Comparison of Angiographic Dissection Patterns Caused by Long vs Short Balloons During Balloon Angioplasty for Chronic Femoropopliteal Occlusions
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1 Comparison of Angiographic Dissection Patterns Caused by Long vs Short Balloons During Balloon Angioplasty for Chronic Femoropopliteal Occlusions Michinao Tan, MD Tokeidai Memorial Hospital Cardiovascular Center, Sapporo, Hokkaido, Japan
2 Speaker name : Michinao Tan, MD I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 The meaning of Successful EVT pre post 1year How to open! How to keep it open!!
4 DCB vs Standard PTA Tepe G, et al. Circulation ;131(5): Rosenfield K, et al. N Engl J Med ;373(2):
5 The longer the lesion is, the higher provisional stent rate is. Dissection!
6 Fujihara M, et al. J Endovasc Ther Jun;24(3):
7 Dissection patterns Severe dissection Fujihara M, et al. J Endovasc Ther Jun;24(3):
8 Dissection patterns and Bailout stent rate Severe 42% Stent rate A. Dissection pattern B. Bailout stent rate Fujihara M, et al. J Endovasc Ther Jun;24(3):
9 PP & FF CD TLR Severe dissection vs Non-severe dissection Fujihara M, et al. J Endovasc Ther Jun;24(3):
10 Predictive factors of Severe dissection RVD < 5mm (P=0.001) Lesion length > 150mm (P< 0.001) CTO (P< 0.001) IVUS usage (P=0.045) Fujihara M, et al. J Endovasc Ther Jun;24(3):
11 Key to achieving leave nothing behind therapy Acute recoil Calcified lesion Vessel dissection following POBA Go back to basics Optimization of balloon angioplasty
12 When we use a short-length balloon in a CTO 220mm 120mm
13 Concept of balloon edge dissection Vessel dissection will occur at the transition between the edge of a balloon and the adjacent lesion.
14 Concept of balloon edge dissection
15 Concept of balloon edge dissection
16 Concept of balloon edge dissection
17 Concept of balloon edge dissection
18 Concept of balloon edge dissection
19 pre Representative angiograms of balloon edge dissection POBA post
20 Ideal balloon angioplasty 220mm 240mm
21 Ideal balloon angioplasty
22 Ideal balloon angioplasty
23 Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
24 Objective The aim of this study was to describe the feasibility of balloon angioplasty using a long-length balloon for chronic femoropopliteal occlusions with TASCⅡclass C/D lesions by evaluating angiographic dissection patterns. Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
25 Study Design A retrospective, single center analysis examined 101 patients with de novo 101 symptomatic femoropopliteal occlusive disease treated with endovascular therapy between August 2012 and October The patients were classified into 2 groups; Long-length balloon group( 220mm) : 51 patients Short-length balloon group( 150mm) : 50 patients Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
26 Study Design Patients with acute limb ischemia were excluded. Cases of in-stent occlusions or those using an atherectomy device or DCB were excluded as well. Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
27 Result (1) Patient Characteristics n(%) or mean ± SD Long balloon (n=51) Short balloon (n=50) P Age 75.0 ± ± Male 34 (66.7%) 31(62.0%) 0.62 Hypertension 34 (66.7%) 34 (68.0%) 0.89 Dyslipidemia 16 (31.3%) 25 (50.0%) Diabetes Mellitus 23 (45.1%) 23 (46.0%) 0.93 Coronary arterial disease 13 (25.5%) 18 (36.0%) 0.25 Cerebrovascular disease 10 (19.6%) 16 (32.0%) 0.15 Chronic kidney disease 21 (41.2%) 26 (52.0%) 0.27 Hemodialysis 9 (17.6%) 8 (16.0%) 0.82 Current smoker 11 (21.6%) 7 (14.0%) 0.32 Previous smoker 20 (39.2%) 21 (42.0%) 0.78
28 Result (1) Patient Characteristics n(%) or mean ± SD Long balloon (n=51) Short balloon (n=50) P Albumin (g/dl) 3.51 ± ± Aspirin 41 (80.4%) 34 (68.0%) 0.15 Thienopyridine 42 (82.4%) 42 (84.0%) 0.82 Cilostazol 18 (35.3%) 26 (52.0%) 0.09 Warfarin 1 (2.0%) 3 (6.0%) 0.30 Rutherford category (76.5%) 37(74.0%) 5(9.8%) 4(8.0%) 7(13.7%) 9(18.0%) 0.77 Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
29 Result (2) Lesion Characteristics n(%) or mean ± SD Long balloon (n=51) Short balloon (n=50) P SFA only/sfa-popliteal 33 (64.7%) / 18 (35.3%) 36(72.0%) / 14 (28.0%) 0.43 TASCⅡ C/D 13 (25.5%) / 38 (74.5%) 15 (30.0%)/ 35 (70.0%) 0.61 Lesion length (mm) ± ± CTO length (mm) ± ± RVD (mm) 5.47 ± ± PACSS (35.3%) 12 (24.0%) 17 (33.3%) 19 (38.0%) 2 (3.9%) 4 (8.0%) 8 (15.7%) 5 (10.0%) 6 (11.8%) 10 (20.0%) 0.26 Runoff (33.3%) 16 (32.0%) 18 (35.3%) 14 (28.0%) 16 (31.4%) 20 (40.0%) 0.89
30 Procedure details Balloon type Bare Cutting / scoring Long balloon (n=51) Short balloon (n=50) P 51 (100%) 48 (96.0%) 0 (0.0%) 2 (4.0%) Balloon length (mm) ± ±24.9 <0.001 Balloon diameter (mm) 4.78 ± ± Average inflation time (s) ± ±54.0 <0.001 Average inflation pressure (atm.) Result (3) Procedure Characteristics and Outcomes ± ± Stenting 44 (86.3%) 49 (98.0%) IVUS use 43 (84.3%) 37 (74.0%) 0.20 Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
31 Result (3) Comparison of Location of dissections Long balloon 32.0% Middle part of a lesion Short balloon 76.0% Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
32 Result (3) Comparison of vessel dissection patterns None 1.9% Severe dissection Long balloon A 11.8% B 39.2% C 21.6% 47.1% D 13.7% E 11.8% A 2.0% 70.0% Short balloon B 28.0% C 12.0% D 36.0% E 22.0% 0% 20% 40% 60% 80% 100% none A B C D E Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
33 Result (4) Comparison of Patient Characteristics between Severe and Non-severe dissection Severe dissection (n=59) Non-severe (n=42) P Age 75.4 ± ± Male 37 (62.7%) 28 (66.7%) 0.68 BMI (kg/m 2 ) 21.8± ± Hypertension 37 (62.7%) 31 (73.8%) 0.24 Dyslipidemia 26 (44.1%) 15 (35.7%) 0.39 Diabetes Mellitus 28 (47.5%) 18 (42.9%) 0.65 Coronary arterial disease 20 (33.9%) 11 (26.2%) 0.41 Cerebrovascular disease 12 (20.3%) 14 (33.3%) 0.14 Chronic kidney disease 25 (42.4%) 22 (52.4%) 0.32 Hemodialysis 11 (18.6%) 6 (14.3%) 0.56 Current smoker 14 (23.7%) 4 (9.5%) Previous smoker 22 (37.3%) 19 (45.2%) 0.42 n(%) or mean ± SD
34 Result (4) Comparison of Patient Characteristics between Severe and Non-severe dissection Severe dissection (n=59) Non-severe (n=42) P HbA1c (%) 6.29 ± ± Albumin (g/dl) 3.43 ± ± Aspirin 45 (76.3%) 30 (71.4%) 0.58 Thienopyridine 49 (83.1%) 35 (83.3%) 0.97 Cilostazol 27 (45.8%) 17 (40.5%) 0.59 Warfarin 1 (1.7%) 3 (7.1%) 0.17 Rutherford category (74.5%) 32(76.2%) 8(13.6%) 1(2.4%) 7(11.9%) 9(21.4%) 0.85 n(%) or mean ± SD
35 Result (5) Comparison of Lesion Characteristics between Severe and Non-severe dissection Severe dissection (n=59) Non-severe (n=42) P SFA only/sfa-popliteal 39 (66.1%) / 20 (33.9%) 30 (71.4%) / 12 (28.6%) 0.57 TASCⅡ C/D 15 (25.4%) / 44 (74.6%) 13 (31.0%)/ 29 (69.0%) 0.54 Lesion length (mm) ± ± CTO length (mm) ± ± RVD (mm) 5.44 ± ± PACSS=4 11 (18.6%) 5 (11.9%) 0.36 Runoff (33.9%) 13 (31.0%) 19 (32.2%) 13 (31.0%) 20 (33.9%) 16 (38.0%) 0.66 n(%) or mean ± SD Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
36 Procedure details Balloon type Bare Cutting / scoring Severe dissection (n=59) Non-severe (n=42) P 58 (98.3%) 41 (97.6%) 1 (1.7%) 1 (2.4%) Balloon length (mm) ± ± Balloon diameter (mm) 4.63 ± ± Average inflation time (s) 92.6 ± ± Average inflation pressure (atm.) Result (6) Comparison of Procedure Characteristics and Outcomes between Severe and Non-severe dissection ± ± Stenting 58 (98.3%) 35 (83.3%) IVUS use 49 (83.1%) 31 (73.8%) 0.26 Outcomes Total length of dissection (mm) ± ±38.8 <0.001 Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
37 Multivariate Analysis of Severe dissection OR [95% CI] p value Hemodialysis 1.53 [0.42,5.54] 0.52 PACSS grade [0.28,4.65] 0.84 Inflation time 3min 1.61 [0.53,4.90] 0.40 RVD 1.10 [0.50,2.42] 0.81 Balloon diameter 0.78 [0.35,1.77] 0.55 Lesion length 0.99 [0.98,1.01] 0.59 CTO length 1.01 [0.99,1.02] 0.27 IVUS usage 2.04 [0.68,6.12] 0.20 Balloon length 220mm 0.29 [0.11,0.83] , Odds Ratio Tan M, Urasawa K et al. J Endovasc Ther Feb 1. [Epub ahead of print]
38 To achieve optimal outcomes in femoropopliteal occlusions TASC Ⅱ C /D lesion with CTOs Appropriate vessel preparation for DCB using a Long-length balloon
39 Comparison of Angiographic Dissection Patterns Caused by Long vs Short Balloons During Balloon Angioplasty for Chronic Femoropopliteal Occlusions Michinao Tan, MD Tokeidai Memorial Hospital Cardiovascular Center, Sapporo, Hokkaido, Japan
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