Reducing Thrombotic Burden in Arterial Interventions. Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy
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1 Reducing Thrombotic Burden in Arterial Interventions Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy
2 Disclosure Speaker name: Mario Galli... 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 TIMI Myocardial Perfusion (TMP) Grades TMP Grade 3 TMP Grade 2 TMP Grade 1 TMP Grade 0 Normal ground glass appearance of blush Dye mildly persistent at end of washout p= % Dye strongly persistent at end of washout Gone by next injection 4.4% Stain present Blush persists on next injection 5.1% No or minimal blush 6.2% n = 203 n = 46 n = 79 N = 434 Gibson et al. Circulation 2000;101:125
4 Catheter-based technique in (high-risk) PE patients with controindication to thrombolysis
5 Current PAD Treatment If Thrombus is present Once Diagnosed (physical exam, history, ultrasound or other imaging) Thrombolysis followed by Primary Endovascular Intervention ( Balloon, Stent) Surgery (not as common) Percutaneous Mechanical Devices, such as AngioJet, used to remove the thrombus followed by Primary Endovascular Intervention (Atherectomy, Balloon, Stent)
6 Limitations of Thrombolysis Duration Time to reperfusion 4-48 hours Difficult on patient and personnel Probability of complications increases with duration Embolization Theorized to wash emboli downstream Often self-treating Expense Drugs Intensive care monitoring Serial arteriography Complications
7 AngioJet TM Thrombectomy System 1996 FDA approval of AngioJet System Clinical Indications Current FDA and CE indications: Coronary native arteries Saphenous Vein Coronary Bypass Grafts Peripheral Arteries AV access hemodialysis grafts Peripheral Veins Pulmonary Embolism (CE)
8 AngioJet TM in Peripheral Procedures DVX / Xpeedior Abdominal Aorta Common Iliac External Iliac Deep Femoral Superficial Femoral XVG / Xpeedior Popliteal mm DVX 6 12 mm DVX 5 9 mm DVX 4 5 mm Xpeedior/DVX 4 6 mm Xpeedior/DVX 3 5 mm AngioJet Catheters are Optimized for Vessel Size XMI Anterior Tibial Peroneal Posterior Tibial Dorsalis Pedis 2 4 mm 2 3 mm 2 4 mm 1 3 mm
9 AngioJet Thrombectomy Catheter Comparison: Relative Areas-of-Effect LF140 XMI XVG Xpeedior DVX Spiroflex Spiroflex VG 22mm tubes were filled with simulated clot and screen mesh to represent a vessel. Each catheter was activated in the tube for about 60 seconds. Bench test results may not necessarily be indicative of clinical performance. BSC data on file.
10 There is a need for a better solution Drug + Devices to debulk the thrombus Lower doses of lytic AngioJet + Lytics Concept : For more challenging cases, Interventionalists are now using combination therapies to : maximize and combine the advantages and minimize the risks and disadvantages of both Thrombolysis and Mechanical Thrombectomy
11 Pharmacomechanical thrombectomy (PMT) PMT - benefits lower dose of thrombolytic agent and decrease of hemorrhagic complications rate shortening the procedure duration shortening the length of ICU stay and hospitalisation
12 AngioJet Pharmacomechanical thrombectomy (PMT) Rapidlysis (20mg Actilyse added to 250/500ml saline) Simultaneous application of thrombolytic with thrombus thrombectomy Power pulse technique (20mg Actilyse added to 50ml saline power pulse spray, then minutes wait and after that thrombectomy) Application of thrombolytic agent and after minute thrombus aspiration
13 Acute Total Aortic Occlusion and Limb-Threatening Ischemia (1) Right Recanalization Basal Angio left Recanalization
14 Acute Total Aortic Occlusion and Limb-Threatening Ischemia (1) PMT + 20 mg rtpa (rapidlysis) Reolytic thrombectomy on right (Solent cath) Reolytic thrombectomy On left (Solent cath) Reolytic thrmbectomy On Aorta Angio Post
15 Acute Total Aortic Occlusion and Limb-Threatening Ischemia (1) Kissing Stent BMS Final Result
16 Acute SFA and TPT Occlusion and Limb-Threatening Ischemia (2) SFA thrombotic occlusion TPT thrombotic occlusion
17 Acute SFA and TPT Occlusion and Limb-Threatening Ischemia (2) PMT + 5 mg rtpa (rapidlysis)
18 Acute SFA and TPT Occlusion and Limb-Threatening Ischemia (2) Final angio afterpmt + 5 mg rtpa (rapidlysis) + PTA
19 Acute SFA and Distal Occlusion and Limb-Threatening Ischemia (3) PMT (DVX) + 5 mg rtpa (rapidlysis)
20 Acute SFA and Distal Occlusion and Limb-Threatening Ischemia (3) Final Angio
21 Acute EIa and Limb-Threatening Ischemia (4) EIA thrombotic occlusion Right Recanalization
22 Acute EIa and Limb-Threatening Ischemia (4) PMT (DVX) + 5 mg rtpa (rapidlysis) Final Angio
23 Acute Viabahn occlusion Limb-Threatening Ischemia (5) SFA thrombotic occlusion Viabahn Recanalization
24 Acute Viabahn occlusion Limb-Threatening Ischemia (5) Distal filter protection Reholityc thrombectomy
25 Acute Viabahn occlusion Limb-Threatening Ischemia (5) Final Angio
26 Acute Aortic Thrombus Embolization (6)
27 Acute Aortic Thrombus Embolization (6) PMT (DVX) + 10 mg rtpa (rapidlysis)
28 Acute popliteal aneurysm occlusion (7) MIP recostruction
29 Acute popliteal aneurysm occlusion (7) PMT (DVX) + 10 mg rtpa (rapidlysis ) + Viabahn
30 Angio control
31 Conclusion Mechanical thrombectomy or PMT offers: Thrombus removal in single procedure Decreased dose and duration of lytic Potential of decreased bleeding complications
32
33 Reducing Thrombotic Burden in Arterial Interventions Mario Galli, MD Cardiovascular Interventional Unit S. Anna Hospital, Como, Italy
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