LINC 2019 live case guide


Find all live cases and live case centers listed below.

 

 

Berlin

4 livecase(s)
  • Tuesday, January 22nd: - , Room 3 - Technical Forum

    Case 20 – Asymptomatic very high grade LICA-Stenosis in a young vascular polytrauma

    Center:
    Berlin
    Case 20 – BLN 02: male, 52 years (R-V)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    High grade bilateral ICA stenosis (left>right)
    Diabetic foot syndrom left
    Bilateral total SFA occlusions (PTA with DEB and Ultrascore 08/2018)
    Bilateral high grade CIA&EIA steosis (PTA and Stenting 08/2018
    Coronary disease (2 vessel, symptomatic)
    High grade left renal stenosis
    Left Subclavian artery high grade stenosis

    RISK FACTORS
    Smoker, diabetes mellitus, art. hypertension

    CT
    Aortic Arch Type 1, left ostial subtotal carotid artery stenosis

    DUPLEX
    High grade stenosis, not much calcium, straight vessel, soft plaques, high grade stenosis

    PROCEDURAL STEPS
    1. Transfemoral access
    - Short 8F sheath (TERUMO)
    2. Sheath placement
    - 8F MP-shape guiding catheter sheath into the left CCA (VISTA BRITE IG, CORDIS)
    3. Distal Protection
    - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
    4. Predilatation
    - 3 x 40 mm Maverick balloon (BOSTON SCIENTIFIC)
    5. Secondary protection/ stenting/ postdilatation
    - Neuroguard IEP stent 9 mm (CONTEGO MEDICAL) filter, Nitinol stent and postdilation balloon in one system
    6. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
    7. Control angiography extra – and intracranial DSA
    8. Access care
    - Angioseal 8F (TERUMO)
    View image
  • Tuesday, January 22nd: - , Room 3 - Technical Forum

    Case 22 – CTO Left popliteal artery (11 cm length)

    Center:
    Berlin
    Case 22 – BLN 03: female, 85 years (G-J)
    Operators:
    • Ralf Langhoff,
    • David Hardung
    CLINICAL DATA
    Recanalisation of the rigt popliteal artery CTO in 11/2018,
    PTA with Sequent Please OTW and 4 Multiloc 5 x 13 mm stents.
    Deep vein thrombosis in 02/2018 with DOAK for 6 months

    PRESENT STATE
    ABI left 0.7, walking distance <50 mm, calf claudication,
    Duplex and Angio showed popliteal segment I CTO

    RISK FACTORS
    Smoking, art. hypertension

    PROCEDURAL STEPS
    1. Cross-over access
    - 6F Fortress 45 cm sheath (BIOTRONIK) right to left
    2. Catheter for lesion crossing
    - Navicross 0.035“ support catheter 90 cm (TERUMO)
    3. Guidewire for lesion crossing
    - Angled stiff glidewire, 260 cm (TERUMO)
    4. Lesion crossing
    5. Backup retrograde access
    - 0.018“ approach, sheathless with CXI 0.018“ support catheter (COOK)
    6. Predilation
    - 3 x 120 mm Passeo 35 balloon (BIOTRONIK)
    7. PTA
    - 5 x 120 mm Sequent Please OTW DEB (B. BRAUN)
    8. Spot Stenting
    - Multi-Loc 5 x 13 mm if needed (B. BRAUN)
    9. Postdilation if stent was necessary
    - 5 mm POBA (BIOTRONIK)
    10. Sheath removal and vessel closure
    View image
  • Tuesday, January 22nd: - , Room 5 - Global Expert Exchange

    Case 29 – Diabetic foot syndrome with CTO of tibioperoneal trunc and distal occlusion of the ATP

    Center:
    Berlin
    Case 29 – BLN 04: male, 62 years, (J-B)
    Operators:
    • Ralf Langhoff,
    • Mehmet Boral
    CLINICAL DATA
    Gangrene Dig. ped. II right, persistend occlusion of right tibioperoneal trunc
    Diabetes mellitus
    Minor amputation of right foot Dig ped I ex-articulation of end-phalanx
    PTA and Supera stenting right SFA & popliteal artery 01/2019
    Impaired renal function
    TEA and Patch bilateral common femoral artery (2015)

    RISK FACTORS
    Hyperlipidemia (Lipidapharesis since 2016), art. hypertension
    CHD (post-MI), recanalisation of inflow was done by cross-over approach,
    wound is only slowly improving

    PROCEDURAL STEPS
    1. Antegrade access
    - Destination 5F sheath (45 cm) right CFA (TERUMO)
    2. Recanalisation
    - supported by CXI Supportcatheter 0.018“ (COOK) and Advantage Glidewire 0.018“ (TERUMO)
    3. PTA
    - 2 x 40 mm ballon Passeo 18 (BIOTRONIK)
    4. Recanalisation of the tibioperoneal trunc & distal ATP to the pedal arch and PTA
    5. Stenting of the tibioperoneal trunc
    - 3.0 x 31 mm Cre8 BTK dedicated DES (ALVIMEDICA)
    6. BACK-UP: transpedal-loop recanalisation of the ATP via the ATA
    - 0.014“ Corsair Microcatheter (ASAHI) and 0.014“ Advantage Wire (TERUMO)
    View image
  • Tuesday, January 22nd: - , Room 2 - Main Arena 2

    Case 17 – High-grade, progressive RICA post radiation and open surgery for parotid tumor

    Center:
    Berlin
    Case 17 – BLN 01: male, 62 years, (J-B)
    Operators:
    • Ralf Langhoff,
    • Andrea Behne
    CLINICAL DATA
    Radiation and open surgery due to parotid cancer (years ago)
    Renal insufficiency (last Creatinin level 2.3 mg/dl)

    DUPLEX
    High grade RICA, PSV 364 cm/sec, EDV >100 cm/sec, MDV 100 cm/sec

    RISK FACTORS
    Ex-nicotine, art. hypertension

    PRESENT STATE
    CTA and MRA not available due to impaired renal function

    PROCEDURAL STEPS
    1. Transfemoral access
    - Short 8F sheath (TERUMO)
    2. Placement of the guiding catheter
    - 8F MP-shape guiding catheter sheath into the right CCA (VISTA BRITE IG, CORDIS)
    3. Distal Protection
    - Filter-wire EZ protection system (BOSTON SCIENTIFIC), alternatively Emboshield Nav 6 (ABBOTT Vascular)
    4. Predilatation
    - 3 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
    5. Stenting
    - Roadsaver 8 x 25 mm Micromesh-stent (TERUMO)
    6. Postdilatation
    - 5 x 20 mm Maverick balloon (BOSTON SCIENTIFIC)
    7. Removal of the stent delivery system and Filter Wire EZ system (BOSTON SCIENTIFIC)
    8. Control angiography extra – and intracranial DSA
    9. Access care
    - Angioseal 8F (TERUMO)
    View image