At LINC 2022, held in Leipzig, Germany, for the first time in two and a half years, a live demonstration session in the main arena was broadcast from the Tokyo Bay Urayasu Ichikawa Medical Center on Tuesday, June 7, at 15:00 Japan time, where Dr. Tatsuya Nakama of the center performed an EVT to the SFA CTO.
Live EVT coverage from Tokyo Bay Urayasu Ichikawa Medical Center to Leipzig
Dr. Dierk Scheinert, LINC course director, and Dr. Hiroyoshi Yokoi of Fukuoka Sanno Hospital facilitated the session from Japan, and Dr. Osamu Iida of Kansai Rosai Hospital and Dr. Daizo Kawasaki of Morinomiya Hospital participated as remote panelists.
The patient is a man in his 70s whose chief complaint is intermittent claudication. He has diabetes, hypertension, dyslipidemia, creatinine level of 0.68, eGFR of 87 mL/min/1.73 m2, and a SMART stent was implanted last month in the left CIA-EIA.
Dr. Nakama punctured the right inguinal region to access the CTO lesion in the left SFA of the target lesion, chose a crossover approach, and started wiring from the antegrade.
The hard lesion blocked the wire and the wire was dislodged from the vessel. The wire was then replaced with a 0.018" to 0.014" (45g) guide wire, advanced into the CTO, and dilated with a 3.0 mm balloon.
The 0.014" wire was then advanced distally using a 4Fr diagnostic catheter, and the guidewire entered the subintimal space. The loop technique was used to advance the wire to the distal portion, but the wire failed to re-enter the true lumen, so the retrograde approach was started.
Wiring was performed bilaterally and finally a reverse CART technique was performed to successfully insert a 0.014" guidewire and microcatheter from the retrograde grade into the antegrade diagnostic catheter. The retrograde wire was subsequently exchanged with a 300 cm wire, and after successful externalization, the lesion was dilated using a 5.0 mm DCB.
A severe dissection occurred in the middle of the lesion after dilated with DCB, and an Eluvia DES was placed distal to proximal to the SFA. Despite the complex lesion, the SFA-EVT treatment was completed in time.
“I use an IVUS to optimize the result. IVUS allows the operator to select a larger sized device in general”, said Dr. Nakama and the session was concluded.
※コンテンツには、国内で未承認、適応外の医療機器、医薬品、または効能・効果/用法・用量の情報を含む場合がありますが、未承認、適応外の使用を推奨するものではありません。
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