LINC Asia-Pacific 2017 live case guide
Find all live cases and live case centers listed below.
Leipzig, Dept. of Angiology
11 livecase(s)
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Tuesday, March 14th: - , Room 2 - Technical Forum
Case 10 – CAS of a progressive internal artery stenosis
- Center:
- Leipzig, Dept. of Angiology
Case 10 – LEI 05: male, 67 years (S-R)- Operators:
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- Andrej Schmidt,
- Matthias Ulrich
CLINICAL DATA
Progressive stenosis left internal carotid artery stenosis
Minor stroke left hemispheric 1/2012
CAD, CABG 2012
RISK FACTORS
Art. Hypertension, diabetes mellitus type II, former smoker
PRESENT STATE
Duplex: PSV left 5.2 m/sec.
MR-angiography: high grade stenosis left ICA;
intracranial MR without pathological findings
PROCEDURAL STEPS
1. Right groin access
- 9F 25 cm sheath (TERUMO)
2. Cannulation of the left external carotid artery
- 5F Judkins right diagnostic catheter (CARDINAL HEALTH)
- 0.035" soft angled glidewire, 190 cm (TERUMO)
- Exchange to 0.035" SupraCore guidewire, 190 cm (ABBOTT)
3. Cerebral protection
- MOMA endovascular clamping device (MEDTRONIC)
4. Predilatation, stenting, and postdilatation
- 3.5/20 mm MiniTrek RX balloon (ABBOTT)
- Roadsaver carotid artery stent system (TERUMO)
- 5.0/20 mm Sterling RX balloon (BOSTON SCIENTIFIC)
5. Aspiration of potential plaque-debris before declamping of the MOMA-system
6. Final angiography -
Tuesday, March 14th: - , Room 1 - Main Arena
Case 05 – Chronic total occlusion left SFA
- Center:
- Leipzig, Dept. of Angiology
Case 05 – LEI 01: male, 66 years (J-R)- Operators:
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- Andrej Schmidt,
- Matthias Ulrich
CLINICAL DATAView image
Severe claudication left calf, Rutherford class 3
CAD, MI 2002, PCA 2002 and 2016
RISK FACTORS
Nicotin abuse, art. Hypertension
PRESENT STATE
ABI left 0.67
Angiography during coronary angiography: long SFA-CTO left
PROCEDURAL STEPS
1. Access right groin and cross-over approach
- 5F diagnostic IMA-catheter (CORDIS/CARDINAl HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)
- 5F Fortress Cross-over sheath 45 cm (BIOTRONIK)
2. Guidewire passage
- 0.035" stiff angled glidewire (TERUMO)
- 0.018" Cruiser guidewire (BIOTRONIK)
3. PTA with drug-coated balloons and stenting on indication
- Passeo 18 balloon 5.0/120 mm for predilatation (BIOTRONIK)
- Passeo LUX DCB 5.0/120 mm (BIOTRONIK)
- Pulsar 18 stent (BIOTRONIK) -
Tuesday, March 14th: - , Room 1 - Main Arena
Case 06 – Chronic occlusion left SFA, reocclusion
- Center:
- Leipzig, Dept. of Angiology
Case 06 – LEI 02: male, 55 years (M-L)- Operators:
-
- Andrej Schmidt,
- Yvonne Bausback
CLINICAL DATAView image
Severe claudication left calf, Rutherford class 3
PTA left CFA and SFA 2/2015
CAD, PTCA 2012
RISK FACTORS
Nicotine abuse, art. Hypertension
PRESENT STATE
ABI left 0.67
PROCEDURAL STEPS
1. Access right groin and cross-over approach
- 5F diagnostic IMA-catheter (CORDIS/CARDINAL HEALTH)
- 0.035" soft angled glidewire 180 cm (TERUMO)
- 0.035" stiff SupraCore guidewire 190 cm (ABBOTT)
- 6F 40 cm Up&Over Sheath, 40 cm (COOK)
2. Passage of the left SFA-CTO
- 0.018" Connect Guidewire, 300 cm (ABBOTT)
- CXC 0.018" 135 cm support catheter (COOK)
3. Predilatation and stenting
- Advance balloon 5.0/100 mm (COOK)
- 14 cm 6 mm Zilver-PTX stent (COOK) -
Tuesday, March 14th: - , Room 1 - Main Arena
Case 07 – CTO left distal SFA, CLI
- Center:
- Leipzig, Dept. of Angiology
Case 07 – LEI 03: male, 65 years (S-P)- Operators:
-
- Andrej Schmidt,
- Matthias Ulrich
CLINICAL DATAView image
Critical limb ischemia left, ulceration Dig II and III left, Restpain, Rutherford class 5
Bypass-occlusion both sides (P1 left)
PTA right SFA 02/2017, CAD, PTCA 2010
RISK FACTORS
Art. Hypertension, diabetes mellitus, former nicotine abuse
PRESENT STATE
ABI right 0.72; left 0.3
Angiography left: distal calcified SFA-CTO, BTK 3-vessel occlusion
PROCEDURAL STEPS
1. Left antegrade approach
- 6F 20 cm Radiofocus Introducer Sheath (TERUMO)
2. Guidewire passage of the SFA-CTO
- 0.018" Connect 250 T guidewire, 300 cm (ABBOTT)
- CXC 0.018" support catheter, 90 cm (COOK)
3. Vessel preparation for the stent implantation
- Advance Enforcer 35 Focal Force PTA balloon 6.0/40 mm, 50 cm (COOK)
4. Stenting
- Zilver-PTX 7/80 mm (COOK) -
Tuesday, March 14th: - , Room 1 - Main Arena
Case 09 – CLI with long BTK-occlusions
- Center:
- Leipzig, Dept. of Angiology
Case 09 – LEI 04: male, 73 years (K-M)- Operators:
-
- Andrej Schmidt,
- Yvonne Bausback
CLINICAL DATAView image
CLI with ulceration left dig 2, restpain
PTA/stent left popliteal artery 1/2016
Amputaiton dig 1 left 1/2016
Reocclusion left popliteal artery, Rotarex-thrombectomy 12/2016
RISK FACTORS
Former smoker, art. Hypertension
PRESENT STATE
Angiography 12/2016, ABI left 0.2
PROCEDURAL STEPS
1. Antegrade approach left
- 5F 55 cm Check-Flo sheath (COOK)
2. Guidewire passage left ATA
- 0.014" PT2 guidewire, 300 cm (BOSTON SCIENTIFIC)
- Ultraverse 0.014" balloon as support (BARD)
In case of failure to pass from antegrade:
3. Retrograde approach via the dorsalis pedis artery
- Transpedal access set: 21 Gauge needle, 2.9F sheath (COOK)
4. PTA
- 2.5/250 mm VascuTrak scoring balloon (BARD)
5. Drug-coated balloon treatment
- Lutonix 2.5/150 mm and 3.0/150 mm drug-coated balloons (BARD) -
Wednesday, March 15th: - , Room 1 - Main Arena
Case 17 – Chronic, calcified common iliac occlusion left
- Center:
- Leipzig, Dept. of Angiology
Case 17 – LEI 06: male, 56 years (J-L)- Operators:
-
- Andrej Schmidt,
- Matthias Ulrich
CLINICAL DATAView image
Severe claudication left leg, walking capacity 150 meters
Failed recanalizaiton attempt left common iliac artery 2/2017
Stenting right CIA 2/2017
RISK FACTORS
Art. Hypertension, nicotine abuse
PROCEDURAL STEPS
1. Left brachial approach
- 6F 90 cm Check-Flo Performer (COOK)
2. Left femoral approach
- 7F 20 cm Radiofocus Introducer sheath (TERUMO)
3. Guidewire passage
- Stiff straight glidewire 260 cm (TERUMO) from both sides
- CART-technique with 5.0/40 mm Admiral balloon (MEDTRONIC)
4. Implantation of a covered stent
- 8.0/38 mm LifeStream (BARD) -
Wednesday, March 15th: - , Room 1 - Main Arena
Case 18 – Subacute in-stent reocclusion left SFA
- Center:
- Leipzig, Dept. of Angiology
Case 18 – LEI 07: male, 61 years (H-S)- Operators:
-
- Matthias Ulrich,
- Andrej Schmidt
CLINICAL DATA
Severe claudication left calf, walking capacity 100 meters, since 2 months
Stenting left SFA 2/2014
CAD, PTCA 2012
ABI left 0.64; right 0.81
Duplex-sonography: total occlusion of stents left SFA
RISK FACTORS
Art. Hypertension, diabetes mellitus type II
Former smoker
Moderat renal insufficiency, GFR 55ml/min
PROCEDURAL STEPS
1. Right groin retrograde and cross-over approach
- IMA diagnostic 5F catheter (CORDIS/CARDINAL HEALTH)
- 0.035" angled soft Radiofocus glidewire, 190 cm (TERUMO)
- 0.035" SupraCore guidewire, 190 cm (ABBOTT)
- 8F Balkin Up&Over Sheath, 40 cm (COOK)
2. Passage of the occlusion and percutaneous thrombectomy
- 0.035" stiff angled glidewire 260 cm (TERUMO)
- 0.035" QuickCross support catheter 135 cm (SPECTRANETICS)
- Exchange to Rotarex guidewire (STRAUB MEDICAL)
- 8F Rotarex thrombectomy catheter (STRAUB MEDICAL)
3. PTA with DCBs
- In.Pact Pacific 5.0/120 mm drug-coated balloons (MEDTRONIC) -
Wednesday, March 15th: - , Room 1 - Main Arena
Case 20 – Popliteal and BTK-CTO with CLI
- Center:
- Leipzig, Dept. of Angiology
Case 20 – LEI 08: male, 64 years (V-S)- Operators:
-
- Andrej Schmidt,
- Matthias Ulrich
CLINICAL DATAView image
CLI with restpain right foot, Rutherford class 4,
TEA right groin 1/2016, stenting right SFA 2010
PTA of a restenosis right SFA 2/2017
RISK FACTORS
Diabetes mellitus type 22, former smoker, art. Hypertension
PRESENT STATE
ABI right 0.32
PROCEDURAL STEPS
1. Right antegrade approach
- 6F 55 cm Check-Flow Performer sheath (COOK)
2. Guidewire passage of the popliteal and peroneal artery right
- 0.018" Connect guidewire, 300 cm (ABBOTT)
- 0.018" Seeker support catheter, 90 cm (BARD)
3. In case of antegrade failure retrograde access via the peroneal artery
- 7 cm 21 Gauge needle (COOK)
- 0.018" Seeker support catheter (BARD)
4. Atherectomy and PTA
- HawkOne directional atherectomy (MEDTRONIC)
- Armada 14 balloon (ABBOTT)
- Pacific balloon (MEDTRONIC)
5. Arterial wall injection of dexamethason
- BullFrog Micro-Infusion-Device (MERCATOR MEDSYSTEMS) -
Wednesday, March 15th: - , Room 1 - Main Arena
Case 21 – Restpain left with popliteal reocclusion
- Center:
- Leipzig, Dept. of Angiology
Case 21 – LEI 09: female, 78 years (M-V)- Operators:
-
- Matthias Ulrich,
- Yvonne Bausback
CLINICAL DATAView image
Critical limb ischemia with restpain left foot, Rutherford class 4
PTA left SFA and popliteal artery (DCBs) 5/2013
PTA right SFA 2/2017
CAD, PTCA 2015
Renal insufficiency, GFR 55 ml/min
RISK FACTORS
Former nicotine abuse, art. Hypertension
PRESENT STATE
ABI left: 0.1
PROCEDURAL STEPS
1. Left antegrade approach
- 6F 55 cm Check-Flo Performer (COOK)
2. Guidewire passage
- 0.018" Connect 250 T, 300 cm guidewire (ABBOTT)
3. PTA
- Armada 5.o/40 mm and 6.0/40 mm balloon (ABBOTT)
4. Stenting
- 5.0/60 mm Supera stent (ABBOTT) -
Thursday, March 16th: - , Room 1 - Main Arena
Case 28 – Extremely calcified SFA-occlusion
- Center:
- Leipzig, Dept. of Angiology
Case 28 – LEI 10: male, 54 years (F-B)- Operators:
-
- Andrej Schmidt,
- Johannes Schuster
CLINICAL DATAView image
Severe clauducation right, walking capacity 100 meters, Rutherford class 3
PTA/stent left SFA 1/2017
CAD, CABG 2006
PRESENT STATE
ABI right: 0.58
Angiography during PTA left SFA: extremely calcified distal right SFA
PROCEDURAL STEPS
1. Right antegrade approach
- 7F 55 cm Check-Flo Performer sheath (COOK)
2. Guidewire passage of the SFA-CTO right
- 0.035" Glidewire Advantage (TERUMO)
- 0.035" CXC support catheter, 90 cm (COOK)
In case of failure to pass the GW from antegarde
3. Retrograde approach via the proximal ATA
- 7 cm 21 Gauge needle (COOK)
- 0.018" CXC support catheter, 90 cm (COOK)
4. PTA
- Pacific 5.0 and 6.0/40 mm balloon (MEDTRONIC)
- VascuTrak 6/40 mm balloon (BARD)
- Conquest high pressure balloon (BARD)
In case of rupture or inability to brake the calcified plaque
5.
- Implantation of a Viabahn 7.0/100 mm (GORE) and
- additional aggressive ballooning after Viabahn implantation
6. Supera stent implantation
- 6.0/150 mm Supera (ABBOTT) -
Thursday, March 16th: - , Room 1 - Main Arena
Case 29 – CLI right, BTK total occlusions
- Center:
- Leipzig, Dept. of Angiology
Case 29 – LEI 11: male, 63 years (L-F)- Operators:
-
- Andrej Schmidt,
- Yvonne Bausback
CLINICAL DATAView image
PAOD Rutherford 5, ulceration forefoot right
Stenting of a SFA-occlusion right 11/2013
Failure to pass the TPT-occlusions right from antegrade 11/2013
ABI right 0.32
CAD, CABG 10/2013
RISK FACTORS
Art. Hypertension, diabetes mellitus type 2
PRESENT STATE
ABI: mediasclerosis
Angiography from previous unsuccessful intervention
PROCEDURAL STEPS
1. Antegrade access right groin
- 5F 55 cm Flexor Check-Flo Introducer (COOK)
2. Retrograde puncture of the peroneal and/or posterior tibial artery
- 21 Gauge / 7 cm needle (COOK)
- 0.018" V-18 control guidewire, 300 cm (BOSTON SCIENTIFIC)
- Trail Blazer support catheter, 90 cm (COVIDIEN)
- Snaring of the retrograde GW to the antegrade sheath
3. Atherectomy of the proximal tibial arteries (bifurcation)
- Small vessel TurboHawk (MEDTRONIC)
4. PTA of the tibioperoneal trunk and posterior tibial artery
- Lutonix DCB (BARD)
Live case transmission centers
During LINC Asia-Pacific 2017 several live cases will be performed from several international centers. All live case transmissions are coordinated, filmed, and produced by the mediAVentures crew, using the latest in high definition television and wireless technology.
• Beijing PLA Hospital, Beijing, China with Wei Guo
• Changi General Hospital, Singapore with Steven Kum
• Singapore General Hospital, Singapore with Tay Kiang Hiong, Chong Tze Tec
• Chonnam National University Hospital, Gwangju, South Korea with Jae-Kyu Kim
• Mount Sinai Hospital, New York, USA with Prakash Krishnan
• University Hospital Leipzig, Division of Interventional Angiology, Leipzig, Germany with Andrej Schmidt, Matthias Ulrich, Johannes Schuster, Yvonne Bausback