Day 2 Talks
CLI real world registry, Japan. Propensity matched.
Message : No difference in AFS and MALE between open and endo, Less reintervention in Endo. CLI with severe wounds : surgery better. Patients in "poor general condition: endo better.
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Message : Don't hesitate to go below upwards on crurals
Talk by THE Peter Schneider. Logic is : Branches come off at caudal angle; distal end of occlusion softer than proximal; pedal and calf / shin punctures are safe.
Mentions importance of dorsi and plantar flexion of the foot to help get the wire up
Usually sheathless and then an 0.018. Need good support catheters : CXI or QuickCross.
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Content Heavy Talk on BTK Technique!
1. Don't use 0.035 for BTK
2. Put two sharp bends in the wire for CTOs
3. Favoured wires : Regalia XS1, Chevalier floppy, Jupiter FC3, Command.
4. Emphasis on the tip weight depending upon purpose of the wire. Chev tapered 15 / 30; Jupiter 45g; Astato XS 9-12 and 9-40
5. Drilling guidewires : Ruby, Treasure
6. Preference is to go intimal by gentle drilling; when too calcified, go suboptimal.
7. The Microknuckle technique : advancing with just the catheter
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Surgeon from Grand Rapids, MI, USA.
Overview of DCB trials.
Do NOT undersize on the DCB; it just wastes drug at best, embolises it down at worst.
"Unlikely to rupture a crural with anything less than 5 mm diameter balloon".
(Dierk Scheinert : Main Academic Organizer of LINC)
BTK Lutonix registry data. Lesions 12 cm on average length +/- 9 cm.
Freedom from TLR at 6 months 90% and at 1 year 75%
Technical talk on BTK calcification implications
Histopathological talk, mostly. Very interesting.
Mentions a device called FreedomFlow that has helical spheres for circumferential rotation in vessels
TOBA!!!
Tack Optimised Balloon Angioplasty - essentially, short stents.
A set of 4 self expanding NiTinol stents with gold RO markers on a single delivery shaft. Trial is at 6 sites in EU and NZ.
TOBA II for BTK is now recruiting at 60 sites in US EU NZ. Apparently very much AHEAD of targets - (couldn't be more different to BASIL 2!!!)
Thomas Zeller : Lithoplasty!
Lithotripsy incorporated into an angioplasty balloon!
30" at 4 atm, then another 30" at 6 atm; up to 6 such cycles in total; 1 shock per second.
Presently only available in 60 mm balloon length. Safety data acceptably good. Quotes luminal gain in the SFA study DISRUPT 1 to have been 3 mm.
The BullFrog Device! Pumping Steroids in!
DANCE study completed - Above Knee with Dexamethasone
LIMBO and TANGO enrolling
LIMBO ATX (atherectomy and steroid, US only); LIMBO PTA (angioplasty and steroid, EU only
Dexa at dose of 0.8 mg/cm of lesion.
TANGO : Dexa + a Limus drug in BTK!
Two Rx arms, low and high dose of drug. Efficacy check with TVAL : Transverse Vessel Area Loss
Mentions TWIST : first polypharmacy trial
GSTT, London
Message :
Limb salvage comparable between open and endo Rx for CLI; late patency and mortality trend to better with endo. From St Thomas', IR Cons.
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IVUS to guide Rx of calcified SFAs...
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Angioscopic SFA biopsies!
Categorising lesions into type A (mostly organised thrombus) and type B (intimal thickening)
For A --> bare stent for the thrombus
For B --> DCB or DES or DAART (directional atherectomy + anti restenosis therapy)
Wound blush as end point of BTK intervention
Multivariate predictors of healing :
Patent BK vessel = 0.96
Pedal arch = 1.12
BA vessel = 1.23
Presence of wound blush = 1. 85 !
Registry info : OLIVE, SPINACH, PRIORITY, WARRIORS
1 year death : 33%
No significant difference in 1yS between revasc and non Vasc groups! Message : Pick who you operate on.
