VRTD 1: Zero-contrast directional atherectomy and antirestenotic therapy
This is the first VRTD (Vascular Round Table Discussion), where 3 specialists discuss all relevant clinical and technical issues about CO2-angiography, directional atherectomy and antirestenotic therapy (DAART) in a young claudicant with a calcified SFA lesion. The specialists highlight relevant aspects of decision making, provide a new technical trick for using CO2 during DAART and demonstrate all steps for a safe DAART. The webinar has been divided in different chapters.
1. What is a Vascular Round Table Discussion
Dr. Bisdas explains the structure of the VRDT and welcomes the invited specialists
2. Case presentation
3. Decision making
The specialists discuss which clinical aspects and lesion's characteristics are relevant to decide about the ideal treatment strategy in this patient.
4. Step 1: Access and diagnostic CO2-angiography
5. Step 2: Recanalisation and placement of distal protection device
6. Step 3: CO2-angiography through the side port of the HawkOne device
7. Step 4: Technical tips and tricks for a safe directional atherectomy
8. What can you do, when the cutter cannot debulk the plaque?
9. How to determine the fullness of the tip?
10. Device torqueing technique
11. Vessel preparation during directional atherectomy
What is vessel preparation? How much of the lesion should we debulk and why?
12. Aneurysmatic degeneration of the lesion post DAART
Dr. Stavroulakis comments on the risk of aneurysm formation after DAART. Which is the reason? How can you avoid it? Which is the natural history?
13. Final result of zero contrast DAART
14. CO2 volumes
Dr. Bisdas summarizes the CO2 volumes and pressures used in this case for each of the diagnostic angiographies (pigtail catheter, 6F sheath, support catheter, HawkOne etc).
15. Antiplatelet treatment after DAART
16. Summary of the evidence about DAART
17. When and why should you use CO2 angiography?
18. The added value of Angiodroid CO2 injector
Dr. Bisdas makes a direct comparison between automated to manual CO2 angiography
19. Break and product advertisement
20. Q & A