Overview
Dr. Jihad Mustapha used orbital atherectomy in the unique treatment of three vessel disease.
Patient History
A 72-year old female patient, fully independent, retired with a goal to be more active with her husband, was complaining of pain at rest in her left leg. Patient was treated using ultrasound-guided tibiopedal access and the total procedure time was 20 minutes.
Over the previous few months, the patient’s claudication symptoms had caused her to limit physical activity and she was experiencing left leg pain at rest. Past medical history included diabetes mellitus, hypertension, hyperlipidemia, and chronic renal disease (stage III).
She did not have a previous history of peripheral or coronary artery disease. She was classified as Rutherford category 4. An angiogram revealed stenosis in the left superficial femoral, popliteal, and anterior tibial arteries.
Treatment Summary
4 Fr. Diamondback 360® Orbital Atherectomy System allowed for unique retrograde treatment approach of three vessel disease.
Using ultrasound guidance, retrograde access was gained through the left anterior tibial artery with a 4 Fr. sheath. An 0.012″* ViperWire® was advanced through the left anterior tibial artery followed by crossing of the popliteal and superficial femoral arteries. A single, 60 cm* Diamondback 360® 1.25 mm Micro Crown was used for retrograde treatment of all three lesions in the superficial femoral, popliteal and anterior tibial arteries. Each lesion was treated using two passes on low and two passes on medium speed with OAS. Low pressure adjunctive balloon angioplasty was performed at 4 ATM for 2 minutes in each lesion. Total procedure time was less than 20 minutes, radiation time was 4 minutes and only 16 cc of contrast was used.
Key Takeaways
- Total procedure time was less than 20 minutes
- Patient was discharged the same day and walked out of the hospital in less than 2 hours post-procedure
- Total radiation time was 4 minutes
- Total contrast used was 16 cc
- OAS has a unique mechanism of action that can allow you to treat multiple vessels with one crown, and also has the option for smaller sheaths
Case Study At a Glance
Category
Access
CSI Device
OAS Crown
Imaging
Rutherford Class
Lesion / Anatomy
Image Gallery
SFA Target Lesion. 5mm x 80mm. ~80% stenosis.
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SFA Target Lesion. 5mm x 80mm. ~80% stenosis.
SFA Final. <5% stenosis.
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SFA Final. <5% stenosis.
Anterior Tibial Target Lesion. 3mm x 220mm. ~95% stenosis.
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Anterior Tibial Target Lesion. 3mm x 220mm. ~95% stenosis.
Anterior Tibial Final. >5% stenosis.
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Anterior Tibial Final. >5% stenosis.
Popliteal Target Lesion. 4mm x 160mm. ~90% stenosis.
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Popliteal Target Lesion. 4mm x 160mm. ~90% stenosis.
Popliteal Final. <20% stenosis.
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Popliteal Final. <20% stenosis.
Indications and Important Safety Information
Diamondback 360® Peripheral Orbital Atherectomy System
Indications Statement: The Diamondback 360® Peripheral Orbital Atherectomy System is a percutaneous orbital atherectomy system indicated for use as therapy in patients with occlusive atherosclerotic disease in peripheral arteries and who are acceptable candidates for percutaneous transluminal atherectomy. The OAS supports removal of stenotic material from artificial arteriovenous dialysis fistulae (AV shunt). The system is a percutaneous orbital atherectomy system indicated as a therapy in patients with occluded hemodialysis grafts who are acceptable candidates for percutaneous transluminal angioplasty.
Contraindications: The Systems are contraindicated for use in coronary arteries, bypass grafts, stents, or where thrombus or dissections are present.
Adverse Events: Although the incidence of adverse events is rare, potential events that can occur with atherectomy include: pain, hypotension, CVA/TIA, death, dissection, perforation, distal embolization, thrombus formation, hematuria, abrupt or acute vessel closure, or arterial spasm.
Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.
Results may vary.
Suggestions on case studies offered by the physician are based on their experience using the Diamondback® Orbital Atherectomy System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgment. CSI does not recommend or endorse any particular course of treatment or medical choice. Before using any medical device, including those demonstrated or referenced in this case study, review all relevant Instructions for Use, with particular attention to the indications, contraindications, warnings and precautions, and steps for use of the device.
*The 0.012” ViperWire and 60 cm length Diamondback 360 device are no longer available. The 60 cm length device has been replaced by the 75 cm Diamondback 360 Exchangeable Series device.
Boost your CSIQ®
Educational opportunities for physicians
CSIQ is the official professional education program of CSI.
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Comprehensive courses taught by leading orbital atherectomy experts
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Personalized, one-on-one proctorships
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National courses
Printed from https://csi360.com/case-studies/ultrasound-guided-treatment/ on 05/31/2023
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