How to perform CFA Supera deployment. Koen Deloose, MD Head Dept Vascular Surgery AZ Sint Blasius Dendermonde, Belgium
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1 How to perform CFA Supera deployment Koen Deloose, MD Head Dept Vascular Surgery AZ Sint Blasius Dendermonde, Belgium
2 Disclosure slide Speaker name: Koen Deloose, MD I have the following potential conflicts of interest to report: Consulting: Medtronic, Spectranetics, Biotronik, Abbott, BD/Bard ivascular, Bentley, Cook, GE Healthcare, Contego medical, Boston Scientific, Cardionovum, B Braun, Terumo Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest 2
3 Among vascular surgeons, the common femoral artery remains one of the last areas of open reconstructive surgery Location prone to crush Bulky, eccentric, heavily calcified plaques (Surgical/EV) access area 3
4 Among vascular surgeons, the common femoral artery remains one of the last areas of open reconstructive surgery (Surgical/EV) access area 4
5 So the Supera is thé tool for a majority of CFA lesions treatment VMI-CFA trial Prospective, multicenter, single arm trial to evaluate the Supera Peripheral Vascular Mimetic Implant Device (Abbott Vascular) for symptomatic (RB 2-4) CFA disease treatment OLV HOSPITAL, AALST AZ SINT-BLASIUS, DENDERMONDE ZNA, ANTWERP IMELDA, BONHEIDEN CHU, NANTES CLINIQUE RHÔNE-DURANCE, AVIGNON CHU, CLERMONT-FERRAND
6 VMI-CFA trial: 1 year results * 95,2% 97,8% time base line 1MFU (30 days) 6MFU (180 days) 6MFU (210 days) 12MFU (365 days) 12MFU (395 days) at risk % ,9 95,2 92,8 time base line 1MFU (30 days) 6MFU (180 days) 6MFU (210 days) 12MFU (365 days) 12MFU (395 days) at risk % ,9 97,8 97,8 Freedom from > 50% restenosis as indicated by DUS PSV-ratio <2,5 in the target lesion - CORE-LAB VERIFIED HOW CAN WE REACH THESE RESULTS?? RESPECTING METICULOUSLY IFU OF SUPERA 6
7 1. GETTING ACCESS Contralateral, cross-over approach (left) Brachial approach Retrograde SFA/PA/distal approach (mostly for passing, no definitive treatment) 6F sheath 45/65/90/100 cm 6F Working-channel as close as possible to the lesion 7
8 2. PASSING STAY INTRALUMINAL if possible 0,035 0,018 guide wires Workhorses CTO guidewires Low profile supporting ( balloon) catheters Fast spinning/drilling Retrograde/bidirectional approach if needed Try to stay intraluminal with all currently available devices & techniques 8
9 2. PASSING STAY INTRALUMINAL if possible 0,035 0,018 guide wires Workhorses CTO guidewires Low profile supporting ( balloon) catheters Fast spinning/drilling Retrograde/bidirectional approach if needed Try to stay intraluminal with all currently available devices & techniques 9
10 2. PASSING 10
11 3. VESSEL PREPARATION Low profile balloons High pressure balloons Scoring cutting sculpting (debulking) 1(,1):1 balloon - RVD ratio Upgrading diameters/pressures Prolonged inflations Vessel prep up to a 1(,1):1 RVD is mandatory If impossible, contra-indication for this technique 11
12 3. VESSEL PREPARATION 12
13 3. VESSEL PREPARATION 13
14 4. Definitive treatment Meticulous sizing of the SUPERA Diameters of mm Lengths of mm Short/long shaft depending on access Perfect imaging (max magnification, ipsilateral anterior oblique) SUPERA FOV 16 CM LAO 25 Meticulous sizing SUPERA in perfect imaging circumstances Discovery 740 GE 14
15 4. Definitive treatment Preparing/unlocking device Starting implantation with roadmap Continue without roadmap Very slow release Nominal implantation!!! Rule of 3 to define landing zone Meticulous NOMINAL implantation SUPERA in perfect imaging circumstances 15
16 4. Definitive treatment Starting implantation with roadmap Continue without roadmap Very slow release Nominal implantation!!! Rule of 3 to define landing zone 16
17 5. Final result imaging Final angiogram AP- & ipsilateral anterior oblique view Outflow check 17
18 5. Final result imaging 18
19 6. Challenging situations 19
20 6. Challenging situations 20
21 Summary the Supera is thé endovascular alternative for surgery for a majority of CFA lesions treatment Getting access : 6F Working-channel as close as possible to the lesion Passing the lesion : Try to stay intraluminal with all currently available devices & techniques Vessel preparation : Vessel prep up to a 1(,1):1 RVD is mandatory ; if impossible, contra-indication for this technique Definitive treatment : Meticulous sizing & nominal implantation of SUPERA in perfect imaging circumstances 21
22 How to perform CFA Supera deployment Koen Deloose, MD Head Dept Vascular Surgery AZ Sint Blasius Dendermonde, Belgium
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