Hybrid atherectomy for the infrainguinal arteries: why, when and how?

This presentation provides a short overview of the most important features and advantages of the hybrid atherectomy, the main indications as well as important technical tips and tricks.


    Dear Theo excellent presentation. Just few questions.

    1) Which is your guide wire of choice and why?

    2) Do you use a distal protection device?

    3) Which is your atherectomy algorithm for tibial disease?

    4) Do you combine atherectomy with DCB for BTK disease?

    Dr. Theodosios Bisdas
    June 18, 2018

    Thank you Kostas! Regarding your questions:
    1. It depends on the vessel that you treat; for SFA I would use the recommended Nitrix wire (Medtronic) or the hi-torque Iron Man (Abbott) and for the below-the-knee arteries more stiff wires like the Hi-Torque Extra S’port (Abbott) and Astato XS 20 (Asahi)
    2. I do not use a DPD and I would not recommend it, because you may have problems between the proximal tip of the device and the wire of the filter.
    3/4. At the moment I use atherectomy for tibial disease only in case of in-stent stenosis and severe recoil after PTA. If I perform atherectomy, then I would combine it with DCB.
    Do you have a different algorithm?

    I am a little bit concerned about the use of DCB + (directional/rotational) atherectomy for BTK lesions, given that the current body of evidence suggest the use of DES as alternative to POBA.
    A viable alternative, might be the use of orbital atherectomy, which is, however, not available in many European countries.

    MD Martin Schroeder
    July 2, 2018

    Dear Theo
    Thank you for this excellent presentation.

    What possibilities do you have if you receive a recanalization subintimally, can you also use the hybrid atherectomy system or is it absolutely necessary to have a true lumen for the atherectomy? If yes – is there a good tip for this? Thanks in advance.

    Dr. Theodosios Bisdas
    July 3, 2018

    It is very important to stay intraluminally! A good tip is to use dedicated support catheters with a 0.018 wire and to avoid wire loops during the recanalization.

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