Optimal assessment observation of intravascular ultrasound

Size: px
Start display at page:

Download "Optimal assessment observation of intravascular ultrasound"

Transcription

1 Optimal assessment observation of intravascular ultrasound Katsutoshi Kawamura and Atsunori Okamura Division of Radiology Cardiovascular Center Sakurabashi Watanabe Hospital SAKURABASHI WATANABE Hospital Cardiovascular Center

2 Backgorund Intravascular ultrasound (IVUS) is an invasive imaging device to visualize coronary crosssectional anatomy and is superior to coronary angiography (CAG) in assessing vessel size, calcium content, and lesion severity.

3 Backgorund Optimal stent sizing may be clinically important in preventing incomplete stent apposition (ISA) and in optimizing initial stent deployment. It can detect some morphological alterations and may be make a prediction of some complication.

4 Outline Basic IVUS method Observing from proximal to distal Driven proximally from the distal Assessment of the three-layer wall Measurements for optimal stent sizing Atheroma morphology Assessment observation for the IVUS Nega-linkage 2 steps things Training method In the beginning, I will talk about the basic IVUS method, an assessment observation for the This IVUS, slide And, shows a routine a brief outline observation of my and presentation. measurements in our hospital.

5 BASIC IVUS METHOD First of all, let me talk about a basic IVUS method.

6 Basic IVUS method 1 : Observing from proximal to distal Distal Proximal As we know, using IVUS we can observe coronary cross-sectional anatomy as if we see it from the proximal to the distal portion of coronary artery.

7 Basic IVUS method 2 : Driven proximally from the distal Distal Proximal IVUS like this driven animation. proximally from the distal portion of coronary artery,

8 Basic IVUS method 3 : Assessment of the three-layer wall Media Plaque Lumen EEM IEL Catheter Adventitia As Most Moving There we left Inner is know, outward panel layer distinct the shows muscular consist from boundary the the of gray lumen, arteries, complex on scale IVUS the IVUS such of second images three as and the the layer separating elements: coronary right is the panel arteries, the intima, media, shows true which atheroma, usually adventitia a schema is have usually and from of three the internal less left IVUS layers. elastic This echogenic The surrounding trailing third atheroma image. membrane. and than edge perivascular the classifies the of most intima. the outer media by tissues. echogenicity layer matches consist the compared of external the adventitia with elastic the membrane and adventitia. periadventitial (EEM). tissues.

9 Basic IVUS method 4 : Measurements for optimal stent sizing Distal Proximal Plaque Plaque Lumen Media Dist. Land. Stenosis site Prox. Land. Term of the measurements Distal landing site : Lumen diameter : Stent size Stenosis site : Vessel diameter : Post dilatation balloon size Proximal landing site : Lumen diameter : Get at complete apposition Between 2 landings : Diameter of the long axis : Stent length This The In And, our lumen area here hospital, is means diameter lumen, after the plaque of IVUS proximal the examination, and distal media. landing The site. our site least So, co-medical decides we plaque can the measure site staffs stent means measure diameter. these lumen distal them The landing diameters suggest Next, point. of balloon Please at Then, the two I we The EEM can landing see or can smallest stent show this at measure the sites panel. size you stenosis lumen and for how This the PCI to size site slide length operators. vessel measure means decides shows between diameter stenosis the optimal schema balloon two at site. the landing stent of size stenosis the for sizing sites. lesion. post site. by dilatation. IVUS images.

10 Basic IVUS method 5 : Atheroma morphology Classed by echogenicity compared with the adventitia Soft plaque Fibrous plaque Attenuation They Next In A zone the have slide left of reduced panel, shows intermediate we the echogenicity can atheroma echogenicity see soft morphology. may plaques also between at the attributable It classifies soft position atheroma by of to echogenicity 2 a to necrotic and 7 O clock. highly zone compared echogenic They within have the with low In calcific the echogenicity plaque, the adventitia. right plaques. an intramural panel, with These we attenuation can hemorrhage, plaques see fibrous shadow. can be or plaques seen a thrombus. in at the the majority position of of atherosclerotic 12 to 5 O clock. lesion.

11 Basic IVUS method 5 : Atheroma morphology Classed by echogenicity compared with the adventitia Calcific plaque AS Next It can panel be also shows seen the as bright calcific echoes plaque with at the acoustic position shadowing, of 4 O clock. and IVUS the is one the accompanied most sensitive by reverberations method in or vivo multiple to detect reflections. the calcium of plaque.

12 ASSESSMENT OBSERVATION THE IVUS Now, let s move on to our second theme, assessment observation the IVUS.

13 Assessment observation the IVUS 1 : Nega-linkage Hypothesis You can not assess the IVUS Can not provide the information Get scolded Dislike the IVUS Thus, Most likely, it speaks you for will itself become that to you dislike must IVUS be able assessment to and IVUS. perhaps you will remain So, Shall You and that I call you then can t this we are imagine situation you provide assess getting will the that get Nega-linkage. to IVUS scolded information love you yet. can t IVUS by assessment. them. for the the request IVUS after of the examination? operators,

14 Assessment observation the IVUS 2 : 2 steps things 1. To detect : detect the morphological alterations 2. To diagnose: identify what kind of IVUS findings There is the flap There is no media at 5 O clock Medial dissection. We At first, should you report should There DETECT is the flap morphological and no media alterations. at the position And you of should 5 O clock. diagnose I One For what Now, What Then, guess the is can let s is we To it assessment the is Detect we can take the IVUS see detect a medial and look finding for them at dissection! observation IVUS in other and bottom following findings. diagnose To panel? IVUS, Diagnose. concrete the you You IVUS should example. findings. have report 2 steps. like the following.

15 Assessment observation the IVUS 3 : Training method 1. Running a IVUS video 2. Making a note of only lumen 3. Making a note of whole media Lumen inside of the media To observe in the whole vessel First, Next, see the IVUS same movie. video, Most Then, As I you Why In will the we suggest should commonly, You can same should see, thing, we the this whole observe it training see to would circle the observe media whole was lumen method be the until traced whole media? until lumen for you on media you detection are in the are media. satisfied. to in observe our hospital. whole vessel.

16 ROUTINE OBSERVATION AND MEASUREMENTS IN CLINICAL CASE Final theme is IVUS examination in case.

17 Routine observation and measurements in clinical case RAO Caudal View RAO Cranial View Left CAG panel revealed shows 75% the stenosis RAO caudal in the view. proximal Right LAD. panel shows the RAO cranial view.

18 Routine observation and measurements in clinical case Proximal LAD diffuse lesion 75% stenosis Runthrough NS wire was advanced IVUS pulled back from middle LAD 7Fr. Back up left 3.5cm Rt. FA approach ViewIT (Terumo) IVUS was used First procedure, a 7Fr back up left 3.5 guiding catheter was engaged in the left coronary Then, artery Next, we PCI through are guide going the wire right to (runthrough show femoral the IVUS approach. NS) information was advanced before in the PCI lesion. procedure.

19 Routine observation and measurements in clinical case

20 Proximal reference marking Distal reference marking Using The We measured left IVUS, panel severe shows the length calcific proximal by plaque manual marking was pull confirmed. point. back, because We ablated it can makes to the smaller lesion by gap 2.00 than mm rota-burr. After And automatic We So we decided right ablation, selected panel pull the with back. the shows lesion stent IVUS distal length which images, marking was is we the 26mm evaluated point. 2.5 between mm diameter the two stenting marking and 28 zone. mm points. length.

21 Routine observation and measurements in clinical case BES 2.5 x 28 mm Post deployment angiogram We deployed the BES in the lesion. Right panel shows the angiogram after stent deployment. TIMI3 flow was obtained.

22 Routine observation and measurements in clinical case

23 Routine observation and measurements in clinical case Medial dissection at distal LMCA At this time, we pointed out this IVUS finding as medial dissection to operator at the This instant panel of detection shows the it. long axis image. We can see the medial dissection at distal LMCA.

24 Routine observation and measurements in clinical case After 5 minutes later We Then, were waiting confirmed for it 5 minutes had no change whether the this angiogram dissection which was expanding has no changing. or not.

25 Conclusion Some measuring is almost measuring automatically by IVUS-staff after the examination in our hospital For the assessment observation the IVUS has 2 procedure steps which are to detect, and to diagnose For the safety and speedy procedure, I think IVUSstaff should need to point out the IVUS findings too

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea

IVUS Analysis. Myeong-Ki. Hong, MD, PhD. Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea IVUS Analysis Myeong-Ki Hong, MD, PhD Cardiac Center, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Intimal disease (plaque) is dense and will appear white Media is made of

More information

IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC

IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC IVUS Guided Case Review Case Performed by Frank R. Arko III, MD Charlotte, NC The opinions and clinical experiences presented herein are for informational purposes only. Dr. Arko is a paid consultant for

More information

Intravascular Ultrasound for Complex Cases

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

More information

J Am Coll Cardiol 1995; 25: 1479

J Am Coll Cardiol 1995; 25: 1479 Complex PCI: IVUS-Guided PCI Junko Honye Fuchu Keijinkai Hospital, Tokyo Gifu Heart Center, Gifu Japan Roles of IVUS during PCI 1. IVUS before PCI (automatic pullback) Device selection: direct stenting?

More information

Effectiveness of IVUS in Complex Cases

Effectiveness of IVUS in Complex Cases Effectiveness of IVUS in Complex Cases Satoru Sumituji,M.D. Rinku General Medical Center IVUS is can provide images of the vessel wall and the tissue around the vessel which cannot be viewed by angiography.

More information

Radiation Safety Abbott Vascular. All rights reserved.

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

More information

PCI for Ostial Lesion

PCI for Ostial Lesion PCI for Ostial Lesion ii) LAD ostial Osamu Katoh,M.D. kyoto Katsura Hospital Cardiovascular Center PCI for a LAD ostial lesion is well-known to be associated with a high restenosis rate because of excessive

More information

Basics of Angiographic Interpretation Analysis of Angiography

Basics of Angiographic Interpretation Analysis of Angiography Basics of Angiographic Interpretation Analysis of Angiography Young-Hak Kim, MD, PhD Cardiac Center, University of Ulsan College of Medicine, Seoul, Korea What made us nervous Supervisors Stent Contrast

More information

Dr Aniket Puri. OCT guided BVS for LMCA to LAD : Optimising the 'Pot'

Dr Aniket Puri. OCT guided BVS for LMCA to LAD : Optimising the 'Pot' OCT guided BVS for LMCA to LAD : Optimising the 'Pot' Dr Aniket Puri MD,DM,FRACP, FACC, FSCAI, FAPSIC Consultant Interventional Cardiologist Christchurch Hospital and Canterbury DHB(Univ of Otago) Christchurch,New

More information

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013

Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Evaluation of Intermediate Coronary lesions: Can You Handle the Pressure? Jeffrey A Southard, MD May 4, 2013 Disclosures Consultant- St Jude Medical Boston Scientific Speaker- Volcano Corporation Heart

More information

Optical Coherence Tomography

Optical Coherence Tomography Optical Coherence Tomography Disclosure Information Demetrius Lopes MD The following relationships exist related to this presentation: University Grant/Research Support: Rush University Industry Grant

More information

Imaging Atheroma The quest for the Vulnerable Plaque

Imaging Atheroma The quest for the Vulnerable Plaque Imaging Atheroma The quest for the Vulnerable Plaque P.J. de Feijter 1. Department of Cardiology 2. Department of Radiology Coronary Heart Disease Remains the Leading Cause of Death in the U.S, Causing

More information

Intravascular Ultrasound

Intravascular Ultrasound May 2008 Beth Israel Deaconess Medical Center Harvard Medical School Intravascular Ultrasound Matthew Altman, HMS III Gillian Lieberman, MD BIDMC Department of Radiology Presentation Overview 1. Patient

More information

Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial

Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Effect of Intravascular Ultrasound- Guided vs. Angiography-Guided Everolimus-Eluting Stent Implantation: the IVUS-XPL Randomized Clinical Trial Myeong-Ki Hong, MD. PhD on behalf of the IVUS-XPL trial investigators

More information

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 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

More information

Evaluation of a new micromesh carotid stent with Optical Coherence Tomography.

Evaluation of a new micromesh carotid stent with Optical Coherence Tomography. Evaluation of a new micromesh carotid stent with Optical Coherence Tomography. Technical case report. J. Lemoine,S. Myla,Z. Chati,R.Aslam, M.Amor Clinic Louis Pasteur,Essey les Nancy.France Disclosure

More information

Shockwave Intravascular Lithotripsy System treatment of calcified lesions: Intravascular OCT analysis

Shockwave Intravascular Lithotripsy System treatment of calcified lesions: Intravascular OCT analysis Shockwave Intravascular Lithotripsy System treatment of calcified lesions: Intravascular OCT analysis Andrew Holden, MBChB, FRANZCR, EBIR Director of Interventional Radiology Auckland, New Zealand LINC

More information

Can IVUS Define Plaque Features that Impact Patient Care?

Can IVUS Define Plaque Features that Impact Patient Care? Can IVUS Define Plaque Features that Impact Patient Care? A Pichard L Satler, K Kent, R Waksman, W Suddath, N Bernardo, N Weissman, M Angelo, D Harrington, J Lindsay, J Panza. Washington Hospital Center

More information

Quick guide. Core. precision guided therapy system

Quick guide. Core. precision guided therapy system Quick guide Core precision guided therapy system The Philips Volcano imaging system should only be operated by trained personnel. The following information is presented for your convenience and is not

More information

Bifurcation stenting with BVS

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

More information

Intravascular Ultrasound (IVUS)

Intravascular Ultrasound (IVUS) University Heart Journal Vol. 10, No. 2, July 2014 Intravascular Ultrasound (IVUS) S MOKADDAS HOSSAIN (SADI) Labaid Cardiac Hospital, Dhaka, Bangladesh Address of Correspondence: Dr. S Mokaddas Hossain

More information

Bifurcated system Proximal suprarenal stent Modular (aortic main body and two iliac legs) Full thickness woven polyester graft material Fully

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

More information

OCT; Comparative Imaging Results with IVUS, VH and Angioscopy

OCT; Comparative Imaging Results with IVUS, VH and Angioscopy OCT; Comparative Imaging Results with IVUS, VH and Angioscopy Takashi Akasaka, M.D. Department of Cardiovascular Medicine Wakayama, Japan Comparison among coronary imaging techniques OCT IVUS MRI CAG Angioscopy

More information

Between Coronary Angiography and Fractional Flow Reserve

Between Coronary Angiography and Fractional Flow Reserve Visual-Functional Mismatch Between Coronary Angiography and Fractional Flow Reserve Seung-Jung Park, MD., PhD. University of Ulsan, College of Medicine Asan Medical Center, Seoul, Korea Visual - Functional

More information

For Personal Use. Copyright HMP 2013

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,

More information

Miami Valves, Miami Florida. Cardiovascular Associates of South Florida

Miami Valves, Miami Florida. Cardiovascular Associates of South Florida Excimer Laser Coronary Angioplasty (ELCA) What Have We Learned? Miami Valves, Miami Florida January 29, 2017 James R. Margolis, MD FACC Cardiovascular Associates of South Florida Coral Gables, Florida

More information

Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome

Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome Culprit Lesion Remodeling and Long-term (> 5years) Prognosis in Patients with Acute Coronary Syndrome Hiroyuki Okura*, MD; Nobuya Matsushita**,MD Kenji Shimeno**, MD; Hiroyuki Yamaghishi**, MD Iku Toda**,

More information

Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection

Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection Invasive Coronary Imaging Modalities for Vulnerable Plaque Detection Gary S. Mintz, MD Cardiovascular Research Foundation New York, NY Greyscale IVUS studies have shown Plaque ruptures do not occur randomly

More information

Copyright HMP Communications. Intravascular Ultrasound is Critical to Insuring Long-Term Stent Performance. Normal Vessel. Intima. Media.

Copyright HMP Communications. Intravascular Ultrasound is Critical to Insuring Long-Term Stent Performance. Normal Vessel. Intima. Media. CLINICAL REVIEW: IVUS IN PAD Intravascular Ultrasound is Critical to Insuring Long-Term Stent Performance Clifford J. Buckley, MD, FACS Introduction In 1972, Bom and colleagues described the application

More information

CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY. Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus

CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY. Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus CLINICAL APPLICATIONS OF OPTICAL COHERENCE TOMOGRAPHY Konstantina P. Bouki, FESC 2 nd Department of Cardiology General Hospital Of Nikea, Pireaus OPTICAL COHERENCE TOMOGRAPHY (OCT) IVUS and OCT IVUS OCT

More information

Left main coronary artery (LMCA): The proximal segment

Left main coronary artery (LMCA): The proximal segment Anatomy and Pathology of Left main coronary artery G Nakazawa Tokai Univ. Kanagawa, Japan 1 Anatomy Difinition Left main coronary artery (LMCA): The proximal segment RCA AV LAD LM LCX of the left coronary

More information

Innovation in Transradial access. Aminian Adel, MD CHU Charleroi Belgium

Innovation in Transradial access. Aminian Adel, MD CHU Charleroi Belgium Innovation in Transradial access Aminian Adel, MD CHU Charleroi Belgium Potential conflicts of interest Speaker's name: Adel Aminian I do not have any potential conflict of interest Limitations of TR access?

More information

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 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-

More information

Zenith Alpha T HORACIC ENDOVASCULAR GRAFT

Zenith Alpha T HORACIC ENDOVASCULAR GRAFT Deployment Sequence Zenith Alpha T HORACIC ENDOVASCULAR GRAFT www.cookmedical.com AI-D21183-EN-F Preparation and flush Proximal and distal components Remove the yellow hubbed inner stylet from the dilator

More information

A Novel Low Pressure Self Expanding Nitinol Coronary Stent (vprotect): Device Design and FIH Experience

A Novel Low Pressure Self Expanding Nitinol Coronary Stent (vprotect): Device Design and FIH Experience A Novel Low Pressure Self Expanding Nitinol Coronary Stent (vprotect): Device Design and FIH Experience Juan F. Granada, MD Medical Director, Skirball Center for Cardiovascular Research The Cardiovascular

More information

OCT GUIDED TREATMENT OF CALCIFIED LESIONS RICHARD SHLOFMITZ, MD CHAIRMAN OF DEPT. OF CARDIOLOGY ST. FRANCIS HOSPITAL ROSLYN, NEW YORK

OCT GUIDED TREATMENT OF CALCIFIED LESIONS RICHARD SHLOFMITZ, MD CHAIRMAN OF DEPT. OF CARDIOLOGY ST. FRANCIS HOSPITAL ROSLYN, NEW YORK OCT GUIDED TREATMENT OF CALCIFIED LESIONS RICHARD SHLOFMITZ, MD CHAIRMAN OF DEPT. OF CARDIOLOGY ST. FRANCIS HOSPITAL ROSLYN, NEW YORK Disclosure Statement of Financial Interest Within the past 12 months,

More information

Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT)

Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) Clare McLaren Great Ormond Street Hospital London Introduction IVUS and OCT supplementary techniques to angiography provide information

More information

Acute dissections of the descending thoracic aorta (Debakey

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

More information

Zenith Alpha T HORACIC ENDOVASCULAR GRAFT

Zenith Alpha T HORACIC ENDOVASCULAR GRAFT Device description Zenith Alpha T HORACIC ENDOVASCULAR GRAFT www.cookmedical.com AI-D21181-EN-F Modular design The two-piece modular system allows the physician to customize a graft system to fit each

More information

FFR and intravascular imaging, which of which?

FFR and intravascular imaging, which of which? FFR and intravascular imaging, which of which? Ayman Khairy MD, PhD, FESC Associate professor of Cardiovascular Medicine Vice Director of Assiut University Hospitals Assiut, Egypt Diagnostic assessment

More information

Imaging Overview for Vulnerable Plaque: Data from IVUS Trial and An Introduction to VH-IVUS Imgaging

Imaging Overview for Vulnerable Plaque: Data from IVUS Trial and An Introduction to VH-IVUS Imgaging Imaging Overview for Vulnerable Plaque: Data from IVUS Trial and An Introduction to VH-IVUS Imgaging Gary S. Mintz,, MD Cardiovascular Research Foundation New York, NY Today, in reality, almost everything

More information

Crossing the Long SFA CTO

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)

More information

THE PROXIMAL LAD VIA SVG IN PATIENT AFTER CABG. Cardiovascular department Tokyo, Japan

THE PROXIMAL LAD VIA SVG IN PATIENT AFTER CABG. Cardiovascular department Tokyo, Japan SUCCESSFUL RECANALIZATION OF CTO IN THE PROXIMAL LAD VIA SVG IN PATIENT AFTER CABG St. Lukes International Hospital Cardiovascular department Tokyo, Japan Hitoshi Anzai MD M.D. Present illness 64 YRS-OLD

More information

Solving the Dilemma of Ostial Stenting: A Case Series Illustrating the Flash Ostial System

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

More information

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 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

More information

Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography

Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography Utility of Image-Guided Atherectomy for Optimal Treatment of Ambiguous Lesions by Angiography Jon C. George, MD; Vincent Varghese, DO From the Deborah Heart and Lung Center, Browns Mills, New Jersey. ABSTRACT:

More information

Carotid Intravascular Imaging Technique and Indication

Carotid Intravascular Imaging Technique and Indication Nurse and Technician Forum Carotid Intravascular Imaging Technique and Indication Gianmarco de Donato Assistant Professor Vascular and Endovascular Surgery University of Siena - Italy Disclosure Speaker

More information

Pathology of Coronary Artery Disease

Pathology of Coronary Artery Disease Pathology of Coronary Artery Disease Seth J. Kligerman, MD Pathology of Coronary Artery Disease Seth Kligerman, MD Assistant Professor Medical Director of MRI University of Maryland Department of Radiology

More information

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 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

More information

Challenging of contrast agent-free endovascular treatment using 3D imaging

Challenging of contrast agent-free endovascular treatment using 3D imaging AC17-0010 Challenging of contrast agent-free endovascular treatment using 3D imaging Amane Kozuki Department of Cardiology, Osaka Saiseikai Nakatsu Hospital Introduction With advances in devices and techniques,

More information

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 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

More information

Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting

Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting Case Study of Implantation of a VICI VENOUS STENT - Combined NIVL and PTS Stenting Courtesy of Mr. Stephen Black United kingdom Patient History 25 y/o female 2011: Conservatively treated ilio-femoral DVT

More information

Analysis of macrophage accumulation using optical coherence tomography one year after sirolimus, paclitaxel and zotarolimus-eluting stent

Analysis of macrophage accumulation using optical coherence tomography one year after sirolimus, paclitaxel and zotarolimus-eluting stent Analysis of macrophage accumulation using optical coherence tomography one year after sirolimus, paclitaxel and zotarolimus-eluting stent implantation. Department of Cardiology, Ehime Prefectural Imabari

More information

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 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,

More information

Welcome to the 8 th European Bifurcation Club October Barcelona

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

More information

(EU), FACC (USA), FSCAI (USA)

(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

More information

av ailab le at jou rn al h om epa g e:

av ailab le at   jou rn al h om epa g e: Journal of Cardiology Cases (2011) 4, e163 e167 av ailab le at www.sciencedirect.com jou rn al h om epa g e: www.elsevier.com/locate/jccase Case Report In vivo intravascular ultrasound imaging of fibromuscular

More information

Cardiovascular Research Foundation and Columbia University Medical Center, New York.

Cardiovascular Research Foundation and Columbia University Medical Center, New York. Virtual Histology Intravascular Ultrasound Analysis of Non-culprit Attenuated Plaques Detected by Grayscale Intravascular Ultrasound in Patients with Acute Coronary Syndromes Xiaofan Wu, Akiko Maehara,

More information

Optimal Techniques for Obtaining Large Caliber Arterial Access

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

More information

The Utility of Atherectomy and the Jetstream Atherectomy System

The Utility of Atherectomy and the Jetstream Atherectomy System The Utility of Atherectomy and the Jetstream Atherectomy System William A. Gray, MD Columbia University Medical Center 2014 Boston Scientific Corporation or its affiliates. All rights reserved. IMPORTANT

More information

Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia

Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia Recurrent Spontaneous Coronary Artery Dissection in a Patient with Fibromuscular Dysplasia Craig Basman, MD; Tannaz Shoja, MD; Aditya Mangla, DO; Jaffar Raza, MD; Suresh Jain, MD; Zoran Lasic, MD Clinical

More information

UNDERSTANDING ATHEROSCLEROSIS

UNDERSTANDING ATHEROSCLEROSIS UNDERSTANDING ATHEROSCLEROSIS UNDERSTANDING ATHEROSCLEROSIS ARTERIES Arteries are blood vessels that carry oxygenated blood to all the organs of the body. Arteries are made up of three important layers:

More information

Angioplasty Summit TCTAP Technical Aspects of Overview in CTO-PCI Toyohashi Heart Center Takahiko Suzuki, M.D

Angioplasty Summit TCTAP Technical Aspects of Overview in CTO-PCI Toyohashi Heart Center Takahiko Suzuki, M.D Angioplasty Summit TCTAP 2010 Technical Aspects of Overview in CTO-PCI Toyohashi Heart Center Takahiko Suzuki, M.D Introduction CTO-PCI has been technically and technologically evolved over the past two

More information

Coronary artery Dissection. Dr TP Singh MD,DM

Coronary artery Dissection. Dr TP Singh MD,DM Coronary artery Dissection Dr TP Singh MD,DM 52 M,Non HT, Non DM,Acute IWMI lysed within 4 hours D2 Coronary angiography RCA mid 90% discrete hazy stenosis LAD non significant ifi disease, LCx Normal Taken

More information

Histopathology: Vascular pathology

Histopathology: Vascular pathology Histopathology: Vascular pathology These presentations are to help you identify basic histopathological features. They do not contain the additional factual information that you need to learn about these

More information

Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent. Masahiko Ochiai MD, FACC, FESC, FSCAI

Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent. Masahiko Ochiai MD, FACC, FESC, FSCAI Management of Non-protected Left-Main Bifurcation without Drug Eluting Stent Masahiko Ochiai MD, FACC, FESC, FSCAI Division of Cardiology and Cardiovascular Surgery Showa University Northern Yokohama Hospital

More information

Ancillary Components with Z-Trak Introduction System

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

More information

Case 9799 Stanford type A aortic dissection: US and CT findings

Case 9799 Stanford type A aortic dissection: US and CT findings Case 9799 Stanford type A aortic dissection: US and CT findings Accogli S, Aringhieri G, Scalise P, Angelini G, Pancrazi F, Bemi P, Bartolozzi C Department of Diagnostic and Interventional Radiology, University

More information

Department of Internal Medicine, Saitama Citizens Medical Center, Saitama , Japan

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

More information

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC

An Overview of Post-EVAR Endoleaks: Imaging Findings and Management. Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC An Overview of Post-EVAR Endoleaks: Imaging Findings and Management Ravi Shergill BSc Sean A. Kennedy MD Mark O. Baerlocher MD FRCPC Disclosure Slide Mark O. Baerlocher: Current: Consultant for Boston

More information

Fielder XT: Initial and. Department of Cardiology, Asan Medical Center, Ulsan University of college of medicine

Fielder XT: Initial and. Department of Cardiology, Asan Medical Center, Ulsan University of college of medicine Fielder XT: Initial and Professional Use for CTO Seung-Whan Lee, MD, PhD D t t f C di l A M di l C t Department of Cardiology, Asan Medical Center, Ulsan University of college of medicine Plastic-Jacket

More information

Making the difference with Live Image Guidance

Making the difference with Live Image Guidance Interventional Cardiology AlluraClarity Making the difference with Live Image Guidance Diagnosis and treatment of coronary artery diseases and atherosclerosis Where/who The First Bethune Hospital of Jilin

More information

Chapter 43 Noninvasive Coronary Plaque Imaging

Chapter 43 Noninvasive Coronary Plaque Imaging hapter 43 Noninvasive oronary Plaque Imaging NIRUDH KOHLI The goal of coronary imaging is to define the extent of luminal narrowing as well as composition of an atherosclerotic plaque to facilitate appropriate

More information

Charles T. Dotter was the first to describe balloon angioplasty

Charles T. Dotter was the first to describe balloon angioplasty Review Article Part 1: Balloon and principle of Balloon Angioplasty in Peripheral Arterial Disease (PAD) Abstract Balloon angioplasty has been one of the modalities of choice in the treatment of peripheral

More information

The Case of the successful PCI for the ostium CTO lesion of the RCA by the retrograde approach

The Case of the successful PCI for the ostium CTO lesion of the RCA by the retrograde approach The Case of the successful PCI for the ostium CTO lesion of the RCA by the retrograde approach NAGOYA KYORITSU HOSPITAL DAISUKE KAMOI K.KAWASHIMA, Y.KAWAMURA, M.TANAKA T.AOYAMA Case : 58y.o. Male CC: CCSⅡ

More information

Elements of CTO PCI. Ashish Pershad, MD FACC Heart and Vascular Center of AZ & Banner Good Samaritan Medical Center

Elements of CTO PCI. Ashish Pershad, MD FACC Heart and Vascular Center of AZ & Banner Good Samaritan Medical Center Elements of CTO PCI Ashish Pershad, MD FACC Heart and Vascular Center of AZ & Banner Good Samaritan Medical Center Disclosures Consultant- Bridgepoint Medical Systems Speakers Honorarium- WL Gore Inc.

More information

Catheter selection for transradial angiography and intervention

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

More information

DK Crush,Culotte,SKS,T or TAP. Subhash Chandra, MD,DM,FACC Chairman,Cardiac Sciences BLK Super Speciality Hospital, Pusa Road, New Delhi

DK Crush,Culotte,SKS,T or TAP. Subhash Chandra, MD,DM,FACC Chairman,Cardiac Sciences BLK Super Speciality Hospital, Pusa Road, New Delhi PCI for Bifurcations: Which is the best strategy DK Crush,Culotte,SKS,T or TAP Subhash Chandra, MD,DM,FACC Chairman,Cardiac Sciences BLK Super Speciality Hospital, Pusa Road, New Delhi CSI 2018 Selection

More information

Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique ".

Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique . Complex PCI of an LAD/Diagonal bifurcation lesion (Medina 1,1,1) utilizing the DK Crush technique ". "Σύμπλοκη αγγειοπλαστική βλάβης διχασμού LAD/Diagonal (Medina 1,1,1) με την τεχνική DK crush ". Anastasios

More information

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 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

More information

Post PCI functional testing and imaging: case based lessons from FFR React

Post PCI functional testing and imaging: case based lessons from FFR React Post PCI functional testing and imaging: case based lessons from FFR React Joost Daemen, MD, PhD, FESC Optics in Cardiology 2018 April 21st, 2018 10.15 10.30h Disclosure Statement of Financial Interest

More information

Χρόνιος διαχωρισμός. υπερηχοκαρδιογραφική. αορτής. παρακολούθηση ή άλλη; Α. Παπασπυρόπουλος ΕΠΙΜΕΛΗΤΗΣ ΓΝ.ΝΙΚΑΙΑΣ ΠΕΜΠΤΗ

Χρόνιος διαχωρισμός. υπερηχοκαρδιογραφική. αορτής. παρακολούθηση ή άλλη; Α. Παπασπυρόπουλος ΕΠΙΜΕΛΗΤΗΣ ΓΝ.ΝΙΚΑΙΑΣ ΠΕΜΠΤΗ Χρόνιος διαχωρισμός αορτής υπερηχοκαρδιογραφική παρακολούθηση ή άλλη; Α. Παπασπυρόπουλος ΕΠΙΜΕΛΗΤΗΣ ΓΝ.ΝΙΚΑΙΑΣ ΠΕΜΠΤΗ 8-2-2018 The Normal Aorta (conduit function + control ) *Aortic expansion is about

More information

Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System

Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System Introducing the GORE TAG Conformable Thoracic Stent Graft with ACTIVE CONTROL System K. Oikonomou Department of Vascular Surgery Regensburg University Disclosures W.L. Gore & Associates Sponsored Presentation

More information

Masashi Kimura, MD Etsuo Tsuchikane, MD Osamu Katoh, MD Toyohashi Heart Center, Japan

Masashi Kimura, MD Etsuo Tsuchikane, MD Osamu Katoh, MD Toyohashi Heart Center, Japan Masashi Kimura, MD Etsuo Tsuchikane, MD Osamu Katoh, MD, Japan Retrograde Approach for Coronary CTO Collateral channels A. bypass graft B. epicardial collateral C. septal perforator Retrograde wiring techniques

More information

RadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.

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 INDICATION: Abdominal aortic aneurysm. INTERVENTIONAL RADIOLOGIST:

More information

Clinical case in perspective. Cases from Poland

Clinical case in perspective. Cases from Poland Clinical case in perspective Cases from Poland Assoc. Prof. Jacek Legutko, MD, PhD President-Elect of the Association for Percutaneous Cardiovascular Interventions of the Polish Cardiac Society Institute

More information

Beyond Stenosis Severity: Top 5 Important Duplex Characteristics to Identify in a Patient with Carotid Disease

Beyond Stenosis Severity: Top 5 Important Duplex Characteristics to Identify in a Patient with Carotid Disease Beyond Stenosis Severity: Top 5 Important Duplex Characteristics to Identify in a Patient with Carotid Disease Jan M. Sloves RVT, RCS, FASE Technical Director New York Cardiovascular Associates Disclosures

More information

Animesh Rathore, MD 4/21/17. Penetrating atherosclerotic ulcers of aorta

Animesh Rathore, MD 4/21/17. Penetrating atherosclerotic ulcers of aorta Animesh Rathore, MD 4/21/17 Penetrating atherosclerotic ulcers of aorta Disclosures No financial disclosures Thank You Dr. Panneton for giving this lecture for me. I am stuck at Norfolk with an emergency

More information

Accurate Vessel Sizing Drives Clinical Results. IVUS In the Periphery

Accurate Vessel Sizing Drives Clinical Results. IVUS In the Periphery Accurate Vessel Sizing Drives Clinical Results IVUS In the Periphery Discussion Iida O, et. al. Study Efficacy of Intravascular Ultrasound in Femoropopliteal Stenting for Peripheral Artery Disease With

More information

Percutaneous Intervention of Unprotected Left Main Disease

Percutaneous Intervention of Unprotected Left Main Disease Percutaneous Intervention of Unprotected Left Main Disease Technical feasibility and Clinical outcomes Seung-Jung Park, MD, PhD, FACC Professor of Internal Medicine Asan Medical Center, Seoul, Korea Unprotected

More information

CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D.

CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D. CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D. Thoracic Aortic Aneurysms Atherosclerotic Dissection Penetrating ulcer Mycotic Inflammatory (vasculitis) Traumatic Aortic Imaging Options Catheter

More information

Complex PCI. Your partner in complex PCI: In-stent restenosis (ISR)

Complex PCI. Your partner in complex PCI: In-stent restenosis (ISR) Comple PCI Your partner in comple PCI: Your partner in comple PCI: Philips provides a portfolio of specialty coronary diagnostic and therapy devices that enable safe and effective treatment of a wide variety

More information

Rationale and algorithm for below-the-knee acute gain optimization

Rationale and algorithm for below-the-knee acute gain optimization Leipzig, 01 Feb. 2018 Rationale and algorithm for below-the-knee acute gain optimization Flavio Airoldi, MD Flavio Airoldi Multimedica IRCCS Milan ITALY flavio.airoldi@multimedica.it Rationale Restenosis

More information

MAXIMIZE RADIAL SOLUTIONS TO PERIPHERAL CHALLENGES

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

More information

PCI for Left Main Coronary Artery Stenosis. Jean Fajadet Clinique Pasteur, Toulouse, France

PCI for Left Main Coronary Artery Stenosis. Jean Fajadet Clinique Pasteur, Toulouse, France PCI for Left Main Coronary Artery Stenosis Jean Fajadet Clinique Pasteur, Toulouse, France Athens, October 19, 2018 Left Main Coronary Artery Disease Significant unprotected left main coronary artery disease

More information

Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices

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,

More information

Percutaneous coronary intervention of RIMA. The real challenge!

Percutaneous coronary intervention of RIMA. The real challenge! Percutaneous coronary intervention of RIMA The real challenge! Speaker's name: I do not have any potential conflict of interest Clinical Case 76-year old woman Previous History Actual Disease Diabetes

More information

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

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

More information

Introduction What Causes Peripheral Vascular Disease? How Do Doctors Treat Peripheral Vascular Disease?... 9

Introduction What Causes Peripheral Vascular Disease? How Do Doctors Treat Peripheral Vascular Disease?... 9 Patient Information Table of Contents Introduction... 3 What is Peripheral Vascular Disease?... 5 What Are Some of the Symptoms of Peripheral Vascular Disease?... 7 What Causes Peripheral Vascular Disease?...

More information

Usefulness of OCT during coronary intervention

Usefulness of OCT during coronary intervention Usefulness of OCT during coronary intervention Takashi Akasaka, M.D. Department of Cardiovascular Medicine Wakayama, Japan Predictors at 12 Months of Stent Thrombosis and Target Lesion Revascularization

More information