LINC 2019 live case guide

Columbus

• Wednesday, January 23rd: 13:30 - 15:00, Room 3 - Technical Forum

  Case 48 – Live case from Columbus

  Center:

  Columbus

  Case 48 – Live case from Columbus

  Information will follow in due time. Thank you for your understanding.
• Wednesday, January 23rd: 15:05 - 15:30, Room 1 - Main Arena 1

  Case 35 – Severe, asymptomatic left internal carotid artery stenosis

  Center:

  Columbus

  Case 35 – COL 01: 71 years (W-M)

  Operators:

  • Michael Jolly,
  • Gary Ansel

  CLINICAL DATA
  Yearly carotid artery surveillance given diffuse vascular disease.
  Asymptomatic patient with progressive LICA disease over past year.
  On optimal medical therapy (ASA, clopidogrel, atorvastatin 80 mg, losartan 100 mg).
  Pt unwilling to undergo carotid surgery
  
  RISK FACTORS
  CAD s/p 4vCABG 2000, prior subsequent PCI, HTN, HLD,
  ischemic cardiomyopathy (EF 40%), stable angina
  
  PRESENT STATE
  Asymptomatic, denies TIA/CVA/amarosis fugax
  
  DUPLEX
  Carotid duplex Nov 2018 – RICA 157/21 cm/s ratio 2.0, LICA 290/104, ratio 5.2;
  CT neck: 70-80% LICA stenosis, no significant LCCA stenosis
  
  ANGIOGRAM
  Carotid angiogram: 80% LICA bifurcation stenosis by NASCET
  
  PROCEDURAL STEPS
  1. Micropuncture femoral artery access
  2. Sheath placement
  - 6F 90 cm braided sheath delivery into LCCA
  3. Distal embolic protection
  - Nav6 Emboshield wire (ABBOTT)
  4. Stenting
  - Xact 10-8 x 40 mm (ABBOTT)
  5. Predilatation
  - 4x20 mm NC balloon (ABBOTT)
  4. Postdilatation
  - 5 x 30 mm NC balloon (ABBOTT)(if necessary)

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• Wednesday, January 23rd: 15:54 - 16:22, Room 1 - Main Arena 1

  Case 36 – Live case from Columbus

  Center:

  Columbus

  Case 36 – Live case from Columbus

  Information will follow in due time. Thank you for your understanding.
• Wednesday, January 23rd: 17:31 - 17:56, Room 1 - Main Arena 1

  Case 38 – Instent restenosis case

  Center:

  Columbus

  Case 38 – COL 03: male, 58 years

  Operators:

  • Mitchell Silver,
  • Michael Jolly,
  • Christopher Huff,
  • Gary Ansel

  CLINICAL DATA
  Pt with 4 year history of PAD, s/p multiple interventions of the iliac, femoropopliteal and tibial vessels for claudication and previous critical limb Ischemia. Originally treated multilevel for left foot ulceration in 2015, restenosis of iliacs treated wtih stent grafts, SFA occlusion attempted to be treated with cilostazol but no effect at 3 months. Now s/p Super stent in 2015 that occluded, treated with DCB and proximal DES extension in 2017. Now with recurrent RC II claudication and duplex scan with restenosis
  ABI R: .96 and L: .88
  
  RISK FACTORS
  DM II, CAD, HTN, hyperlipidemia, past smoker
  
  DUPLEX
  Peak velocity of 343 within the stent
  
  PROCEDURAL STEPS
  1. Contralateral femoral access
  2. Placement of 7F or 8F braided sheath
  3. Excimer Laser debulking
  4. Hig pressure PTA
  5. If good result DCB, if poor result consider DES
  6. Suture based sheath removal

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