The Crack and Pave technique for highly resistant calcified lesions. Manuela Matschuck MD University Hospital Leipzig Department Angiology
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1 The Crack and Pave technique for highly resistant calcified lesions Manuela Matschuck MD University Hospital Leipzig Department Angiology
2 Disclosure Speaker name: Dr. med. Manuela Matschuck I have the following potential conflicts of interest to report: X 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 Severe Calcification of the SFA
4 Ineffective Predilatation
5 Pave and Crack
6 Tumescent anaesthesia Lidocain 1% 21 gauge needle 9cm long
7 Relining with Supera -Stent
8 Demographics and Clinical Features at Baseline Demographics and Clinical features at baseline Patient Demographics Gender Male Age (years) Comorbidities Diabetes Smoking (previous or current) Dyslipidemia Hypertension Coronary artery disease Chronic heart failure (NYHA II and III) Cerebrovascular disease Chronic renal insufficiency (grade 2-5) Chronic pulmonary obstructive disease Number/Total (%) or mean±sd 54/67 (80.6%) 71.4 ± /67 (52.2%) 49/62 (79.0%) 60/67 (89.6%) 65/67 (97.0%) 30/66 (45.5%) 12/65 (18.5%) 16/66 (24.2%) 24/46 (52.2%) 12/62 (19.4%) Contralateral treated or symptomatic disease Previous surgical or endovascular treatment of target limb Previous surgical treatment of target lesion b Previous endovascular treatment of target lesion Previous failed target lesion revascularization Baseline Rutherford Class (Target limb) /65 (80.0%) 45/67 (67.2%) 29/67 (43.3%) 18/67 (26.9%) 10/66 (15.2%) 2/64 (3.1%) 40/64 (62.5%) 4/64 (6.2%) 13/64 (20.3%) 5/64 (7.8%) IQR interquartile range, NYHA New York Heart Association classification for heart failure, PTA angioplasty, SD standard deviation, SFA superficial femoral artery. b Femoropopliteal or femoro-btk bypass or femoral thromboendarterectomy
9 Angiographic Features at Baseline Angiographic Features at Baseline Number/Total (%) or mean±sd TASC II class B C D 4/67 (6.0%) 11/67 (16.4%) 52/67 (77.6%) Chronic total occlusion 61/66 (92.4%) Target Lesion Anatomical Distribution SFA P1 P2 P3 Calcification (PACSS) Severe calcification a Number of runoff BTK vessels /67 (94.0%) 47/65 (72.3%) 35/65 (53.8%) 15/64 (23.4%) 3/64 (4.7%) 2/64 (3.1%) 19/64 (29.7%) 40/64 (62.5%) 40/66 (60.6%) 1/62 (1.6%) 19/62 (30.6%) 26/62 (41.9%) 16/62 (25.8%) Lesion Length (cm) 26.9±11.2 BTK bellow-the-knee vessels, IQR interquartile range, P1-P3 first, second and thirds segment of popliteal artery, PACSS peripheral artery calcium scoring system, SD standard deviation, SFA superficial femoral artery. a Dense circumferential calcification and calcification extending more than 5 continuous centimetres of the length prior to contrast ejection.
10 Intervention Features Intervention Features Number/Total (%) or mean±sd Maximum balloon diameter (mm) /59 (5.1%) 28/59 (47.4%) 21/59 (35.6%) 5/59 (8.5%) 2/59 (3.4%) Use of high pressure or cutting balloon 23/65 (35.4%) Perforation 39/66 (59.1%) Viabahn cumulative length (cm) b 16.5±8.7 Viabahn maximum diameter (mm) /67 (2.9%) 34/67 (50.7%) 28/67 (41.8%) 3/67 (4.5%) SUPERA cumulative length (cm) b 22.9±12.0 SUPERA maximum diameter (mm) Additional procedures Iliac FP DCB Nitinol stent DES Other BTK Manual aspiration thrombectomy 32/67 (47.8%) 34/67 (50.7%) 1/67 (1.5%) 4/66 (6.1%) 42/66 (62.1%) 24/64 (37.5%) 18/64 (25.0%) 11/64 (17.2%) 5/64 (7.8%) 13/67 (19.4%) 1/67 (1.5%) Procedure duration (min) a 125±43 Radiation Dose area product (Gycm2) b 50,0±39,0 Fluoroscopy time (min) c 40±16 BTK bellow-the-knee vessels, CFA common femoral artery, DCB drug-coated balloon, DES drug-eluting stent, FP femoropopliteal, IQR interquartile range, P1-P3 first, second and thirds segment of popliteal artery, PACSS peripheral artery calcium scoring system, SD standard deviation, SFA superficial femoral artery. a Data available in 67 patients. b Data available in 51 patients. c Data available in 52 patients.
11 Primary Patency 79% Primary Patency at 12 month Time after intervention (months) Number at risk Estimate Standard error
12 Secondary Patency 91% Secondary Patency at 12 month Time after intervention (months) Number at risk Estimate Standard error
13 Freedom from TLR 85% freedom from TLR at 12 month Time after intervention (months) Number at risk Estimate Standard error
14 ABI und Rutherford classification Boxplot of the ankle brachial index (ABI) before (pre) and after (post) intervention, and at the first/second follow up visits (FU1 and FU2) Boxplot of the Rutherford class before (pre) and at the first/second follow up visits (FU1 and FU2)
15 Conclusions A novel endovascular strategy for severely calcified femoropopliteal lesions Even for long and complex lesions A high proportion of immediate technical success and safety Durable results out to 12-month follow up
16 Thank you for your attention
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