09 aimradial2016 fri2 C Trani
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Radial artery for iliac/SFA, C Trani
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09 aimradial2016 fri2 C Trani
- 1. Radial artery for iliac/SFA CARLO TRANI
- 2. 22 Disclosures I do not have any potential conflict of interest
- 3. 3 Why TRA lower limb interventions • Simultaneous access to both limbs, even in case of severe PVD • Feasible in case of EIA/CFA involvement or impossible crossover • Better patient acceptance • Reduction of access site-related complications (vs. femoral) • Avoid brachial access!!!!!!
- 4. TRA lower limb interventions
- 5. 55 Specific technical issues of radial approach in lower limb interventions • Size of radial artery
- 6. 66 Saito et al. CCI 1999 6F OD 2.52 mm 7F OD 2.85 mm 8F OD 3.22 mm
- 7. 77 LESS-INVASIVE STRATEGY • Difference in Puncture Site Surface Area (PSSA)
- 9. 9 GUIDING CATHETERS FOR NATIVE VESSELS The sheathless revolution LESS-INVASIVE STRATEGY
- 10. 1010 • Size of radial artery • Distance from the target lesion Specific technical issues of radial approach in lower limb interventions
- 12. 1212 Long (> 90cm) Sheaths
- 14. 1414 Long (120cm) Guiding Sheath
- 15. 1515 • Size of radial artery + • Distance from the target lesion Technical limitations of radial approach in lower limb interventions
- 18. 1818 How to make it? to make TR peripheral porcedures as much as possible similar to coronary ones
- 21. 21 Long-shaft (180cm) SE stents
- 22. 22 Long (> 400cm) Wires
- 23. 23 Peripheral PTA Rome-UCSC experience 1,097 procedures 300 (27%) Radial Femoral
- 24. 24 Renal Lower limbs Carotid Upper Limb Other 300 procedures 96% procedural success Iliac SFA Transradial Peripheral PTA Rome-UCSC experience
- 27. 27
- 29. 2929 Combined antegrade (transradial) and retrograde (transfemoral) approach
- 32. 3232 Facilitated retrograde crossing 0.018” hydrophilic wire
- 33. 3333 Retrograde wiring of the right and antegrade of the left
- 34. 3434 Kissing stenting with 2 BE stents 8x58 (right) and 7x28 (left)
- 35. 35 Final result
- 36. 36 New low-profile (5Fr) BE stent 150cm long shaft coming soon
- 37. 37 Basal angio (5F pigtail)
- 38. 38 7.5F MP Sheathless™ GC 0.018’’ wire (Connect™ 300cm) QBX5F™ 8x37mm stent
- 39. 39 Final result
- 40. 40 pre vs post
- 41. 41 no options for femoral access!!!!!
- 42. 42 no options for femoral access!!!!!
- 43. 43 • Left ulnar access (RA occluded!!!) • 5-in-6 slender sheath • 6F 125cm long MP GC no options for femoral access!!!!!
- 44. 44 0,018’’ 480cm long Roadrunner™ Wire QBX5F™ 9x26mm stent
- 45. 45 QBX5F™ 9x26mm stent deployment
- 46. 46 pre vs post
- 47. 47
- 48. 48
- 49. 49 Trani C et al, Catheter Cardiovasc Interv. 2010 (in press)
- 50. 50 RRA 6F Slender Glidesheath 6F 125 cm long MP GC
- 51. 51 After dilation with 4x80x180cm balloon over a 450cm 0,018” guidewire
- 52. 52 6x80x180cm Vascuflex SE stent
- 53. 53
- 54. 54
- 55. 55
- 56. 56 0.018” 300cm wire 4.0x40x180 balloon
- 57. 57 0.018” 480cm wire 4.0x40x180 balloon 0.018” 480cm wire 4.0x40x180 balloon
- 58. 58
- 59. 59 6.0x80x180 SE stent 6.0x60x180 SE stent
- 60. 60
- 61. 61 Left PA subtotal focal stenosis (A) and multiple stenoses of ATA and PA with PTA occlusion (B e C) B CA How far can we go?
- 62. 62 • MP 6F 125 cm Guiding Catheter 0.018” 300cm wire • 180cm long shaft 5x80 mm balloon (10 atm) (D) • Final result (E) D E TR treatment of ATK-PA
- 63. 63 E F • In-sheath balloon technique (no GC) • 200cm long shaft balloon TR treatment of BTK-ATA
- 64. 64 TR treatment of BTK-ATA E F • 0.018” 300cm wire • Multiple dilations with 200cm long shaft balloon 2.5x150 mm (F) • Final result (G e H) G HF
- 65. 65 WHAT’S COMING NEXT Courtesy of QualiMed
- 66. 66 Micro-Invasive Strategy Products (5F introducer sheath compatibility or less) Description Est. Approval Date 400 CM Guide Wire .018 4th Quarter 2016 Radial, Brachial, Femoral 6F outer 5.5 F inner Guide Cather with Support Catheter: Lengths from 25 CM to 180 cm) Q1 2017 Self-expanding stents with 150 cm long catheters for radial and brachial access. Q4 2017 (150 cm catheter length 5F compatible) PTFE Covered self-expanding and balloon expandable for perforations, dissections, hypertension, and the like. Q4 2017 (5F & 6F compatible) Dilating tip introducer to minimize Puncture Site Diameter (PSD) & Puncture Site Surface Area (PSSA) Q1 2018 WHAT’S COMING NEXT
- 67. 67 Courtesy of Terumo WHAT’S COMING NEXT
- 68. 68 Pacific In.Pact MOST WANTED !!!!!
- 69. 69 Unmet needs • 5 Fr long hydrophilic Sheaths (> 120 cm) • 5 Fr compatible Ballon Expandable stents (CrCo, 0,018’’, > 150 cm shaft) • 5 Fr compatible large Balloons (>7 mm) • 4 or 5 Fr compatible long shaft (>180 cm) DCB
- 70. 70 We have a dream…....…....the dream is coming true
- 71. 71 TR peripheral MANTRA • Smaller • Longer
Editor's Notes
- Limitations: Equipment Length Truesdell et al. Interv Cardiol 2015;7(1):55-76. * 200 cm shaft balloons only up to 5.0 mm
- Limitations: Equipment Length 135 cm 145 cm Truesdell et al. Interv Cardiol 2015;7(1):55-76.