Rotarex mechanical thrombectomythe first line option for thrombotic occlusions?
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1 Rotarex mechanical thrombectomythe first line option for thrombotic occlusions? Dierk Scheinert, MD Division of Interventional Angiology University Hospital Leipzig, Germany
2 Disclosure Advisory Board /Consultant: Abbott, Biotronik, Boston Scientific, Cook Medical, Cordis, CR Bard, Gardia Medical, Medtronic/Covidien, TriReme Medical, Trivascular, Upstream Peripheral Technologies
3 Risk of Thrombus... and embolization Concentric stenoses CTO lesions Acute occlusions
4 Thrombus-Containing Lesions Specific endovascular strategies are needed to open the vessel AND to avoid distal embolization: - Thrombus aspiration - Thrombolysis - Mechanical thrombectomy (Rotarex)
5 Local bleeding after 12h low-dose thrombolysis
6 Thrombus-Containing Lesions Specific endovascular strategies are needed to open the vessel AND to avoid distal embolization: - Thrombus aspiration - Thrombolysis - Mechanical thrombectomy (Rotarex)
7 Rotarex S Catheter (Straub-Medical) rpm Detachment (up to 1 cm/s) Suction Fragmentation Transport
8 Thrombus aspiration in P3 and TPT Rotarex Thrombectomycatheter 6F Short activation time
9 Rotarex for Acute Occlusions Proglide-closure left groin and puncture right CFA 2 passages Rotarex 8F short activation-time
10 CTO of the left SFA, 8 Fr Rotarex First pass Several passes
11 Rotarex for Chronic SFA-CTOs 2 x 5.0/120 In.Pact Pacific 12 months results
12 Rotarex + DEB Registry Femoropopliteal Lesions Clinically chronic Apop-occlusion 6 Fr Rotarex After DEB
13 Rotarex mechanical thrombectomy: The Leipzig experience in patients - Single center registry: - Use of Thrombectomy device in PAOD patients - Safety and efficacy - Consecutive patient enrollment - Real world scenario patients treated (from 1/ /2013) patients were analyzable (86,9%)
14 Rotarex mechanical thrombectomy: The Leipzig experience in patients Intervention Feature - Native virgin arteries - Surgical bypasses - Redo procedures - In-stent procedures 1203 Procedures
15 Rotarex mechanical thrombectomy in native arteries: Acute results Procedural success rate: 1139 (94.7% ) Main performed procedure Rotational Thrombectomy alone: 255 (21.2%) Rotational Thrombectomy + PTA: 597 (49.6%) Additional Stenting: 251 (29.2%) Additional Thrombolysis: 113 (9.4%) Mean time follow-up: 12 ± 2.4 months
16 Rotarex mechanical thrombectomy in native arteries: Acute results - Complications Major Adverse Events (MAE) to 30 postoperative day MAE All events n (%) Perforation 22 (1.8) Bleeding 29 (2.4) Dissection 108 (9) Acute closure 27 (2.2) Emboli 87 (7.2) Infection 14 (1.2)
17 Rotarex mechanical thrombectomy in native arteries: Acute results Stenting-rate: 29.2 % Full lesion stenting: 7.6 % Focal stenting: 21.6 %
18 Rotarex mechanical thrombectomy in native arteries: Clinical Follow-up: 30-day results Major Adverse Events (MAE) to 30 postoperative day MAE Events (%) Death MI * TLR ** TVR *** Major Amputation Total Table 4. Major Adverse Events (MAE) to 30 postoperative day. Values are rate numbers (%) of observations Myocardial infarction ** Target-lesion revascularization *** Target-vessel revascularization
19 Rotarex mechanical thrombectomy in native arteries: Clinical Follow-up: 12 months results Major Adverse Events (MAE) to 12-months post-intervention MAE Events (%) Death MI * TLR ** TVR *** Major Amputation
20 Rotarex mechanical thrombectomy in ISR Subacute in-stent occlusion right SFA and PA
21 Rotarex mechanical thrombectomy in ISR Result after Rotarex-thrombectomy
22 Rotarex mechanical thrombectomy in ISR Result after additional balloon angioplasty
23
24 Rotarex for Bypass Occlusion - Iliaco-fem Bypass right -Fem-pop Bypass right, now occluded - Severe claudication since 6 month
25 Rotarex for Bypass Occlusion Recanalization with 8F Rotarex
26 Rotarex for Bypass Occlusion Rotarex demasks the culprit lesion
27 Rotarex for Bypass Occlusion Result after PTA of the anastomoses
28 When to use a protection device? Recommended only in case of - necessity for additional ballooning - one-vessel run-off - contraindication for thrombolysis Intensive thrombectomy of the proximal part before passing the last cm of the occlusion also helps to avoid embolization.
29 Conclusion Particular endovascular techniques are available to treat thrombus containing lesions without the harm of distal embolization Mechanical thrombectomy with the Rotarex device is safe and effective Sophisticated embolic protection systems are available to improve our results in selected cases
30 Rotarex mechanical thrombectomythe first line option for thrombotic occlusions? Dierk Scheinert, MD Division of Interventional Angiology University Hospital Leipzig, Germany
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