Research competition

354 views
313 views

Published on

Dr Imran Javed.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
354
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Research competition

  1. 1. ______ _________ ____ ___ __ Initial Experience with the Jetstream™ Pathway Device _____ ______ _____ ___ for Femoro-Popliteal Disease _____ ________ ______ Imran Javed, MBBS, FCPS. Vekatesh Ramaiah, MD, FACS David Terry, MD Julio Rodriguez, MD, FACS Matt Nammany, MD
  2. 2. ABSTRACTInitial Experience with the Jetstream™ Pathway Device for Femoro-Popliteal Disease.Imran Javed, MBBS, FCPS., Vekatesh Ramaiah, MD, FACS., David Terry, MD.,Julio Rodriguez, MD, FACS., Matt Nammany, MD.Arizona Heart Institute, Phoenix, Arizona, USA.Objectives: To report safety and efficacy of Jetstream™ Pathway rotational atherectomy/ thrombectomy device for the treatment of femoro-popliteal arterial lesions with special emphasis on rate of re-intervention and intervention free period.Materials & Methods: Duration of study is from Mar 2008 to Nov 2009 (21Months). Total numbers of patients is 86. Males are 55(64%) & Females are 31(36%). Age range is 36 to 87 Years. All patients underwent Pathway Atherectomy during this time period regardless of their previous status were included. Re intervention in the same limb after atherectomy was endpoint of the study.Results: TLR (Target Lesion Revascularization) was 15% in patients during follow up period. Re intervention was more common in first 3 months after first intervention. It was more common in TASC II type B lesions and mostly managed by Balloon Angioplasty. Conclusion: The JetStream™ Pathway device with thrombectomy and aspiration capabilities has added advantages to femoro-popliteal atherectomy. Adjunctive stenting remains very low in this difficult segment.Long term follow up will definitely be needed for durability and patency.Key Words: Femoro-Popliteal Disease, JetStream™ Pathway device, Re intervention.
  3. 3. Purpose of Study• To report safety and efficacy of Jetstream™ Pathway rotational atherectomy/ thrombectomy device for the treatment of femoro-popliteal arterial lesions with special emphasis on rate of re-intervention and intervention free period.
  4. 4. PATIENTS & METHODS• Duration: Mar 2008 to Nov 2009 (21M).• Total patients: 86• Sex: Males 55(64%) Females 31(36%).• Age range: 36 to 87 Yrs.• Inclusion Criterion: – All patients underwent Pathway Atherectomy during this time period regardless of their previous status.• End point of study: – Re intervention in the same limb after atherectomy and determine intervention free time period.
  5. 5. PATHWAY DEVICE
  6. 6. CLINICAL FINDINGS• Total No of Lesions: 113• Site of Lesion: – SFA: 74 (65.5%) – Popliteal: 30 (26.6%) – Other Vessels: 4 (3.5%) – Instent Restenosis: 4 (3.5%) – Femropopliteal Bypass: 1 (0.9%)
  7. 7. CLINICAL FINDINGS• Presentations:Rutherford Class I: Claudication: 58 (67.4%)Rutherford Class II: Rest Pain: 13 (15.1%)Rutherford Class III: Tissue Loss: 15 (17.5%)• Limb Involved: • Right: 32 (37%) • Left:54 (63%)
  8. 8. CLASSIFICATION OF LESIONS ON BASIS OF TASC II GUIDELINES 30 24 23 25 20 18 15 13 10 8 5 27.9% 26.7% 20.9% 15.1% 9.4% 0 Type A Type B Type C Type D Undefined
  9. 9. OPERATIVE FINDINGS Type of Pathology: Occlusion: 47 (54.7%) Stenosis: 27 (31.4%) Both: 12 (13.9%) Distal Run Off: Single Vessel: 43 (50%) Double Vessel: 31 (36%) Triple Vessel: 3 (3.5%) Collaterals: 9 (10.5%)
  10. 10. FOLLOW UP OF PATIENTS • 3-6 Month: 10 (11.6%) • 6-12 Months: 71 (82.6%) • > 12 Months: 5 (5.8%)
  11. 11. Pathway Jetstream™ Atherectomyof Severe Calcific Popliteal StenosisSevere calcific 90% Excellent post Jetstream™ atherectomy results,stenosis of the popliteal without dissection, PTA or embolizationartery across the kneejoint
  12. 12. REINTERVENTIONS• Total: 13 (15.1%)• Limb Involved: • Right: 6 (46%) • Left: 7 (54%).• Time Line: • 0-3 Months: 8 (61.5%) • 4-6 Months: 1 (7.7%) • >6 Months: 4 (30.8%)
  13. 13. REINTERVENTIONSReintervention In Different Typesof Lesions (Tasc II)Type A: 1 (4.2%)Type B: 6 (26.1%)Type C: 2 (11.1%)Type D: 2 (15.4%)Undefined: 2 (25%)
  14. 14. TYPES OF RE-INTERVENTIONSBalloon Angioplasty+- Stent: 6 (46.2%)Remote Endarterectomy: 2 (15.3%)Repeat Atherectomy: 4 (30.8%)Below Knee Amputation: 1 (7.7%)
  15. 15. RESULTS• TLR was 15% in patients at 6 months as only 5.8% have completed 1 year• Reintervention was more common in first 3 months after first intervention (learning curve)• Reinterventions were mostly balloon angioplasty in nearly half of cases.• Reinterventions were more common in TASC II type B lesions.
  16. 16. Conclusion• The JetStream™ Pathway device with thrombectomy and aspiration capabilities has added advantages to femoro-popliteal atherectomy• Reninterventions were managed mostly by endovascular techniques.• Intervention free period is similar to reports from other institutions especially from Germany.• Long term follow up and comaprison with other athrectomy devices will definitely be needed for durability and patency

×