Variation of stent placement for distal abdominal aorta Lesion

Transcription

1 Variation of stent placement for distal abdominal aorta Lesion Tatsuki Doijiri M.D Department of Cardiology Yamato-Seiwa Hospital Kanagawa Japan

2 Disclosure Speaker name: Tatsuki Doijiri... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

3 Introduction How should stent be deployed from distal abdominal aorta to proximal iliac artery?

4 Variation of stent placement A B

5 A Kissing Stenting

6 B Just Size Stenting

7 In case of Just Size Stenting

8 Advantage Disadvantage Anatomical No stent strut in center of vessel Impossible in large aorta Complex procedure in Leriche syndrome

9 Abd.Ao iliac lesion (Leriche syndrome) Need re-wiring after stenting of Abdominal aorta However, if success is gained, I think it is the most ideal result.

10 Adaptation cases In my opinion, we should consider whether this is possible in all cases. However, in reality Lesion in only Abdominal aorta and Farther from bifurcation

11 Adaptation Case

12 Epic 12 40mm

13 In case of Kissing Stenting

14 Stenting from Abdominal Aorta to Bi iliac artery

15 Advantage Disadvantage Simple procedure before stenting Non-anatomical? Difficult for crossover Possible to even in case of large vessel about 20mm Stent strut in center of vessel Some cases occur thrombus

16 Point of Kissing stenting Must adjust Stent Edge Stent Diameter Stent Type

17 Different radial force in Stent edge and Stent body

18 Different radial force in Stent diameter

19 Different radial force in Stent type

20 Kissing stent with different radial force, weak radial force stent collapses.

21 Stent placement method one operator two operator

22 Stenting by two opeartor Sometimes do not match each other SMART mm SMART mm

23 How to accurately place self expandable stent 1. Deploy stent by a little length. 2. Pull stent system slowly until the shape of the stent changes. 3. Put stent in place while paying attention to being displaced.

24 Stenting by one operator 1. Place one stent by a little length. 2. Place the stent on the opposite side aligned with proximal edge of the first stent. 3. Place both stents in place while paying attention to being displaced.

25 For safely place stent Balloon dilatation moderately Use self Expandable stent Stent expansion in chronic phase

26 Preparation of Leriche syndrome If kissing stenting is selected, we should pass the wire another two route or Dilate with large diameter balloon

27 Abdominal Aorta

28

29 Abdominal Aorta

30

31 In Abdominal aorta, if we pass wire one route or dilate with moderate diameter balloon before stenting, Stent may collapse.

32 Case 60 M

33 Sterling mm

34 SMART mm SMART mm

35 Final AOG

36 Next day Proximal Distal Stent collapse

37 Abdominal Aorta

38 Stent collapse

39 Kissing stenting in Leriche syndrome Lesion Preparation before stenting is important.

40 Hybrid stenting

41 Pre AoG

42 Kissing stenting(distal) SMART mm SMART mm

43 Just size stenting(proximal) Protege mm

44 Final AoG

45 Conclusion Patency in Aorto-iliac lesion is good. However stent can t be removed from patient. No evidence show, but, optimal stenting is important.

46 Variation of stent placement for distal abdominal aorta Lesion Tatsuki Doijiri M.D Department of Cardiology Yamato-Seiwa Hospital Kanagawa Japan