Bergamo

• Tuesday, January 28th: 10:12 - 10:48, Room 3 - Technical Forum

  Case 17 – Symptomatic high-risk carotid artery disease

  Center:

  Bergamo

  Case 17 – BG 03: male, 82 years (P-R)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  No relevant prior vascular history
  One month ago transient ischemic attack with left-sided hemyparesis
  
  RISK FACTORS
  Hypertension, hypercholesterolemia
  
  IMAGING
  DUS: 85% RICA stenosis with significant flow acceleration
  CT angio: sub-occlusive right ICA disease with presence of thrombus
  
  PROCEDURAL STEPS
  1. Right femoral access (9F)
  2. Selective right carotid cannulation
  – JR4 guiding cathether (CORDIS/CARDINAL HEALTH)
  3. Proximal protection
  – MOMA 9F (MEDTRONIC)
  4. Lesion crossing
  – 0.014‘‘ guidewire
  5. Direct stenting
  – C-Guard double mesh stent (Inspire MD)
  6. Postdilatation
  – 5.0 mm Ultrasoft balloon (BOSTON SCIENTIFIC)
  7. Debris aspiration (if any)
• Tuesday, January 28th: 13:51 - 14:16, Room 1 - Main Arena 1

  Case 05 –Symptomatic occlusive early restenosis of right SFA

  Center:

  Bergamo

  Case 05 – BG 02: male, 67 years, (G-B)

  Operators:

  • Antonio Micari,
  • Fausto Castriota

  CLINICAL DATA
  No CV history
  Previous right SFA PTA with plain balloon
  During the last 3 months severe right leg claudication (walking distance 70 m)
  
  RISK FACTORS
  Hypertension, hypercholesterolemia, previous history of smoking
  
  DUPLEX
  Distal right SFA occlusion with flow demodulation in BTK vessels
  
  PROCEDURAL STEPS
  1. Femoral access (7F)
  2. Lesion crossing
  – 0.018‘‘ Control Wire + BerII 4F catheter
  3. Wire exchange
  – 0.018‘‘ wire with 0.014‘‘ wire Choice PT (BOSTON SCIENTIFIC)
  4. Embolic protection
  – Distal 6.0 mm Spider FX (MEDTRONIC)
  5. Directional atherectomy
  – HawkOne (MEDTRONIC)
  6. Balloon dilatation
  – 5.0 mm Inpact Admiral drug-coated balloon (MEDTRONIC)
  7. Postdilatation if needed
  

  View image
• Tuesday, January 28th: 15:19 - 15:39, Room 3 - Technical Forum

  Case 21 – Symptomatic right carotid artery disease in a patient with known history of cardiovascular disease

  Center:

  Bergamo

  Case 21 – BG 04: female, 69 years, (A-M)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  Previous CABG (LIMA to LAD, VG to posterolateral branch) + ascending aorta repalcament (2015)
  Previous multiple PCI (the last one in 2017 to LCx artery)
  Currently asymptomatic for angina, negative stress echo in 2019
  In December 2019 episode of left-sided hemiparesis with full neurological recovery
  
  RISK FACTORS
  Hypertension, hypercholesterolemia
  
  IMAGING
  DUS: severe right carotid artery stenosis with flow acceleration up to 473 cm/sec
  
  PROCEDURAL STEPS
  1. Radial access (6F)
  2. Right carotid artery selective cannulation
  – IM guiding catheter
  3. Support guidewire
  – 0.035‘‘ Supracore wire in ECA
  4. Sheath placement
  – Destination 6F long 90 cm sheath (TERUMO)
  5. Filter placement
  – Spider FX filter (MEDTRONIC) in RICA
  6. Direct stenting
  – Roadsaver double mesh stent (TERUMO)
  7. Postdilatation
  – 5.5 mm Ultraverse balloon (BOSTON SCIENTIFIC)

  View image
• Tuesday, January 28th: 16:30 - 18:00, Room 3 - Technical Forum

  Case 23 – Severe right leg claudication in a patient with history of heavy smoking

  Center:

  Bergamo

  Case 23 – BG 05: male, 69 years (G-Z)

  Operators:

  • Fausto Castriota,
  • Antonio Micari

  CLINICAL DATA
  Previous coronary angiogram (abnormal stress test) showing unobstructed coronary arteries
  Severe right leg claudication (90 m) much impairing quality of life
  Quit smoking 1 year ago
  
  RISK FACTORS
  Mild hypertension, dyslipidemia
  
  IMAGING
  DUS: flow demodulation in right CFA compatible with iliac occlusion
  Angio MRI: right distal common iliac occlusion
  
  PROCEDURAL STEPS
  1. Left femoral access (6F)
  2. Cross-over approach
  – 45 cm Destination sheath (TERUMO)
  3. Right femoral access
  – Back-up, 4F sheath
  4. Lesion crossing from cross-over system
  – 0.018‘‘ Control wire or hydrophilic 0.035‘‘ wire (TERUMO)
  5. Predilatation
  6. Stenting with self-expandable stent
  – Everflex (MEDTRONIC)
  7. Postdilatation

  View image