK)
  2. Passage of the occlusion left SFA
  - 0.035“ Radiofocus angled stiff guidewire, 260 cm (TERUMO)
  - 0.035“ CXC support catheter, 135 cm (COOK)
  
  In case of failure guidewire passage from antegrade:
  3. Retrograde approach via distal SFA
  - 9 cm 20 Gauge spinal needle (BD)
  - 0.018“ V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 4F 10 cm Radiofocus introducer (TERUMO)
  - Passeo 18 4.0/40 mm balloon, 90 cm (BIOTRONIK)
  4. PTA
  - Passeo 18 Ballon 5 x 150 mm (BIOTRONIK)
  - 5 mm Passeo 18 Lux DCB (BIOTRONIK)
  5. Stenting on indication, spot-stenting
  - Pulsar 18-T3 stent (BIOTRONIK)

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• 17:24 - 17:50, Room 1 - Main Arena 1

  Case 08 – Live case from New York

  Center:

  New York

  Case 08 – Live case from New York

  Information will follow in due time. Thank you for your understanding.