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LINC Asia-Pacific 2016 live case guide

Find all live cases and live case centers listed below.

Conference day 2

  • - , 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
  • - , Room 1 - Main Arena 1

    Case 14 – CGH 06: Left SFA and ATA occlusion, TPT stenosis

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 14 – CGH 06: female, 91 years (P-M)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg shallow wounds and rest pain PAOD Rutherford 5
    DM hypertension right SFA in-stent occlusion Rotarex and DEB
    Left 4th /5th toe dermal gangrenet, EF 60%, Cr normal

    PROCEDURAL STEPS
    1. Contralateral cross-over access via right groin
    - 6F 40 cm long Balkin sheath (COOK)

    2. Passage of the lesion
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" TERUMO angled Soft/Stiff guide-wire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)

    3. Treatment with stent /DEB
    - SUPERA 5 X 150 (ABBOTT) after predil with DORADO 6 x 40 (C.R.BARD)

    4. ATA recanalization via antegrade (retrograde DP access in event of failure)
    - 0.014" Command ES Wire (ABBOTT)
    - Armada 14 2.5/3 x 120 (ABBOTT)

    5. Treatment of TPT
    - 3.5 x 15 NC TREK balloon for TPT lesion (ABBOTT)
    - 3.5 x 28 ABSORB Bioabsorbable Vascular Scaffold/BVS (ABBOTT) for TPT lesion
    - Post Dil 3.5 x 15 NC TREK balloon (ABBOTT)
    View image
  • - , Room 1 - Main Arena 1

    Case 15 – BPH 01: Left SFA long occlusion

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 15 – BPH 01: female, 65 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Claudication of left leg for 6 months; Rutherford 3

    RISK FACTORS
    Diabetes, hypertension

    PROCEDURAL STEPS
    1. Right femoral retrograde access and cross-over
    - 6F 40 cm long sheath (COOK)

    2. Crossing the occlusion
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)

    3. Retrograde distal SFA bailout access for unsuccessful passage

    4. Predilatation
    - 4/220 mm SAVVY Long OTW balloon, 130 cm (CORDIS)

    5. DCB and proventional stent
    - 5/200 mm Orchid DCB Balloon, 130 cm (ACOTEC)
    - 6.0/200 mm, EVERFLEX, Nitinol stent system 120 cm (EV3)
    View image
  • - , Room 1 - Main Arena 1

    Case 16 – CGH 07: Left SFA in-stent occlusion

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 16 – CGH 07: female, 88 years (S-A-L)
    Operators:
    • Steven Kum,
    • Yih Kai Tan,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg claudication PAOD Rutherford 4
    DM hypertension hyperlipidemia PPM previous left SFA stenting

    PROCEDURAL STEPS
    1. Contralateral cross-over access via Right groin
    - 8F 40 cm long Balkin sheath (COOK)

    2. Antegrade passage of the lesion with hydrophilic wire
    - 0.018" V-18 control wire, 300 cm (BOSTON SCIENTIFIC)
    - 0.035" Radiofocus TERUMO angled soft guidewire, 250 cm (TERUMO)

    3. Retrograde puncture of occluded stent in event of antegrade failure
    - 0.035" Radiofocus TERUMO angled soft guidewire, 250 cm (TERUMO)
    - 4F CXI support catheter

    4. Mechanical thrombectomy and debulking
    - Predilatation with Powercross 2/3 x 120 balloon (MEDTRONIC)
    - 8F Rotarex (STRAUB MEDICAL)

    5. Post debulking IVUS
    - o.014" Eagle Eye® Platinum IVUS catheter with virtual histology

    6. Treatment with DEB and stent on indication
    View image
  • - , 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
  • - , Room 1 - Main Arena 1

    Case 17 – LEI 05: SFA occlusion left

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 17 – LEI 05: male, 61 years (K-M)
    Operators:
    • Matthias Ulrich,
    • Andrej Schmidt
    CLINICAL DATA
    Severe claudication left calf, walking capacity 200 meters, ABI left 0.67
    CAD, PTCA 2013

    DUPLEX
    Long SFA-occlusion left

    RISK FACTORS
    Art. hypertension, nicotin abuse

    PROCEDURAL STEPS
    1. Access right groin and cross-over approach
    - 5F diagnostic IMA-catheter (CARDINAl HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)

    2. Guidewire passage
    - Mustang balloon 5.0/120 mm (BOSTON SCIENTIFIC)
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    in case of failure to reenter distal:
    - attempt with Victory 18 30 gramm 300 cm (BOSTON SCIENTIFIC)

    3. PTA with drug-coated balloons and stenting on indication
    - Ranger DCB (BOSTON SCIENTIFIC)
    - EPIC selfexpanding nitinol-stent (BOSTON SCIENTIFIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 18 – CGH 08: May Thurner syndrome

    Center:
    Changi General Hospital, Singapore, Singapore
    Case 18 – CGH 08: female (J-L)
    Operators:
    • Yih Kai Tan,
    • Steven Kum,
    • Sven Bräunlich
    CLINICAL DATA
    Left leg swelling. Recent cellulitis
    Hypothyroidism, recent left calf DVT on Warfarin.
    CT venogram done.

    PROCEDURAL STEPS
    1. Left mid SFV access under ultrasound
    - 5F TERUMO sheath
    - 12F Peel-away Safe-sheath (ANGIODYNAMICS)

    2. Passage of the lesion with hydrophilic wire and stiff wire
    - 0.035" Radiofocus TERUMO angled soft guidewire, 260 cm (TERUMO)
    - 4F Ber II catheter (CORDIS)
    - 0.035" Supra Core guidewire, 300 cm (ABBOTT)

    3. Venogram and IVUS
    - 8.5F Visions® PV.035 (VOLCANO)

    4. Predilatation
    - 16/18 x 40 Atlas balloon (C.R.BARD)

    5. Iliac Vein Stenting
    - Wallstent 18 x 90 (BOSTON SCIENTIFIC)

    6. Postdilatation and IVUS control
    - 16/18 x 40 Atlas balloon (C.R.BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 19a – LEI 06A: Flush occlusion right SFA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 19a – LEI 06A: male, 61 years (F-H)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication right calf, walking capacity 100 meters,
    ABI right 0.54
    CAD, MI and PTCA 2012
    Renal artery stenosis PTA 2013
    COPD
    failed antegrade recanalization attempt right SFA 2/2016

    PROCEDURAL STEPS
    1. Access left groin and cross-over approach
    - 5F diagnostic IMA-catheter (CARDINAl HEALTH)
    - 0.035" soft angled glidewire 180 cm (TERUMO)
    - 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)

    2. Guidewire passage of the right SFA-flush-occlusion
    - 0.035" stiff angled glidewire, 260 cm (TERUMO)
    - 5F diagnostic IMA-catheter (CARDINAl HEALTH)
    In case of failure to enter the CTO retrograde approach via distal SFA:
    - 9 cm 21 Gauge needle (COOK)
    - 0.018" V-18 Control guidewire 300 cm (BOSTON SCIENTIFIC)
    - 0.018" Seeker support catheter 90 cm (C.R.BARD)

    3. PTA and stenting on indication
    - VascuTrak scoring balloon 5.0/300 mm (C.R.BARD)
    - Lutonix 5.0 or 6.0 150 mm DCB (C.R.BARD)
    - Lifestent (C.R.BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 19b – LEI 06B: 3-vessel occlusion right BTK, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 19b – LEI 06B: male, 81 years (F-F)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 5, forefoot right
    SFA-Angioplasty right 02/2016
    CAD, PTCA 8/2013
    Diabetes mellitus type 2
    former smoker

    ANGIOGRAPHY
    Occlusion of all 3 BTK vessels,
    collateral filling of the distal peroneal artery and dorsalis pedis artery

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 5F 55 cm Flexor Check-Flo introducer (COOK)

    2. Antegrade passage and PTA
    - Command ES guidewire 300 cm (ABBOTT)
    - Ultraverse 0.014" balloon 2.0/120 mm (C.R.BARD)
    - VascuTrak 2.5/250 mm Balloon (C.R.BARD)

    3. In case of antegrade failure:
    retrograde puncture of the dorsalis pedis/peroneal artery
    - 21 Gauge / 7 cm needle (COOK)
    - Connect 300 cm guidewire (ABBOTT)
    - Seeker support catheter 0.018" 90 cm (C.R.BARD)

    4. PTA with DCBs
    - Lutonix 2.5/150 mm DCB (C.R.BARD)
    View image
  • - , Room 1 - Main Arena 1

    Case 20 – BPH 02: Left iliac occlusion

    Center:
    Beijing PLA Hospital, Beijing, China
    Case 20 – BPH 02: male, 73 years
    Operators:
    • Wei Guo,
    • Xin Jia
    CLINICAL DATA
    Claudication of left leg for 8 months; Rutherford 3

    RISK FACTORS
    Smoking; hypertension; CAD

    PROCEDURAL STEPS
    1. Right brachial access
    - 6F 90 cm long sheath (COOK)

    2. Crossing the occlusion
    - 0.018" V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)

    3. Left femoral retrograde bailout access

    4. PTA and proventional stent
    - 6/80 mm ADMIRAL OTW balloon, 130 cm (MEDTRONIC)
    - 8/120 mm, COMPLETE SE, nitinol stent system 120 cm (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 21 – LEI 07: Popliteal occlusion right, CLI

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 21 – LEI 07: male, 57 years (D-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    PAOD Rutherford 4, restpain right, severe claudication, walking capacity 100 meters
    ABI right 0.44
    Aortic valve replacement 2009
    Diabetes mellitus type 2
    former smoker
    PTA of a proximal SFA-stenosis right 1/2016,
    failed antegrade passage of the popliteal occlusion right

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 7F 55 cm Flexor Check-Flo Introducer (COOK)

    2. Retrograde passage via the anterior tibial artery
    - 7 cm 21 gauge needle (COOK)
    - 0.018" QuickCross support catheter 90 cm (SPECTRANETICS)
    - 0.018" Connect guidewire 300 cm (ABBOTT)
    - Snaring of the retrograde guidewire from retrograde

    3. Atherectomy
    - 4 mm Spider filter (MEDTRONIC)
    - HawkOne 6 cm tip (MEDTRONIC)

    4. PTA with DCBs
    - In.Pact Pacific DCB (MEDTRONIC)
    View image
  • - , Room 1 - Main Arena 1

    Case 22 – LEI 08: Forefoot ulcerations right, Bullfrog-PTA

    Center:
    University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany
    Case 22 – LEI 08: female, 79 years (I-S)
    Operators:
    • Andrej Schmidt,
    • Yvonne Bausback
    CLINICAL DATA
    PAOD Rutherford 5, forefoot-ulcerartion right, restpain toes
    ABI right 0.22
    PTA of a popliteal stenosis right,
    failure to recanalize a posterior tibial occlusion from antegrade
    CAD, PTCA 2004
    Diabetes mellitus type 2 with diabetic nephropathy, GFR 53 ml/min
    paroxysmal atrial fibrillation
    BTK: patent peroneal artery, flush-occlusion of the posterior tibial artery

    PROCEDURAL STEPS
    1. Antegrade access right groin
    - 6F 55 cm Flexor Check-Flo introducer (COOK)

    2. Retrograde passage via the posterior tibial artery
    - transpedal puncture-kit (COOK)
    (4 cm 21 gauge needle, 2.9F sheath)
    - CXI 0.018" 90 cm support catheter (COOK)
    - CTO-Approach 0.014" guidewire, 18 gramm, 300 cm (COOK)
    - Advance Micro-balloon 2.5/120 mm (COOK)

    3. PTA and arterial wall-injection of dexamethason
    - BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS)
    View image
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