1455_Fanelli.pdf

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1、My Personal Algorithm of When and How to Vessel Prep in BTK DiseaseFabrizio Fanelli,MD,EBIRProfessor of Interventional RadiologyDirector Vascular and Interventional Radiology DepartmentCareggi University HospitalFlorence-ItalyDisclosures Consultant/Speaker/Proctor/Advisory Board Abbott BD Bard Bosto

2、n Scientific Cook iVascular Medtronic Merit Penumbra Philips Volcano W.L.Gore&Associates Zylox Tonbridge Small vessels Long lesions Occlusions stenoses More vessels Calcifications0100200300400500600700IliacFemoralPoplitealPeronealPost TibAnt TibStenosisOcclusionBTK VesselsComplex Lesions Require Mul

3、tidisciplinary and Multi Tool ApproachPTAAtherectomyDebulking ToolsAnti-restenoticTherapySpecialty PTA(Plaque modification-Chocolate PTA,Cutting,Scoring Balloons)Stents(Bailout Scenarios:Persistent Recoil,Flow-limiting Dissection,Residual Stenosis)Adjunctive ToolsCrossing&Re-entryVessel Preparation

4、ToolsBalloons Standard Balloons Cutting Balloons Scoring Balloons“Non-conventional balloons”Atherectomy Directional Orbital Rotational Hybrid LaserOthers IVL FLEX Vessel Prep System Spur stentPlaque Removal(debulking)Plaque ModificationThe current body of evidence on vessel preparation in BTK arteri

5、esis largely based on observational studies with a large amount ofheterogeneity and inconsistencies regarding patient selection,treatment indications,lesion characterization,choice of end points,and the report of outcomes.Caution!Stand-alone therapyPlaque debulkingDCB/StentISRDistal embolizationVess

6、el perforationTime consumingLearning curveCostAtherectomy DevicesProConsMy Approach to Complex LesionsVessel PreparationAnti-restenoticTherapy+Vessel prep is improving the local environment of the vessel prior to the final treatment whith angioplasty or stent with/without anti-proliferative agent Al