mechanical thrombectomy using rotarex device in paod with ... · mechanical thrombectomy using...
TRANSCRIPT
![Page 1: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/1.jpg)
Mechanical Thrombectomyusing Rotarex® device
in PAOD with Thrombotic Occlusion
Jae Kyu, Kim MD, PhDProfessor
Department of RadiologyChonnam National University
School of MedicineGwangju, Korea
LINC AP 2019 1
![Page 2: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/2.jpg)
Disclosure
Speaker name: Jae Kyu Kim. MD, PhD
.................................................................................
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
v I do not have any potential conflict of interest
![Page 3: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/3.jpg)
PTA / Stent
Thrombolysis / Thrombectomy+ PTA or stent
Embolization !!
![Page 4: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/4.jpg)
LINC AP 2019 4
![Page 5: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/5.jpg)
LINC AP 2019 5
![Page 6: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/6.jpg)
Patient Demography
Period 2014.03~2018.10
Pts 43(46 session)
Age 55~84(70.3) yrs
Sex(M:F) 42:1
Risk factors HTN< DM< Smoking, MI, CVA
Sx(RF) IIa(8), IIb(14), III(16), IV(8)
Lesion length 5 ~45 (27.1) cm
Site SFA 16, PA 6, SFA –PA 16, PA-TPT1 ,iliac –SFA 2, CFA-PA 1
Etiology Native occlusion 24 stent occlusion / ISR 17 Embolism 1 post-op thrombectomy 1Fem-fem bypass graft occlusion 1
LINC AP 2019 6
![Page 7: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/7.jpg)
• Thrombotic filling in enhanced CTA
( “Target sign”)
• Intraluminal passage of GW
![Page 8: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/8.jpg)
ROTAREX®(Straub Medical, AG)
LINC AP 2019 8
![Page 9: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/9.jpg)
• Catheter sizes
▪ 6F Catheter: vessels 3-5 mm
▪ 8F Catheter: vessels 5-8 mm
▪ 10F Catheter: vessels 7-12 mm
LINC AP 2019 9Generator
Ready status
![Page 10: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/10.jpg)
Four functions of ROTAREX ® device
• Detachment of the occlusive material from the vessel
(up to 1cm/sec, 40,000~60,000 rpm)
• Aspiration of the detached material into the catheter
head
• Fragmentation of the aspirated material
• Transportation out of the patient’s body
LINC AP 2019 10
![Page 11: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/11.jpg)
Rotarex catheter 6 Fr 37 8 Fr 6
Kind of procedure Rotarex only 6
(46 sessions) Rotarex + DCB 18
Rotarex + stent 8
Rotarex + PTA 9
Rotarex + UK 1
Rotarex + DCB + stent 2
Technical success 100%
Complication Distal embolism 1
Dissection 2
Pseudoaneurysm 2
Recurrence 10/43 (re-do in 3 cases)
Results
LINC AP 2019 11
![Page 12: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/12.jpg)
Initiall
68yrs, MRF IV 5 , Left legD; 2 msSmoking, rehab for CVA
LINC AP 2019 12
![Page 13: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/13.jpg)
LINC AP 2019 13
![Page 14: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/14.jpg)
Post-Rotarex
DCB
LINC AP 2019 14
![Page 15: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/15.jpg)
POD# 2 yrs
LINC AP 2019 15
![Page 16: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/16.jpg)
Post-stent 3 days
82yrs, MRF III 4 Right legSFA stent POD# 3 dsNo RFs
LINC AP 2019 16
![Page 17: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/17.jpg)
LINC AP 2019 17
![Page 18: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/18.jpg)
8 Fr
ABI 0.5 -> 0.9LINC AP 2019 18
![Page 19: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/19.jpg)
Initial
80yrs, MRF IIB 4 right legD; 1day (surgical Fogarty thrombectomy)HTN, DM
LINC AP 2019 19
![Page 20: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/20.jpg)
Rotarex 8 Fr
LINC AP 2019 20
![Page 21: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/21.jpg)
POBA
ABI 0.8 -> 1.14
Post-Rotarex
LINC AP 2019 21
![Page 22: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/22.jpg)
76yrs, M
RF IIA 1 , Left leg
D; 3ms
HTN,DM, CVA LINC AP 2019 22
![Page 23: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/23.jpg)
5ms, 30msTampon
Post-tampon
LifeStreamStent-graft
ABI 1.01
Post-Rotarex
LINC AP 2019 23
![Page 24: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/24.jpg)
Summary
• Thrombotic occlusion should be observed in CT angiography
(“Target sign”)
• Intraluminal passage of guidewire is highly recommended.
• Femoropopliteal artery including proximal tibioperoneal trunk
(“straight segment”) can be applied.
• Combination therapy such as DCB or stent can be also possible.
• But, we need the more data!!
LINC AP 2019 24
![Page 25: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/25.jpg)
Conclusion
Percutaneous mechanical thrombectomy in arterial
thrombotic occlusion using Rotarex ® catheter
showed the safe result with acceptable technical
success rate.
LINC AP 2019 25
![Page 26: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/26.jpg)
Thanks for your kind attentions !
LINC AP 2019 26
![Page 27: Mechanical Thrombectomy using Rotarex device in PAOD with ... · Mechanical Thrombectomy using Rotarex® device in PAOD with Thrombotic Occlusion Jae Kyu, Kim MD, PhD Professor Department](https://reader031.vdocuments.mx/reader031/viewer/2022040318/5e37ebabca47dc11483bff89/html5/thumbnails/27.jpg)
Mechanical Thrombectomyusing Rotarex® device
in PAOD with Thrombotic Occlusion
Jae Kyu, Kim MD, PhDProfessor
Department of RadiologyChonnam National University
School of MedicineGwangju, Korea
LINC AP 2019 27