Appropriate Patient Identification For Renal Artery Intervention Remains Challenging
|
|
|
- Mercy Baker
- 6 years ago
- Views:
Transcription
1 Renal Intervention Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Director, Interventional Cardiology, Cardiovascular Institute Director, Cardiac Cath Labs, Rhode Island &The Miriam Hospitals
2 None Disclosures
3 Appropriate Patient Identification For Renal Artery Intervention Remains Challenging Renal-artery stenosis Renal-artery stenosis and HTN HTN Renal-artery stenosis, hypertension and CKD Renal-artery stenosis, and CKD CKD
4 Observational Studies of Renal Artery Stenting Blood Pressure Lowering BP (mm Hg) Pre- and Post-Stenting Harden DBP Pre-Stent Watson SBP Post-Stent White SBP Stabilization Of Renal Function N = 25 N = 18 Regression line slopes of reciprocal S Cr over time Harden PN, et al. Lancet 1997;349: , Watson PS, et al. Circulation 2000;102: , White CJ et al. J Am Coll Cardiol 1997;30:
5 Renal Artery Intervention Meta-Analysis of 7 RCTs (n=2,139) Riaz IB, et al. Am J Cardiol 2014;114:
6 Renal Artery Intervention Meta-Analysis of 7 RCTs (n=2,139) Riaz IB, et al. Am J Cardiol 2014;114:
7 Renal Artery Stenting Meta-Analysis of 7 RCTs (n=2,139) A = revascularization; B = medical therapy Riaz IB, et al. Am J Cardiol 2014;114:
8 Renal Artery Stenting Meta-Analysis of 7 RCTs (n=2,139) A = revascularization; B = medical therapy Riaz IB, et al. Am J Cardiol 2014;114:
9 Renal Artery Stenting Meta-Analysis of 7 RCTs (n=2,139) A = revascularization; B = medical therapy Riaz IB, et al. Am J Cardiol 2014;114:
10 Renal Artery Stenting Meta-Analysis of 7 RCTs (n=2,139) Riaz IB, et al. Am J Cardiol 2014;114:
11 Pre-CORAL RCTs: Study Limitations: Small Sample Size EMMA SNRASCG DRASTIC ASTRAL STAR NITER Publication Year Location France UK Netherlands UK, AU, NZ Netherlands France Italy Indication HTN Unilat RAS Resistant HTN (likely CRI) Resistant HTN < mild CRI Resistant HTN or unexplained CRI CRI Resistant HTN CRI Percutaneous/medical 23/26 25/30 56/50 403/403 64/74 28/24 Mean follow up (mo) HTN Baseline S Cr Bilateral stenosis Mean % stenosis NA NA NA 80 Crossover to intervention 27% 6% 44% 6% 1% 2% PTA Only Kumbhani DJ, et al. Am Heart J 2011;161:622-30
12 Pre-CORAL RCTs: Study Limitations: Stents Underutilized EMMA SNRASCG DRASTIC ASTRAL STAR NITER Publication Year Location France UK Netherlands UK, AU, NZ Netherlands France Italy Indication HTN Unilat RAS Resistant HTN (likely CRI) Resistant HTN < mild CRI Resistant HTN or unexplained CRI CRI Resistant HTN CRI Percutaneous/medical 23/26 25/30 56/50 403/403 64/74 28/24 Mean follow up (mo) HTN Baseline S Cr Bilateral stenosis Mean % stenosis NA NA NA 80 Crossover to intervention 27% 6% 44% 6% 1% 2% PTA Only no 7 no % stent 28% stent Kumbhani DJ, et al. Am Heart J 2011;161:622-30
13 Pre-CORAL RCTs: Study Limitations: Mild Stenosis EMMA SNRASCG DRASTIC ASTRAL STAR NITER Publication Year Location France UK Netherlands UK, AU, NZ Netherlands France Italy Indication HTN Unilat RAS Resistant HTN (likely CRI) Resistant HTN < mild CRI Resistant HTN or unexplained CRI CRI Resistant HTN CRI Percutaneous/medical 23/26 25/30 56/50 403/403 64/74 28/24 Mean follow up (mo) HTN Baseline S Cr Bilateral stenosis % pts < 75% stenosis Mean % stenosis NA NA NA 80 Crossover to intervention 27% 6% 44% 6% 1% 2% 41% pts < 70% stenosis 50% pts < 70% stenosis PTA Only Kumbhani DJ, et al. Am Heart J 2011;161:622-30
14 Pre-CORAL RCTs: Study Limitations: Short Follow Up EMMA SNRASCG DRASTIC ASTRAL STAR NITER Publication Year Location France UK Netherlands UK, AU, NZ Netherlands France Italy Indication HTN Unilat RAS Resistant HTN (likely CRI) Resistant HTN < mild CRI Resistant HTN or unexplained CRI CRI Resistant HTN CRI Percutaneous/medical 23/26 25/30 56/50 403/403 64/74 28/24 Mean follow up (mo) HTN Baseline S Cr Bilateral stenosis Mean % stenosis NA NA NA 80 Crossover to intervention 27% 6% 44% 6% 1% 2% PTA Only Kumbhani DJ, et al. Am Heart J 2011;161:622-30
15 CORAL s Limitations Inclusion & Exclusion Criteria Excluded from CORAL - Hospitalization for heart failure within 30 days - UA or MI within 30 days of study entry Included in CORAL - HTN on 2 or more anti-hypertensives
16 Renal Artery Stenting Potential Candidates Moving Forward? The following patient populations have not been well represented in RCTs to date; RAS may be helpful in these settings: - Cardiac disturbance syndromes (ACS or flash pulm edema) - Resistant HTN or ischemic nephropathy in setting of hemodynamically significant stenoses (e.g. FFR, HSG) - Resistant HTN despite OMT (3-drugs, incl a diuretic +/- spironolactone) - When there is not clinical equipoise!
17 SCAI Renal Artery Stenting ECD Parikh SA, et al. Catheter Cardiovsasc Interv 2014;84:
18 SCAI Renal Artery Stenting ECD Parikh SA, et al. Catheter Cardiovsasc Interv 2014;84:
19 How To Perform Renal Artery Intervention When Appropriate - Vascular access - Invasive diagnostics - Renal artery access - Guidewires - EPDs - Pre-dilation - Stenting - Completion angiography - Challenging lesion subsets
20 Vascular Access Bleeding Risk Aortoiliac Issues (AAA, sev athero, tortuosity) Equipment options Backup support Downgoing artery Radial Brachial Femoral
21 Invasive Diagnostics Non-selective abdominal aortography (origins L1-L2) Selective renal angiography prn; avoid scraping - CFA=>RDC, JR4, IM, Sos, Cobra -UE=>HS, MP FFR - No role for adenosine (vasoconstrictor) - NTG, papavarine, Ach incr renal blood flow -Independent predictor of BP response to stenting IVUS - Can be helpful as adjunct to intervention - Does not independently predict BP response
22 Renal Artery Access Exchange Bare-wire Direct guide No-touch Telescoping
23 Renal Artery Access: Exchange Engage 5 or 6F diagnostic cath/wire Exchange for long sheath or guide Advance PTA cath and stent to lesion Feldman RL, et al. CCI 1999;46:245-8
24 Renal Artery Access: Bare-Wire Engage 5 or 6 F diagnostic cath/wire as in Exchange Method but w/o long sheath or guide (E) Advance balloon/stent per routine (F) Can only perform angio if 2 nd angio catheter inserted Feldman RL, et al. CCI 1999;46:245-8
25 Renal Artery Access: Direct Guide Advance guide over wire in abdominal aorta Remove wire Engage artery w/ bare guide (considerable contact/scraping) Once guide seated, wire, balloon and stent advanced to lesion as per routine Feldman RL, et al. CCI 1999;46:245-8
26 Renal Artery Access: No-Touch Advance wire beyond guide tip. This straightens catheter variably depending upon length advanced (A) Advance /0.018 guidewire into artery once adjacent/engaged (A) Remove wire (B) Intervene as per routine (C) Feldman RL, et al. CCI 1999;46:245-8
27 Renal Artery Access: Telescoping Telescope Bates M. TCT 2010, 2012
28 Guidewires Avoid hydrophilic wires and mind wire tip at all times to prevent distal perforation Use support wires with short transition to facilitate device delivery and prevent proximal perforation Bates MC. TCT 2012
29 EPDs? Embolization is Ubiquitous N = 28 patients undergoing RAS Debris retrieved in all patients. Particles = 98.1 ± 60 (13 to 208) Size = 201 ± 76 µ (38 to 6,206 µ) Henry M, et al. Catheter Cardiovasc Interv 2003;60:
30 EPD 2x2 RCT (n=100) Renal Artery Stent +/- EPD +/- Abciximab 0-2% % Change % GFR p value No Angioguard -10% 0.08 Angioguard -2% Cooper CJ, et al. Circulation 2008;117:
31 Pre-dilation Outline lesion before stenting Verify vessel diameter Ease stent delivery Avoid situation where deployed stent cannot be expanded (e.g., heavy Ca++) Photo: Cooper C. TCT 2008
32 Lesions typically short/ostial Usually 6-7 mm diameter stent Few mm prox/distal to stenosis Stents reduce restenosis Stenting Size to normal vessel diameter (not post-stenotic dilated segment) Stop, if pain develops!
33 Renal Artery Stent Placement: Avoid Geographic Miss ( Stick the Landing ) 2 mm into aorta Ostial atheroma Stent with protrusion into aortic lumen Zeller T et al. J Interv Card 2005;18:
34 Stenting: The RAO Myth An MRA Study (n=137) Think 3-dimensionally at time of deployment Avg angle perpendicular to RRA ~ 20 and LRA ~ LAO allows visualization of both renal artery ostia in 75% (range 50 RAO-85 LAO) Bates MC, et al. Catheter Cardiovasc Interv 2006;67:283-7.
35 Stenting Techniques to stick the landing Szabo Anchorwire under most proximal strut Anchor wire Guidewire Guidewire Stent catheter Bending of anchoring wire at ostium Ostial Pro TM BullsEye TM Jokhi P, Curzen N. Eurointervention 2009;5:511-4
36 Completion Angiogram As stent delivery balloon deflates, gently advance guide/sheath over system Avoids stent trauma Facilitates re-crossing lesion if needed Allows optimal opacification for final angio
37 Challenging Lesion Subsets For More Experienced Operators Tortuous renal artery Calcified lesion Restenotic lesion Abdominal aortic aneurysm Dual adjacent arteries Early bifurcation
38 Conclusions Renal artery stenting an option for certain patient subsets Vascular access tailored to patient bleeding risk and anatomy Minimize aortic scraping when seating the guide catheter Choose support wires Routinely pre-dilate Avoid geographic miss when stenting Be familiar with challenging lesion subsets Be prepared for potential complications CORAL-2 may be on the way
Ostial Stents and Distal Embolic Protection During Renal Stenting
Ostial Stents and Distal Embolic Protection During Renal Stenting John R. Laird, MD Professor of Medicine Director of the Vascular Center UC Davis Medical Center Limitations of Current Techniques of Renal
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention
Life After CORAL: What Did CORAL Prove? David Paul Slovut, MD, PhD Co-director TAVR, Dir of Advanced Intervention No Relationships to Disclose The Need for Modern Renal Trials Increased rate of RAS diagnosis
Renal Artery Stenting
Renal Artery Stenting J.P. Reilly, MD, FSCAI Ochsner Medical Center Speaker s bureau: Astra Zeneca and Lilly/Diachi Sankyo Prevalence of RAS is high in cath population. Renal artery intervention can help
SCAI Fall Fellows Course Subclavian/Innominate Case Presentation
SCAI Fall Fellows Course 2012 Subclavian/Innominate Case Presentation Daniel J. McCormick DO, FACC, FSCAI Director, Cardiovascular Interventional Therapy Pennsylvania Hospital University of Pennsylvania
Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis
Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Etiology Fibromuscular
Subclavian Revascularization. Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014
Subclavian Revascularization Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014 Disclosure Information Douglas E. Drachman, MD, FACC Abbott Vascular, Inc.:
Renal Intervention. Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014
Renal Intervention Douglas E. Drachman, MD, FSCAI Division of Cardiology Vascular Medicine Section December 9, 2014 Disclosure Information Douglas E. Drachman, MD, FACC Abbott Vascular, Inc.: Advisory
Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.
Coral Trials: A personal experience that challenges its results in patients with uncontrolled blood pressure.. Dr. Javier Ruiz Aburto, FACS, FICS Assistant Professor Ponce School of Medicine Puerto Rico
Coronary angiography and PCI
Coronary arteries Coronary angiography and PCI Samo Granda, Franjo Naji Department of Cardiology Clinical department of internal medicine University clinical centre Maribor Coronary arteries Atherosclerosis
PCI for Renal Artery stenosis
PCI for Renal Artery stenosis Why should we treat Renal Artery Stenosis? Natural History of RAS RAS is progressive disease Study Follow-up (months) Pts Progression N (%) Total occlusion Wollenweber Meaney
DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service
M AY. 6. 2011 10:37 A M F D A - C D R H - O D E - P M O N O. 4147 P. 1 DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service Food and Drug Administration 10903 New Hampshire Avenue Document Control
Antegrade techniques for CTO recanalization. Dr. George Karavolias, MD, PhD, FESC, FACC Interventional Cardiologist
Antegrade techniques for CTO recanalization Dr. George Karavolias, MD, PhD, FESC, FACC Interventional Cardiologist can CTOs be reliably opened by PCI? Meta-Analysis of 18,061 Patients Patel V, J Am Coll
MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES
MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES PUSHING BOUNDARIES Terumo Interventional Systems is committed to your success with innovative procedural solutions and ongoing support for your most challenging
Basic Technique of PAD Intervention (Renal Artery)
Joint meeting of Coronary Revascularization, Pusan, Korea 1 Basic Technique of PAD Intervention (Renal Artery) Won Ho Kim, MD M.D. Division of Cardiology, Eulji University Hospital Eulji University School
Michael Meuse, M.D. Vascular and Interventional Radiology
Michael Meuse, M.D. Vascular and Interventional Radiology Which patient would likely benefit from renal artery revascularization? Patient A- 60 y/o male with 20 year hx of htn; on 2 drug therapy for 10
Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy
Le# main treatment with Stentys stent Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement
Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System
Volume 1, Issue 1 Case Report Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System Robert F. Riley * and Bill Lombardi University of Washington Medical Center, Division
Calcium Removal and Plaque Modification in the Era of DEB and Contemporary Stenting for Femoro- Popliteal Disease
Calcium Removal and Plaque Modification in the Era of DEB and Contemporary Stenting for Femoro- Popliteal Disease Thomas M. Shimshak, MD Heart and Vascular Center Florida Hospital Heartland Medical Center
Catheter selection for transradial angiography and intervention
Catheter selection for transradial angiography and intervention Sandeep Nathan, MD, MSc, FACC, FSCAI Assistant Professor of Medicine Director, Interventional Cardiology Fellowship Program Director, Interventional
Renal Artery Stenosis: Insights from the CORAL Trial
Renal Artery Stenosis: Insights from the CORAL Trial Christopher J. Cooper, M.D., FACC, FACP Dean and Senior Vice President University of Toledo, College of Medicine President, Ohio Chapter ACC State of
Optimal Techniques for Obtaining Large Caliber Arterial Access
Optimal Techniques for Obtaining Large Caliber Arterial Access Gerald Yong MBBS (Hons) FRACP FSCAI Interventional Cardiologist Royal Perth Hospital Western Australia APCASH 11 October 2014 Disclosure Statement
Techniques for Carotid Interventon
Techniques for Carotid Interventon Jay S. Yadav MD Cleveland, Ohio Disclosures Inventor of Angioguard; fixed and recurring payments from JNJ Advisor: JNJ, Guidant Understand the Patient What is the Cause
Acute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
History of the Powerlink System Design and Clinical Results. Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ
History of the Powerlink System Design and Clinical Results Edward B. Diethrich Arizona Heart Hospital Phoenix, AZ Powerlink System: Unibody-Bifurcated Design Long Main Body Low-Porosity Proprietary eptfe
(EU), FACC (USA), FSCAI (USA)
How to reduce vascular complications of TAVI Paul TL Chiam MBBS (S pore), MMed, MRCP (UK), FAMS FRCP (Edin), FESC (EU), FACC (USA), FSCAI (USA) Cardiologist Mount Elizabeth Hospital Singapore Definition
Renal Artery FFR. Woo-Young Chung. Seoul National University, College of Medicine Boramae Medical Center Cardiovascular Center
Renal Artery FFR Woo-Young Chung Seoul National University, College of Medicine Boramae Medical Center Cardiovascular Center Why renal FFR? Renal artery angioplasty (PTRA) Indication of Renal artery angioplasty
Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully
Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully supported by self-expanding z-stents H&L-B
For Personal Use. Copyright HMP 2013
Case Report J INVASIVE CARDIOL 2013;25(2):E39-E41 A Case With Successful Retrograde Stent Delivery via AC Branch for Tortuous Right Coronary Artery Yoshiki Uehara, MD, PhD, Mitsuyuki Shimizu, MD, PhD,
Issam D. Moussa, MD. Professor of Medicine Mayo Clinic College of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, FL
Carotid Technologies and Protection Issam D. Moussa, MD Professor of Medicine Mayo Clinic College of Medicine Chair, Division of Cardiovascular Diseases Mayo Clinic Jacksonville, FL Disclosure Statement
CAROTID ARTERY ANGIOPLASTY
CAROTID ARTERY ANGIOPLASTY Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline
PCI for Left Anterior Descending Artery Ostial Stenosis
PCI for Left Anterior Descending Artery Ostial Stenosis Why do you hesitate PCI for LAD ostial stenosis? LAD Ostial Lesion Limitations of PCI High elastic recoil Involvement of the distal left main coronary
Case Presentation #1
Case Presentation #1 SCAI Fellows Course December 7, 2013 Barry F Uretsky, MD University of Arkansas for Medical Sciences Central Arkansas Veterans Health System Little Rock, AR Case Presentation #1 65
Quick Reference Guide
Quick Reference Guide Indications for Use The AFX Endovascular AAA System is indicated for endovascular treatment in patients with AAA. The devices are indicated for patients with suitable aneurysm morphology
FLEXIBLE, BALOON EXPANDABLE
EARLY RESULTS OF A CLINICAL TRIAL OF FLEXIBLE, BALOON EXPANDABLE COVERED STENT GRAFT IN ILIAC OCCLUSIVE DISEASE Chris LeCroy Coastal Vascular and Interventional Pensacola, Florida Clinical Trial WL GORE
Masahiko Fujihara, MD
Verify the efficacy of renal artery stenting to define the predictive factors by physiological assessment with pressure wire gradient VERDICT study Masahiko Fujihara, MD Kishiwada Tokushukai Hospital Osaka,
FRACTIONAL FLOW RESERVE USE IN THE CATH LAB BECAUSE ANGIOGRAPHY ALONE IS NOT ENOUGH!!!!!!!!
FRACTIONAL FLOW RESERVE USE IN THE CATH LAB BECAUSE ANGIOGRAPHY ALONE IS NOT ENOUGH!!!!!!!! Juan Antonio Pastor-Cervantes,M.D FSCAI, FACC Cardiovascular Institute Memorial Regional Hospital Hollywood Florida
Carotid Artery Stenting
Carotid Artery Stenting Natural history of the carotid stenosis Asymptomatic 80% carotid stenosis - 6% risk of stroke / year Symptomatic carotid stenosis have 10% risk of CVA at one year and 40% at 5 years
Left Main Intervention: Will it become standard of care?
Left Main Intervention: Will it become standard of care? David Cox, MD FSCAI, FACC Director, Interventional Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown,
Technique Of Carotid Stenting Decision Making Analysis To Overcome Challenges
Technique Of Carotid Stenting Decision Making Analysis To Overcome Challenges Subbarao Myla MD FACC Hoag Memorial Hospital Presbyterian Newport Beach, CA USA Presenter Disclosure Information Name: Subbarao
2017 Cardiology Survival Guide
2017 Cardiology Survival Guide Chapter 2: Angioplasty/Atherectomy/Stent The term angioplasty literally means "blood vessel repair." During an angioplasty procedure, the physician inserts a catheter, with
Subclavian artery Stenting
Subclavian artery Stenting Etiology Atherosclerosis Takayasu s arteritis Fibromuscular dysplasia Giant Cell Arteritis Radiation-induced Vascular Injury Thoracic Outlet Syndrome Neurofibromatosis Incidence
My Indications are based on anatomy
Update in Carotid Artery Stenting &Stroke Management How to choose the best therapy? My Indications are based on anatomy Max Amor M.D max-amor@wanadoo.fr C.Breton,Z.Chati,G.Ethevenot,J.Lemoine,J.P.Simon
Complex Coronary Interventions: Bifurcations. John M. Lasala MD PhD Professor of Medicine Washington University St Louis, Missouri
Complex Coronary Interventions: Bifurcations John M. Lasala MD PhD Professor of Medicine Washington University St Louis, Missouri Disclosures Advisory Board Boston Scientific, St. Jude Medical Speaker-
LM stenting - Cypher
LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with
Flexibility of the COMBO Dual Therapy Stent
TM CaseSpotlight Flexibility of the COMBO Dual Therapy Stent Doctor Peter den Heijer is an of the Catheterization Laboratory at the Department of Cardiology of the Amphia Ziekenhuis, Breda, The Netherlands.
Appropriate Device Selection for Endovascular Procedures
Appropriate Device Selection for Endovascular Procedures Thomas M. Shimshak, MD Florida Hospital Heartland Medical Center Sebring, Florida Disclosures Speaker s Bureau: Abbott Vascular Boston Scientific
Vascular V12. Covered Stent. The New Standard of Care
Vascular V12 Covered Stent The New Standard of Care Innovation Novel Thermo-Conformable Covered Stent 316L stainless steel stent completely encapsulated in a proprietary one piece eptfe film cast covering
Excimer Laser for Coronary Intervention: Case Study RADIAL APPROACH: CORONARY LASER ATHERECTOMY FOR CTO OF THE LAD FOLLOWED BY PTCA NO STENTING
Excimer Laser for Coronary Intervention: Case Study RADIAL APPROACH: CORONARY LASER ATHERECTOMY FOR CTO OF THE LAD FOLLOWED BY PTCA NO STENTING 1 2013 Spectranetics. All Rights Reserved. Approved for External
Radiation Safety Abbott Vascular. All rights reserved.
Radiation Safety More and more complex cases are performed Complexity Index and Fluoroscopy Time 2 3 Collimators / Distances The intensity of scattered radiation is a function of exposed field size Use
Selection and Use of Basic Equipment : Guiding Catheters, Wires and Balloons
SCAI Interventional Cardiology Fall Fellows Course 2014 Selection and Use of Basic Equipment : Guiding Catheters, Wires and Balloons December 7, 2014 8:30 am John S. Douglas Jr, MD Professor of Medicine
The variation of carotid origin, the divergent orientation of common carotid (frequent posterior and left to right direction of right common as
1 Introduction The access to the common carotid during carotid stenting is very challenging and is responsible of a significant number of embolic complications in the ipsilateral but also in the contralateral
Zenith Renu AAA Converter Graft. Device Description Planning and Sizing Deployment Sequence Patient Follow-Up
Zenith Renu AAA Converter Graft Device Description Planning and Sizing Deployment Sequence Patient Follow-Up Device description: Device indications The Zenith Renu AAA Converter Graft with Z-Trak Introduction
PCI for Chronic Total Occlusions
PCI for Chronic Total Occlusions Chronic Total Occlusions Why not Medical Treatment? Medical Treatment CTO in 891 pts over 24 years High 10% Mortality Low 2 % 1 year 10 years Puma JA, et al. JACC 1994;23:390A
Bifurcation stenting with BVS
Bifurcation stenting with BVS Breaking the limits or just breaking the struts? Maciej Lesiak Department of Cardiology University Hospital in Poznan, Poland Disclosure Speaker s name: Maciej Lesiak I have
The Challenge of Accurately Stenting Aorto-Ostial Lesions
The Challenge of Accurately Stenting Aorto-Ostial Lesions In a retrospective study of 100 patients in whom stents were placed using angiographic landmarks, correct stent positioning was achieved in only
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Joey English MD, PhD Medical Director, Neurointerventional Services California Pacific Medical Center Hospitals, San Francisco,
An Expedient and Versatile Catheter for Primary STEMI Transradial Catheterization/Intervention
An Expedient and Versatile Catheter for Primary STEMI Transradial Catheterization/Intervention Jack P. Chen, MD, FACC, FSCAI, FCCP Medical Director, Northside Heart Institute, Atlanta, GA and Tak Kwan,
Department of Internal Medicine, Saitama Citizens Medical Center, Saitama , Japan
Case Reports in Cardiology Volume 2016, Article ID 8790347, 5 pages http://dx.doi.org/10.1155/2016/8790347 Case Report GuideLiner Catheter Use for Percutaneous Intervention Involving Anomalous Origin of
Filters versus Occlusion Balloons during CAS Is there a clear preference?
Washington TCT 2005 Filters versus Occlusion Balloons during CAS Is there a clear preference? K. Mathias Department of Radiology Teaching Hospital of Dortmund - Germany Presenter Disclosure Information
Access Closure: Manual vs. Device
Access Closure: Manual vs. Device Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Director, Interventional Cardiology, Cardiovascular Institute Director, Cardiac Cath Labs, Rhode Island &The Miriam Hospitals
Why I try to avoid side branch dilatation
Why I try to avoid side branch dilatation Hyeon-Cheol Gwon Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Why I don t kiss? I kiss! I prefer to discuss SB ballooning rather
Ancillary Components with Z-Trak Introduction System
Ancillary Components with Z-Trak Introduction System Zenith Flex AAA Endovascular Graft Ancillary Components Converter Converters can be used to convert a bifurcated graft into an aortouniiliac graft if
My personal experience with INCRAFT in standard and challenging cases
My personal experience with INCRAFT in standard and challenging cases G Pratesi, MD Vascular Surgery University of Rome Tor Vergata giovanni.pratesi@uniroma2.it Disclosure Speaker name: Giovanni Pratesi,
Managing Carotid Access from Straight - Forward to Complex Bernhard Reimers Cardiology Dept. Mirano Italy
Managing Carotid Access from Straight - Forward to Complex Bernhard Reimers Cardiology Dept. Mirano Italy Cerebrovascular Interventions Disclosure Statement of Financial Interest I, Bernhard Reimers DO
Access More Patients. Customize Each Seal.
Access More. Customize Each Seal. The Least Invasive Path Towards Proven Patency ULTRA LOW PROFILE TO EASE ADVANCEMENT The flexible, ultra-low 12F ID Ovation ix delivery system enables you to navigate
Complicaciones de Acceso Radial Cómo se Manejan?
Complicaciones de Acceso Radial Cómo se Manejan? Mauricio G. Cohen, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac Catheterization Laboratory University of Miami Miller School of Medicine
Copyright HMP Communications
Ocelot With Wildcat in a Complicated Superficial Femoral Artery Chronic Total Occlusion Soundos K. Moualla, MD, FACC, FSCAI; Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI From Phoenix Heart Center, Phoenix,
TRANSRADIAL PERIPHERAL VASCULAR INTERVENTIONS
TRANSRADIAL PERIPHERAL VASCULAR INTERVENTIONS Cezar Staniloae NYU Heart and Vascular Institute May 27, 2015 Radial Artery is an Ideal Acess Site Easily accessible even in subjects with severe PVD Major
Cook Medical. Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training
Cook Medical Zenith Flex AAA Endovascular Graft with Z-Trak Introduction System Physician Training Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full-thickness,
11 TH ANNUAL VASCULAR NONINVASIVE TESTING SYMPOSIUM NOVEMBER 10, 2018
11 TH ANNUAL VASCULAR NONINVASIVE TESTING SYMPOSIUM NOVEMBER 10, 2018 RENAL ARTERY DISEASE AND RENOVASCULAR HYPERTENSION 1 WHAT IS RENOVASCULAR HYPERTENSION? https://my.clevelandclinic.org/health/diseases/16459-renovascular-hypertension
STENTYS for Le, Main Sten2ng. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy
STENTYS for Le, Main Sten2ng Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement or affilia2on
Renal Artery Stenting With Embolic Protection
Renal Artery Stenting With Embolic Protection Embolic protection during renal stenting may be beneficial, but new device designs are necessary. BY RAJESH M. DAVE, MD Renal artery stenosis (RAS) is the
Fractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center
Fractional Flow Reserve: Basics, FAME 1, FAME 2 William F. Fearon, MD Associate Professor Stanford University Medical Center Conflict of Interest Advisory Board for HeartFlow Research grant from St. Jude
Modified Reverse CART technique in a near-ostial
Modified Reverse CART technique in a near-ostial RCA CTO Dr. Vincent O.H. Kwok MB BS (HK) FRCP (Lond( Lond, Edin, Glasg) ) FACC FSCAI Consultant Cardiologist & Director Cardiac Catheterization & Intervention
Radial Artery Access Improving Outcomes and Decreasing Costs
Howard A. Cohen, MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute Institute DISCLOSURE Nothing to disclose
Left Main Intervention: Where are we in 2015?
Left Main Intervention: Where are we in 2015? David A. Cox, MD FSCAI Director, Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown, PA Fall Fellows Course Laa
Side Branch Occlusion
Side Branch Occlusion Mechanism, Outcome, and How to avoid it From COBIS II Registry Hyeon-Cheol Gwon Cardiac&Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine SB occlusion
Welcome to the 8 th European Bifurcation Club October Barcelona
Welcome to the 8 th European Bifurcation Club 12-13 October 2012 - Barcelona Safety and clinical efficacy of Sideguard stent for treatment of bifurcation lesions Interim results from European multicentre
Cardiologic history. Anamnesis. Female BD Risk factors HTN, DM, Dyslipidaemia. Cardiologic Long history. Last admission Heart failure
Anamnesis Cardiologic history Female BD 29.7.1939 Risk factors HTN, DM, Dyslipidaemia Cardiologic Long history Last admission Heart failure 2004 NSTEMI CX stenosis DES on CX 2012 Acute Pulmonary Oedema
Crossing the Long SFA CTO
Crossing the Long SFA CTO Techniques and Variables You need to Know Kyoto Katsura Hospital Cardiovascular Center Shigeru Nakamura M.D. Korea Soul 2011.4.28 28 Back ground Superficial femoral artery (SFA)
Peter A. Soukas, M.D., FACC, FSVM, FSCAI, RPVI
Peter A. Soukas, M.D., FACC, FSVM, FSCAI, RPVI Director, Peripheral Vascular Interventional Laboratory Director, Vascular & Endovascular Medicine Fellowship Program Assistant Professor of Medicine The
How to Choose Among Carotid Embolic Protection Devices?
How to Choose Among Carotid Embolic Protection Devices? James P. Zidar, M.D., F.A.C.C., F.S.C.A.I. Associate Professor of Medicine Duke University Medical Center Director, Cardiovascular Services Duke
To To Advance Clinical Performance
To Flexible Solutions The ANGIO Mentor family of products exemplifies Simbionix s commitment to provide educators and clinicians with flexible, cost-effective solutions suitable for a wide range of settings.
Coronary Artery Perforation Angioplasty Summit Seoul April 30, 2005
Coronary Artery Perforation Angioplasty Summit Seoul April 30, 2005 James R. Margolis, M.D. Miami International Cardiology Consultants Miami, Florida USA Introduction In the stent era, coronary artery
Endovascular Repair of Combined Occluded Femoral and Popliteal Arteries
MEET 2013 Endovascular Repair of Combined Occluded Femoral and Popliteal Arteries ALI AMIN MD, FACS,FACC, RVT CHIEF OF ENDOVASCULAR INTERVENTIONS READING HOSPITAL AND MEDICAL CENTER READING, PA USA Chronic
PCI Update Qesaria 2009
PCI Update Qesaria 2009 Amit Segev Interventional Cardiology Chaim Outline Primary PCI Non-ST elevation ACS Multi-vessel disease Hemodynamic assessment of borderline lesions - FFR Stable AP Non-coronary
Endovascular Approach to CTOs: Crossing methods and Devices
Endovascular Approach to CTOs: Crossing methods and Devices Anish J. Thomas, MD FACC FSCAI Interventional Cardiology Vascular/Endovascular Medicine SSM Heart Institute St. Louis, MO Disclosure Consultant:
The SYNTAX-LE MANS Study
The SYNTAX-LE MANS Study Synergy Between PCI with TAXUS Express and Cardiac Surgery: Late (15-month) Left Main Angiographic Substudy A. Pieter Kappetein, MD, PhD Erasmus MC, Rotterdam, NL SYNTAX-LE MANS
Renal artery stenosis (RAS) is a relatively common
The Importance of Appropriate Renal Artery Stenting Considerations for diagnosis and treatment of patients with renal artery stenosis. By Massoud A. Leesar, MD, FACC, FSCAI Renal artery stenosis (RAS)
Renal Artery Disease. None > 65,000,000. Learning objectives: Renal Artery Disease
Renal Artery Disease Robert D. McBane, M.D. Division of Cardiology Mayo Clinic Rochester Financial Disclosure Information Renal Artery Disease Robert McBane, MD None To appreciate: Learning objectives:
ILLUMENATE FIH Direct DCB Cohort 12-Month Results
ILLUMENATE FIH Direct DCB Cohort 12-Month Results Stephan Duda Berlin Study Investigators: H. Schröder (PI), B. Lux, F. Rücker, M. Martorana, D. Meyer, H. Hartmann, S. Duda Disclosure Speaker name: S.
NC EMERGE TM PTCA Dilatation Catheter
LEARN MORE Indications, contraindications, warnings and instructions for use can be found in the product labeling supplied with each device. Information for use only in countries with applicable health
Cannulating LIMA Graft Using Right Transradial Approach: Two Simple and Innovative Techniques
Catheterization and Cardiovascular Interventions 80:316 320 (2012) Cannulating LIMA Graft Using Right Transradial Approach: Two Simple and Innovative Techniques Tejas Patel, 1,2 * MD, FACC, FSCAI, Sanjay
Why I m afraid of occlusive devices
Why I m afraid of occlusive devices Cannes 28.06.2008 Carlo Cernetti Cardiology Department Mirano (Venice) MEET 2008 CANNES I HAVE NOT FINACIAL INTEREST/ARRANGEMENT OR AFFILIATION CONFLICT Obstructive
Guide Wires design and selection Abbott Vascular. All rights reserved.
Guide Wires design and selection the cardiac catheter was...the key in the lock Cournand AF, Nobel lecture December 11, 1956; nowadays, the coronary guidewire is the master key to all locks Colombo et
Intravascular Ultrasound for Complex Cases
Intravascular Ultrasound for Complex Cases The Practical Value of IVUS Shigeru Nakamura M.D. Intravascular ultrasound imaging provides short axis information about the vessel. Image quality is not as clear
How to manage TAVI related vascular complications. Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI
How to manage TAVI related vascular complications Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI Definition VARC-2 consensus statement Complications caused by: Wire Catheter Anything related to vascular access
RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant Week of November 19, 2018 Abdominal Aortogram, Bilateral Runoff
Instantaneous Wave-Free Ratio
Instantaneous Wave-Free Ratio Alejandro Aquino MD Interventional Cardiology Fellow Washington University in St. Louis Barnes-Jewish Hospital Instantaneous Wave-Free Ratio Alejandro Aquino MD Disclosure
MEET /06/2013 SESSION : RENAL AND VISCERAL
MEET 2003 11/06/2013 SESSION : RENAL AND VISCERAL AFTER 35 YEARS, WHAT ARE THE INDICATIONS AND RESULTS OF PTRA IN PATIENTS WITH RI OR RVH? THOMAS SOS, MD NYPH CORNELL New York, NY THOMAS SOS, MD NYPH CORNELL