1200_Babaev.pdf

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1、My Algorithm to Treat the Heavily Calcified SFA Stenosis?Anvar Babaev,MD,PhDDirector,Endovascular Interventions,Cardiac CathLab,NYU LangoneMedical CanterClinical Professor of Medicine,NYU School of MedicineDisclosures Consultant/Speaker:-Medtronic-Abbott-Shockwave-BSCI66F with severe RLE claudicatio

2、nTreatmentTreatment 4x150 mm balloonShockwave 6x80 mmJetStream 2.4x3.4 mmWhats the Next Step?Whats the Next Step?Balloon didnt expandShockwave didnt expand after 400 pulsesJetStream wouldnt cross the lesion despite multiple“pecking”Final ResultFinal Result Coronary NC 4x20 mmFinal result after stent

3、ing4.Fanelli F,et al.Cardiovasc Intervent Radiol.2014;37(4):898-907.5.Fitzgerald,et al.Circulation.1992;86(1):64-70.Why Modify Calcium?Calcium is heavily present in peripheral lesions1 Presence of calcium necessitates greater balloon pressures2,3 Calcium might influence drug-coated balloon efficacy4

4、 Plaques associated with arterial dissections commonly have significant calcium deposits5Artery CalcificationResistance to Balloon DilationCalcium Increases Arterial Resistance to Balloon Dilation2(Rabbit Model of Atherosclerosis)1.Bishop,et al.Ann Vasc Surg.2008;22:799-805.2.Demer.Circulation.1991;

5、83:2083-2093.3.Makam.J Invasive Cardiol.2013;25(2):85-8.Calcium Reduces Drug-coated Balloon Efficacy 60 patients with SFA stenosis or occlusion treated with DCB CTA,DSA,and IVUS used to quantify the calcium burden At 1 year,greater calcification was associated with:Lower patency 50%for 270-360vs 100

6、%for 0-90 Lower ankle-brachial index Greater late lumen loss and TLR rateCTA,computed tomography angiography;DCB,drug-coated balloon;DSA,digital subtraction angiography;IVUS,intravascular ultrasound;SFA,superficial femoral artery;TLR,target lesion revascularization.Fanelli F,et al.Cardiovasc Interve