LINC Asia-Pacific 2019 live case guide

Find all live cases and live centers listed below

Conference day 1

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    Case 01 – SFA occlusion

    Center:
    Beijing PLA Hospital
    Case 01 – BPH 01: male, 62 years
    Operators:
    • Wei Guo
    CLINICAL DATA
    Severe claudication right calf for 3 years, walking capacity 100 meters
    Rutherford: 3
    TASC: B
    ABI: L 0.86, R 0.52

    RISK FACTORS
    Hypertension, smoking, DM

    PROCEDURAL STEPS
    1. Left femoral access and cross-over approach
    – 6F 55 cm sheath (COOK)
    2. Passage of the occlusion
    – 0.018" V-18 guidewire 300 cm (BOSTON SCIENTIFIC)
    – 0.018" Trailblazer support catheter, 135 cm (MEDTRONIC)
    3. POBA and DCB
    – 5/60 mm Armada 18 balloon (ABBOTT)
    – 5/60 mm DCB (AcoArt I)
    – 6/60 mm Zilver-stent (COOK) implantation in case of severe dissection
    4. Puncture site closure
    – Exoseal 6F (CORDIS/CARDINAL HEALTH)
    View image
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    Case 02 – In-stent restenosis right SFA

    Center:
    Seoul National University Hospital
    Case 02 – SNU 01: male, 74 years (M-H)
    Operators:
    • Hwan Jun Jae,
    • Saebeom Hur,
    • Sanghyun Ahn
    CLINICAL DATA
    Claudication right calf
    ABI: 0.76/0.96

    RISK FACTORS
    CAD, former smoker

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    – 7F sheath (Terumo)
    2. Guidewire passage and PTA
    – 0.018" HT Command 18 LT wire 210 cm (ABBOTT) and Rubicon 18 support catheter 90 cm (BOSTON SCIENTIFIC) for intraluminal or subintimal guidewire passage
    3. Atherectomy of ISR
    – Jetstream (BOSTON SCIENTIFIC) with Emboshield (ABBOTT) or
    – HawkOne (MEDTRONIC) with SpiderFX (MEDTRONIC)
    4. PTA with scoring balloon
    – Vascutrak PTA dilatation catheters (BARD/BD)
    5. PTA
    – Lutonix drug coated balloon (BARD/BD)
    6. Bail-out stenting
    – Innova stent (BOSTON SCIENTIFIC)
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    Case 03 – Prox SFA diffuse disease and distal SFA occlusion

    Center:
    The Chinese University of Hong Kong, Prince of Wales Hospital
    Case 03 – POW 01: female, 65 years (PLT)
    Operators:
    • Bryan Yan,
    • Skyi Yin Chun Pang,
    • GuangMing Tan,
    • Sven Bräunlich
    CLINICAL DATA
    DM/HT/Lipid/IHD
    Right RF 4 claudication
    ABI right 0.5, left 0.83

    ANGIOGRAPHY
    Diagnostic angiogram shows right proximal SFA multi-focal stenosis and distal SFA occlusion

    PROCEDURAL STEPS
    1. Cross-over approach
    – 6F Destination cross-over sheath (TERUMO)
    2. Antegrade crossing
    – V18 wire (BOSTON SCIENTIFIC)
    – CTO wire (ASAHI)
    3. Retrograde distal access and wiring if antegrade failure
    4. Proximal SFA directional atherectomy
    – HawkOne (MEDTRONIC)
    – In.Pact DCB (MEDTRONIC)
    5. Bail-out stenting on indication
    – Complete nitinol-stent (MEDTRONIC)
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    Case 04 – Chronic CTO right SFA

    Center:
    Seoul National University Hospital
    Case 04 – SNU 02: male, 71 years (K-L)
    Operators:
    • Hwan Jun Jae,
    • Saebeom Hur,
    • Sanghyun Ahn
    CLINICAL DATA
    Claudication right calf, walking capacity 200 meters
    ABI: 0.72 / 0.87

    RISK FACTORS
    Art. hypertension

    PROCEDURAL STEPS
    1. Antegrade approach right groin
    – 6F sheath (TERUMO)
    2. Guidewire passage
    – 0.018“ Hi-Torque Command 18 LT wire 210 cm (ABBOTT)
    – Rubicon 18 support catheter 90 cm (BOSTON SCIENTIFIC)
    3. Predilatation
    – Sterling balloon (BOSTON SCIENTIFIC)
    4. PTA
    – Passeo-18 Lux drug coated balloon (BIOTRONIK)
    5. Bail-out stenting
    – Pulsar-18 self expanding stent (BIOTRONIK)
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    Case 05 – SFA-CTO in a patient with severe claudication

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 05 – LEI 01: female, 65 years (I-S)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Severe claudication left, walking capacity 150 meters
    ABI left 0.67, Rutherford class 3
    PTA / Stenting of the distal SFA 2016 elsewhere
    Aorto-iliac bifurcational stenting 2015, elsewhere
    CAD, PTCA 2012
    Art. hypertension, diabetes mellitus Type 2

    PROCEDURAL STEPS
    1. Antegrade access left
    – 5F 10 cm Radiofocus Introducer sheath (TERUMO)
    2. Guidewire passage
    – 0.018“ Command 18 Guidewire, 300 cm (ABBOTT)
    – Passeo 18 5.0/120 mm balloon (BIOTRONIK)

    In case of failure from antegrade:
    3. Retrograde approach via the distal SFA or stent-puncture
    – 9 cm 20 gauge needle (B. BRAUN)
    – V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    4. Angioplasty, DCB-treatment and stenting
    – Passeo 18 Lux DCB 5.0/120 mm (BIOTRONIK)
    – Pulsar 18-T3 stent (BIOTRONIK)
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    Case 06 – Distal SFA-CTO left

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 06 – LEI 02: male, 62 years (F-F)
    Operators:
    • Matthias Ulrich,
    • Manuela Matschuck
    CLINICAL DATA
    Disabeling claudication left, walking capacity 100 meters
    ABI left 0.56, Rutherford class 3
    COPD, CAD

    RISK FACTORS
    Art. hypertension, diabetes mellitus Type 2, smoker

    PROCEDURAL STEPS
    1. Left antegrade access
    – 6F 55 cm sheath, Ansel-modification (COOK)
    2. Antegrade guidewire passage
    – Command 18 guidewire, 300 cm (ABBOTT)
    – CXI support catheter (COOK)

    In case of antegrade failure:
    3. Retrograde access to the proximal anterior tibial artery
    – 7 cm 21 Gauge needle (COOK)
    – Command 18 guidewire, 300 cm (ABBOTT)
    – CXI support catheter (COOK)
    4. Angioplasty and stenting
    – Advance 18 balloon 5.0/100
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    Case 07 – Long chronic total occlusion right SFA

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 07 – LEI 03: male, 63 years (F-H)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Severe claudication right, walking capacity 150 meters
    ABI right 0.67, Rutherford class 3
    CAD, PTCA 2016
    Moderate renal insufficiency (GFR 58 ml/min)

    RISK FACTORS
    Art. hypertension

    PROCEDURAL STEPS
    1. Left retrograde and cross-over access
    – 6F 40 cm Balkin Up&Over sheath (COOK)
    2. Antegrade guidewire passage Zilver-PTX stents (COOK)
    – 6F Judkins-Right guiding catheter (MEDTRONIC)
    – CXC 0.035“ support catheter, 130 cm (COOK)
    3. Angioplasty and stenting Zilver-PTX stents (COOK)
    – Advance 35 balloon 5.0/100 mm (COOK)

    In case of residual stenosis:
    – Advance Enforcer balloon
    – Zilver-PTX stents (COOK)
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    Case 08 – CLI with total occlusion of the anterior tibial artery left

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 08 – LEI 04: male, 76 years (F-F)
    Operators:
    • Matthias Ulrich,
    • Manuela Matschuck
    CLINICAL DATA
    Critical limb ischemia left, ulcerations dig II and III
    ABI left 0.25, Rutherford class 5
    Renal insufficiency, GFR 40ml/min
    CAD, CABG 2012
    Heart failure, EF 35%

    RISK FACTORS
    Art. hypertension, former smoker

    PROCEDURAL STEPS
    1. Left antegrade approach
    – 5F 50 cm sheath, Ansel Modification (COOK)
    2. Guidewire passage
    – Command ES guidewire, 300 cm (ABBOTT)
    – 0.018“ Seeker support catheter, 130 cm (BARD/BD)

    In case of antegrade failure:
    3. Retrograde approach
    – Transpedal kit (COOK)
    – 21 Gauge 4 cm needle, 2.9F pedal sheath
    – CXI 0.018“ support catheter (COOK)
    4. PTA
    – VascuTrak scoring balloon 2.5–250 mm (BARD/BD)
    – Lutonix DCB 3.0/150 mm (BARD/BD)
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    Case 09 – Severely calcified occlusion right popliteal artery

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 09 – LEI 05: male, 58 years (V-D)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Critical limb ischemia right, minor ulcerations dig 1 right
    ABI right 0.44, Rutherford class 5
    CAD, CABG 2011
    COPD
    Renal insufficiency, GFR 65 ml/min

    PROCEDURAL STEPS
    1. Right antegrade approach
    – 7F 55 cm sheath, Ansel Modification (COOK)
    2. Guidewire passage antegrade
    – 0.018“ Connect 250 T guidewire, 300 cm (ABBOTT)
    – 0.018“ TrailBlazer support catheter, 90 cm (MEDTRONIC)
    3. Angioplasty
    Stepwise balloon-angioplasty:
    – 5.0/40 mm Armada 18 balloon (ABBOTT)
    – 6.0/40 mm Armada 18 balloon (ABBOTT)
    – 7.0/20 mm Conquest high pressure balloon (BARD/BD) (optional)
    4. Stenting
    – 5.5 or 6.5 mm Supera Interwoven Nitinol stent (ABBOTT)
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Conference day 2

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    Case 10 – Juxtarenal AAA-EVAR with fenestrated stentgraft

    Center:
    Beijing PLA Hospital
    Case 10 – BPH 02: male, 67 years
    Operators:
    • Wei Guo
    CLINICAL DATA
    Abdominal pulsating mass detected for 3 years
    Cr: 120 umol/L

    RISK FACTORS
    Hypertension, smoking

    PROCEDURAL STEPS
    1. Bifemoral percutaneous approach
    – Preclosing with Proglide closure devices (ABBOTT)
    2. Implantation of the main stentgraft
    – 28/109 mm (COOK)
    – Preset Rosen guidewire to both renal arteries
    – Implanting stents 7–17 mm in bilateral renal arteries
    3. Implantation of the bifurcated stentgraft
    – 24/20/94 mm (COOK)
    4. Implantation of iliac stentgraft
    – 18/39 mm (COOK)
    5. PTA of the graft
    – Coda balloon catheter (COOK)
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    Case 20 – Left common iliac occlusion (May-Thurner Syndrome)

    Center:
    The Chinese University of Hong Kong, Prince of Wales Hospital
    Case 20 – POW 05: male, 47 years (M-C)
    Operators:
    • Bryan Yan,
    • GuangMing Tan,
    • Steven Kum,
    • Sven Bräunlich
    CLINICAL DATA
    JAK2 +ve Myeloproliferative disease
    History of left ilio-femoral DVT and PE 2017
    Persistent left leg swelling and pain
    CEAP 4 and Villalta 18

    IMPORTANT ITEMS
    CT showed left CIV compression
    Latest DUS showed proximal clot extended to left CIV with partial recanalization
    Popliteal vein patent

    PROCEDURAL STEPS
    1. (day before) Left popliteal puncture under ultrasound
    2. (day before) Antegrade crossing of left CFV-EIV-CIV
    – Advantage wire (TERUMO)
    – Navicross support catheter (TERUMO)
    3. (day before) Ultrasound assisted thrombolysis infusion catheter (BOSTON SCIENTIFIC)
    4. (day before) 24 hour ultrasound assisted thrombolytic infusion
    5. Balloon angioplasty
    – Conquest or Atlas (BARD/BD)
    6. Intravascular ultrasound guided vessel sizing
    – Volcano Vision PV .035 (PHILIPS)
    7. Stenting
    – Venovo stent (BARD/BD)
    View image
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    Case 11 – Rotational atherectomy with DCB for recurrent popliteal artery stenosis

    Center:
    Seoul National University Hospital
    Case 11 – SNU 03: male, 59 years (K-P)
    Operators:
    • Hwan Jun Jae,
    • Saebeom Hur,
    • Sanghyun Ahn
    CLINICAL DATA
    Severe claudication at left leg
    Artery function test: 1.12/0.75 (2019.2.13)

    IMPORTANT ITEMS
    ESRD on HD, ASO
    Left SFA and POP lesion:
    Initial: Jestreatm + DCB (Lutonix) at Lt POP occlusion
    & DCB at Lt distal SFA stenosis (2017.5.16)
    1st TLR: DCB (Passeo) at Lt POP occlusion & DES at Lt SFA (2018.3.28)
    2nd TLR: DCB (Passeo) at Lt POP occlusion (2018.8.2)

    PROCEDURAL STEPS
    1. Antegrade access left groin
    – 7F sheath (TERUMO)
    2. Intraluminal passage of the occluded segment at P2
    – V-18 control wire (BOSTON SCIENTIFIC)
    – CXI support catheter (COOK)
    3. Rotational atherectomy of the occluded segment
    – Jetstream (BOSTON SCIENTIFIC)
    – Emboshield (ABBOTT)
    4. DCB application
    – InPACT Admiral (MEDTRONIC) or
    – Ranger (BOSTON SCIENTIFIC)
    5. Bail-out stenting
    – Supera stent (ABBOTT)
    View image
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    Case 12 – Long femoral-popliteal occlusion

    Center:
    The Chinese University of Hong Kong, Prince of Wales Hospital
    Case 12 – POW 02: male, 51 years (YCP)
    Operators:
    • GuangMing Tan,
    • Skyi Yin Chun Pang,
    • Bryan Yan,
    • Steven Kum,
    • Sven Bräunlich
    CLINICAL DATA
    Debilitating bilateral RF3 claudication; previous PTA to right side

    RISK FACTORS
    Smoker

    ANGIOGRAPHY
    Diagnostic angiogram shows long CTO from mSFA to TPT

    PROCEDURAL STEPS
    1. Antegrade CFA 6F sheath
    2. Antegrade wire crossing
    – V18 (BOSTON SCIENTIFIC)
    – CTO wires (ASAHI)
    – Navicross support catheter (TERUMO)
    3. Retrograde distal tibial puncture and wire crossing
    4. Optimal predilatation
    5. Stenting
    – Supera stent (ABBOTT)
    View image
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    Case 13 – Recurrent cephalic arch stenosis

    Center:
    Seoul National University Hospital
    Case 13 – SNU 04: male, 56 years (K-P)
    Operators:
    • Saebeom Hur,
    • Sanghyun Ahn
    CLINICAL DATA
    AVF formation at 2006.6 (Radiocephalic fistula)
    Last PTA for cephalic arch stenosis at 2018.6.25

    PROCEDURAL STEPS
    1. Left arm AVF access under US guidance
    – 6F 10 cm Supersheath (BOSTON SCIENTIFIC)
    2. Guidewire passage
    – 0.035“ Radiofocus soft angled guidewire 150 cm (TERUMO)
    – Kumpe catheter 65 cm (COOK)
    3. Angioplasty
    – 6 mm, 7 mm/40 mm Conquest high pressure balloon (BARD/BD)
    – 6 mm, 7 mm/40 mm Lutonix drug coated balloon (BARD/BD)
    View image
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    Case 21 – Embolization of a Type-II endoleak

    Center:
    Beijing PLA Hospital
    Case 21 – BPH 03: male, 72 years
    Operators:
    • Wei Guo
    CLINICAL DATA
    EVAR of AAA 1 year ago, diameter increasing 5mm for 6 month,
    intermittent abdominal pain for 1 weeks
    Hb: 121 g/L

    RISK FACTORS
    CHD, smoking, DM

    PROCEDURAL STEPS
    1. Right femoral access
    – 6F sheath (COOK)
    2. Selective angiography of SMA and Riolans’ arch
    – Vertebral catheter (TERUMO)
    3. Approach to IMA and embolization
    – 0.026“ microcatheter, 135 cm (COOK)
    – 0.018“ 15/40 mm Interlock Coil (BOSTON SCIENTIFIC)
    4. Puncture site closure
    – Exoseal 6F (CORDIS)
    View image
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    Case 14 – Complex aortoiliac occlusion

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 14 – LEI 06: male, 58 years (G-R)
    Operators:
    • Andrej Schmidt,
    • Matthias Ulrich
    CLINICAL DATA
    Severe claudication (right >> left), pain-free walking capacity 150 meters
    ABI right 0.67, left 0.72, Rutherford class 3

    RISK FACTORS
    Art. hypertension, nicotine abuse

    PROCEDURAL STEPS
    1. Left brachial access
    – 7F 90 cm Check-Flo Performer sheath 90 cm (COOK)
    2. Right femoral approach
    – 9F 10 cm Radiofocus Introducer sheath (TERUMO)
    3. Guidewire passage from brachial
    – 6F Judkins Right coronary guiding catheter (MEDTRONIC)
    – 0.035“ Seeker support catheter, 125 cm (BARD/BD)
    – 0.035“ stiff angled glidewire, 260 cm (TERUMO)

    In case of failure:
    4. Additional retrograde guidewire access to the CTO right iliac
    – 4.0/40 mm Admiral balloon for support (MEDTRONIC)
    – 0.035“ stiff angled glidewire, 180 cm (TERUMO)
    – potentially CART-technique
    5. Stenting
    – LifeStream covered stent 8.0 mm in kissing technique for the aorto-iliac bifurcation (BARD/BD)
    – Covera Plus selfexpanding covered stent 8.0/100 mm right iliac (BARD/BD)
    View image
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    Case 15 – Subacute occlusion left popliteal artery

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 15 – LEI 07: male, 68 years (K-T)
    Operators:
    • Matthias Ulrich,
    • Manuela Matschuck
    CLINICAL DATA
    Subacute occlusion left popliteal artery, severe claudication
    Permanent atrial fibrillation, previously unknown
    NSTEMI 2/2019, PTCA RCA

    RISK FACTORS
    Former smoker, diabetes mellitus Type 2, art. hypertension

    PROCEDURAL STEPS
    1. Antegrade access left groin
    – 6F 50 cm sheath, Raab modification with detachable valve (COOK)
    2. Guidewire passage
    – Command 18 guidewire (ABBOTT)
    3. Thrombectomy
    – Rotarex (STRAUB MEDICAL)

    In case of incomplete thrombectomy:
    4. Low-dose thrombolysis for < 12 hours
    View image
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    Case 16 – Right calcified SFA CTO

    Center:
    The Chinese University of Hong Kong, Prince of Wales Hospital
    Case 16 – POW 03: male, 62 years (TKP)
    Operators:
    • Bryan Yan,
    • Skyi Yin Chun Pang,
    • GuangMing Tan,
    • Steven Kum,
    • Sven Bräunlich
    CLINICAL DATA
    DM, debilitating claudication RF3 symptoms

    ANGIOGRAPHY
    Diagnostic angiogram showed bilateral SFA occlusion
    Refused surgery

    PROCEDURAL STEPS
    1. Antegrade CFA
    – 6F sheath
    2. Antegrade truelumen wire crossing
    – V18 (Boston scientific)
    – CTO wires (Asahi)
    – Navicross support catheter (TERUMO)
    3. Retrograde distal PTA puncture and crossing if antegrade failure
    4. Diamondback orbital atherectomy if no significant dissection (CSI)
    5. In.Pact DCB +/- bailout Supera stent (ABBOTT)
    View image
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    Case 17 – Chronic total occlusion of right SFA

    Center:
    Seoul National University Hospital
    Case 17 – SNU 05: male, 81 years (I-P)
    Operators:
    • Hwan Jun Jae,
    • Saebeom Hur,
    • Sanghyun Ahn
    CLINICAL DATA
    Claudication, both legs
    ASO, s/p Lt. Fem-PTA bypass (2002/03)
    ABI: 0.48/0.64

    RISK FACTORS
    DM, art. hypertension, dyslipidemia

    PROCEDURAL STEPS
    1. Cross-over access
    – 6F 40 cm Balkin sheath (COOK)
    2. Guidewire passage
    – 0.035“ Radiofocus soft angled guidewire 150 cm (TERUMO)
    – Rubicon 35 support catheter 90 cm (BOSTON SCIENTIFIC)
    3. Retrograde puncture in the right distal SFA
    – V-18 control wire (BOSTON SCIENTIFIC)
    – CXI support catheter (COOK)
    4. Predilatation
    – Vascutrak PTA dilatation catheter (BARD/BD)
    5. Drug eluting stent implantation
    – Zilver-PTX (COOK)
    View image
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    Case 18 – Long CTO right SFA in a CLI patient

    Center:
    University Hospital Leipzig, Department of Angiology
    Case 18 – LEI 08: male, 72 years (G-B)
    Operators:
    • Andrej Schmidt,
    • Axel Fischer
    CLINICAL DATA
    Critical limb ischemia right, minor ulceration bilateral forefoot
    ABI right 0.54, left 0.65; Rutherford class 5
    PTA left iliac and left profunda femoris 2/2019
    CAD; CABG 2016
    Diabetes mellitus Type 2

    RISK FACTORS
    Art. hypertension, former smoker

    PROCEDURAL STEPS
    1. Left femoral retrograde and cross-over access
    – 6F 40 cm Balkin Up&Over sheath (COOK)
    2. Antegrade guidewire passage
    – V-18 Control guidewire, 300 cm (BOSTON SCIENTIFIC)
    – Sterling balloon 4.0/100 mm as support catheter (BOSTON SCIENTIFIC)

    In case of antegrade failure:
    3. Retrograde approach via proximal anterior tibial artery
    – 7 cm 21 Gauge needle (COOK)
    – V-18 Control guidewire (BOSTON SCIENTIFIC)
    – 0.018“ support catheter, 90 cm (e.g. Rubicon, BOSTON SCIENTIFIC)
    4. PTA and stenting
    – Sterling 5.0 or 6.0 mm balloon (BOSTON SCIENTIFIC)
    – Eluvia drug-eluting stents (BOSTON SCIENTIFIC)
    View image
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    Case 19 – Femoral-popliteal CTO

    Center:
    The Chinese University of Hong Kong, Prince of Wales Hospital
    Case 19 – POW 04: female, 71 years (TTL)
    Operators:
    • GuangMing Tan,
    • Bryan Yan
    CLINICAL DATA
    DM/HT/Lipid, recent Rt B/T infection with ray amputation
    Complicated by post op NSTEMI with PCI done
    Non healing wound

    ANGIOGRAPHY
    Diagnostic angiogram shows distal SFA to P3 occlusion, focal ATA lesion

    PROCEDURAL STEPS
    1. CFA antegrade puncture under ultrasound
    – Micropuncture kits (COOK)
    2. Antegrade crossing
    – V18 wire (BOSTON SCIENTIFIC )
    – CTO wires (Asahi)
    3. Retrograde distal ATA puncture and crossing if antegrade failure
    4. Optimal balloon dilatation
    – Jade (OrbusNeich)
    5. Ranger DCB (BOSTON SCIENTIFIC) +/- bailout stent
    View image

Live case transmission centers

 

During LINC Asia-Pacific 2019 several live cases will be performed from 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
• Seoul National University Hospital, Seoul, Republic of Korea with Hwan Jun Jae, Saebeom Hur, and Sanghyun Ahn 
• The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong with Bryan Yan and Steven Kum
• University Hospital Leipzig, Department of Angiology, Leipzig, Germany with Andrej Schmidt