S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR

Transcription

1 Thursday, January 1, :24-12:30 Crush Stenting An Alternative Approach to Manage Occluded Femoropopliteal Stents S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR ACADEMIC HOSPITALS Flensburg of Kiel University Faculty of Medicine Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, FLENSBURG Dept. of Diagnostic and Interventional Radiology / Neuroradiology 1

2 Disclosure I have the following potential conflicts of interest to report: Consulting Boston Scientific, Terumo, GE, Eurocor 2

3 Objectives Crush-stenting What is beyond this term? Crush-stenting What is the exact technique, when used as Treatment For Occluded Fempop Stents? 3

4 Crush-Stenting (I): BES + BES A. Colombo, G. Stankovic, D. Orlic, et al.modified T-stenting with crushing for bifurcation lesions: immediate results and 30-day outcome. Catheter Cardiovasc Interv, 60 (2003), pp BES crushed BES 4

5 Crush-Stenting (II): SES + BES A large, self-expanding stent was implanted from the lower aorta to one iliac branch, followed by deployment BES of a balloonexpandable stent in the contralateral iliac artery such that its proximal edge protruded a few millimeters through the struts of the self-expanding stent into the aorta SES n=23 Midulla M, Martinelli T, Goyault G, Lions C, Abboud G, Koussa M, Mounier-Véhier C, Beregi JP. T- stenting with small protrusion technique (TAP-stenting) for stenosed aortoiliac bifurcations with small abdominal aortas: an alternative to the classic kissing stents technique. J Endovasc Ther Oct;17(5): % primary 16 months [TAP (T And Protrude)-stenting technique] 5

6 Crush-Stenting (III): BES + BES Complication management of intraoperative blind subintimal stenting BES crushed BES crushed BES 6

7 Crush-Stenting (IV): SES + SES Complication management of misplaced SES (sidebranch) SES crushed SES 7

8 Treatment For Occluded Fempop Stents Standard: PTA-DCB Literature: Debulking+DCB 8

9 Treatment For Occluded Fempop Stents Standard: PTA-DCB Literature: Debulking+DCB 9

10 Treatment For Occluded Fempop Stents If intraluminal RECA fails? Trespassing PIER-wise + subintimal stenting of the neo-lumen Unintentially pass of the occluded stent: Older occlusion Fibrosed tissue Re-organized thrombus Go ahead with PIER (per-interventional extraluminal recanalization)! Duterloo D, Lohle PN, Lampmann LE. Subintimal double-barrel restenting of an occluded primary stented superficial femoral artery. Cardiovasc Intervent Radiol May-Jun;30(3):

11 Treatment For Occluded Fempop Stents If intraluminal RECA fails? Unintentially pass of the occluded stent: Older occlusion Fibrosed tissue Re-organized thrombus Trespassing PIER-wise + subintimal stenting of the neo-lumen SES Double-Barrel Restenting SES crushed SES Go ahead with PIER (per-interventional extraluminal recanalization)! Duterloo D, Lohle PN, Lampmann LE. Subintimal double-barrel restenting of an occluded primary stented superficial femoral artery. Cardiovasc Intervent Radiol May-Jun;30(3):

12 Treatment For Occluded Fempop Stents If intraluminal RECA fails? Unintentially pass of the occluded stent: Older occlusion Fibrosed tissue Re-organized thrombus Trespassing PIER-wise + subintimal stenting of the neo-lumen SES Double-Barrel Restenting SES crushed SES Go ahead with PIER (per-interventional extraluminal recanalization)! Nakamura A, Nakajima S, Endo H, Takahashi T, Nozaki E. Successful outside-the-stent stenting for an occluded primary stented superficial femoral artery. Cardiovasc Interv Ther % patency 12

13 Case 1: Index procedure 13

14 Case months PIER Hydrophylic guidewire inch or inch Re-entry technology 14

15 Case months High-pressure PTA SES Neo-lumen creation Crush- or double-barrel stenting Final PTA 15

16 Case months Coloured duplex 16

17 Case 2: Intraluminal Sure? 17

18 SES SES crushed 18

19 Treatment For Occluded Fempop Stents -If intraluminal RECA fails PIER Support technology Re-entry technology Kirk J, Wilson R, Kovacs F, Tennant W, Braithwaite B, Habib S. Successful extraanatomical recanalization of occluded superficial femoral arteries using the Outback device--a report of 2 cases. Vasc Endovascular Surg Jan;46(1):

20 Treatment For Occluded Fempop Stents Can be a challenge PIER-technique Hydrophylic guide wire tip Support catheter Re-entry-technique Re-entry catheters Dedicated techique and technology is required: Advantages: Stents required: Aggressive re-stenting-technique Double-barrel- or crush-stenting High technical success + high mid-term patency SES, intervoven Nitinol? 20

21 Thursday, January 1, :24-12:30 Crush Stenting An Alternative Approach to Manage Occluded Femoropopliteal Stents S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA, FSIR ACADEMIC HOSPITALS Flensburg of Kiel University Faculty of Medicine Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, FLENSBURG Dept. of Diagnostic and Interventional Radiology / Neuroradiology 21