LINC Asia-Pacific 2016 live case guide

Taipei Tzu Chi General Hospital, Taipei City, Taiwan

• Wednesday, March 9th: 8:00 - 8:30, Room 1 - Main Arena 1

  Case 13 – TTC 01: Restenosis and reocclusion of left TP trunk to posterior tibial artery

  Center:

  Taipei Tzu Chi General Hospital, Taipei City, Taiwan

  Case 13 – TTC 01: male, 83 years (C-C)

  Operators:

  • Hsin-Hua Chou,
  • Hsuan Li Huang

  CLINICAL DATA
  Bilateral feet resting pain (left > right) with ulceration at left great toe for 1 month
  PTA for left TP trunk and post. tibial A 02/2013
  PTA and stenting for right SFA 01/2016, PTA for right peroneal artery 01/2016
  ESRD under regular H/D, 3-V CAD s/p PCI, Type 2 DM, HTN
  ABI: right:0.73; left:0.58
  
  ANGIOGRAPHY
  Stenosis at left popliteal artery, restenosis at left TP trunk to single remaining post. tibial A, reocclusion at left distal post. tibial A
  
  PROCEDURAL STEPS
  1. Left CFA antegrade access
  - 6F 10 cm sheath (TERUMO)
  - 6F 55 cm Multipurpose guiding catheter (BOSTON SCIENTIFIC)
  
  2. Passage of the lesion(s)
  - 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
  - 0.018" CXI support-catheter, 150 cm (COOK)
  - In case of failure, exchange to V-18 control guidewire, 300 cm (BOSTON SCIENTIFIC)
  
  3. Lesion preparation
  - Amphirion Deep, 2.0–2.5/210 mm (MEDTRONIC)
  
  4. Drug-coated balloon angioplasty
  - Lutonix 014 Drug-coated balloon, 2.5/120 mm for distal post. tibial A (COOK)
  - Lutonix 014 Drug-coated balloon, 3.0/120 mm for proximal post. tibial artery (COOK)
  
  5. Stenting for TP trunk on indication
  - Bioabsorbable vascular scaffold 3.5/28 mm (ABBOTT)
  - With/without OCT study (ST. JUDE MEDICAL)
  
  6. Drug-coated balloon angioplasty
  - In.PACT Admiral drug-coated balloon 4.0/80 mm for pop. A (MEDTRONIC)

  View image
• Wednesday, March 9th: 12:30 - 14:15, Room 2 - Technical Forum

  Case 23 – TTC 02: Calcified stenosis of left common femoral artery

  Center:

  Taipei Tzu Chi General Hospital, Taipei City, Taiwan

  Case 23 – TTC 02: male, 60 years, (Chen)

  Operators:

  • Hsuan Li Huang,
  • Hsin-Hou Chou

  CLINICAL DATA
  Intermittent claudication of left leg for months
  Diabetes mellitus, arterial hypertension, hyperlipidemia
  Duplex US showed the dampened waveform distal to CFA
  The ABI levels: left 0.77, right 0.89
  CTA: heavily calcified stenosis involving Lt CFA, mild stenosis at left middle SFA
  
  PROCEDURAL STEPS
  1. Right femoral cross-over access
  - 8F Balkin 40 cm cross-over sheath (COOK)
  
  2. Guidewire passage and distal protection
  - 0.014" PT2 guidewire 300 cm (BOSTON SCIENTIFIC)
  - Spider FX embolic protection device (MEDTRONIC-COVIDIEN)
  
  3. IVUS assessment
  - Visions® PV 0.018 catheter (VOLCANO)
  
  4. Directional atherectomy
  - Turbohawk LS-C or LX-C (MEDTRONIC-COVIDIEN)
  
  5. Drug coated balloon angioplasty
  - In.PACT Admiral 0.035" 7.0/60 mm (MEDTRONIC)

  View image