the presto technique...challenging case 1 • 87 y/o m, pad, rf 5. • s/p evar. • s/p pvi 4 days...
TRANSCRIPT
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COMPLEX INFRAINGUINAL CTO’s:The PRESTO Technique
Precise REtrograde Supera sTenting Ostium
Larry J. Diaz-Sandoval, MD, FACC, FSCAI, FAHA, FSVM
Director, Endovascular & Vascular Medicine Fellowship
Metro Health Hospital
Assistant Professor of Medicine
Michigan State University
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Disclosures
CSI
Terumo
Bard
Spectranetics
Abbott
Phillips-Volcano
Medtronic-Covidien
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CHALLENGING CASE 1
• 87 y/o M, PAD, RF 5.
• s/p EVAR.
• s/p PVI 4 days before.
• Found to have cold leg in nursing
home.
• Recently placed subintimal SES is…
• No flow to the foot. Cold leg.
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EVUS MAPPING
EIA CFA
SFA
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EVUS MAPPING
dSFA Pop TPT
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EVUS MAPPING
dPT dPA dAT
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Peripheral Intervention
What
Access
Would
You
Use ??
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Peripheral Intervention
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Peripheral Intervention
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Final
Angio
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Peripheral Intervention
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THE
GLOBAL
FACE
OF
CLI…
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• Attempt antegrade crossing.
• If unable: retrograde access.
• Retro crossing + “rendez-vous”.
• If retro access in mid-distal SFA
/ Popliteal: Use 6 Fr dilator to
create tract, and pass stent
sheathless.
“PRESTO”
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• If retro access in prox tibials:
4 Fr Dilator to create tract, +
sheathless stenting.
• If retro access in distal tibials,
can only use PRESTO if able to
pass a 5/6 Slender sheath (avoid
sheathless).
“PRESTO”
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Given the idiosyncrasies of the
deployment mechanism of Supera,
PRESTO allows accurate and
predictable deployment of the first
crown of the stent right at the
Ostium.
“PRESTO”
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The “PRESTO” Technique
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COMPLEX INFRAINGUINAL CTO’s:The PRESTO Technique
Precise REtrograde Supera sTenting Ostium
Larry J. Diaz-Sandoval, MD, FACC, FSCAI, FAHA, FSVM
Director, Endovascular & Vascular Medicine Fellowship
Metro Health Hospital
Assistant Professor of Medicine
Michigan State University