Vascular Device Forum

Chronic Total Occlusion-optoons

The voluntary withdrawal of the Outback Re-entry device from the vascular device market by Cordis Vascular (Johnson and Johnson) has left a void in the tool box with regards to the treatment of long segment total occlusive lesions of the femoral popliteal segment. I found an interesting article recently reviewing the FDA approved options. click here

Vascular Device Forum welcomes submission on tips about recanalizing CTO lesions.

New Guidelines recommend thrombolysis for Proximal DVT

Dr Santiago Chahwan from the Naples Florida Vascular Group posted previously on his extensive experience with pharmaco-mechanical thrombolysis of ilio femoral deep venous thromboses using the trellis-8 device from Bacchus Vascular. Successful thrombolysis improves patient outcomes when the endpoints of limb function, symptom severity and post thrombotic syndrome are assessed.

The newly-published 2008 clinical guidelines for physicians from the American College of Chest Physicians (ACCP) on how to treat DVT and other forms of venous thromboembolic disease now recommend pharmacomechanical thrombolysis for treatment of acute proximal DVT. The guidelines are available as a complimentary download at:

http://www.thenewguidelines.org

Hopefully, this will encourage our medical colleagues to accept pharmacomechanical thrombolysis as the treatment of choice in the appropriately selected candidate patients. This validates the management strategy, however I still think there are quite a few institutions that do not utilize this option sufficiently in this large group of patients.

Cook begins peripheral drug eluting stent trial

Cook Medical of Bloomington Indiana has completed enrollment in a clinical trial to assess the outcomes of drug eluting stents in the peripheral circulation. This places Cook at the forefront of peripheral device companies poised to bring drug elutin stent technology to the peripheral circulation. The trial of the ZilverPTX (zilverPTXtrial.com) uses paclitaxel coated nitinol stents to treat the SFA.

Cook has licensed the right to use a proprietary technology which binds the drug to the stent without the assistance of a polymer which may theoretically lessen the risk of allergic reaction.

Michael Dake MD, Professor of Radiology at University of Virginia health system is the primary investigator for the study and the results were released at SVS 2008

Diamondback Atherectomy in Philadelphia at Penn Presbyterian

Recently, Penn Presbyterian Hospital in The University of Pennsylvania Health System acquired the Diamondback Atherectomy system from CSI. The Diamondback orbital atherectomy system will compliment the extensive experience with directional atherectomy with the Silverhawk device from EV3/Foxhollow.

http://link.brightcove.com/services/player/bcpid1772133234

"We have a large diabetic population and a high volume wound care facility (Penn Woundcare Center) which presents the challenge of having a lot of patients who present with limb threatening ischemia in the form of tissue loss. At imaging they are often found to have heavy calcium burden in the infrapopliteal vascular tree. I have not been impressed with the success of angioplasty, stenting or directional atherectomy in the face of severely calcified tibial vessels. I know that the Diamonback will present a welcome addition to our procedural toolbox. Most of these therapies are complimentary and allow us to tailor a solution for the patient's particular challenge. I still believe that with patencies approaching 80% at 5 years open bypass with autogenous vein is the treatment of choice and provides a significant long term patency advantage.  But many patient have medical conditions that are prohibitive for surgical bypass and the Diamondback will increase our ability to treat this group"

Lee Kirksey MD, MBA Director Penn Woundcare Center Clinical Assistant Professor of Surgery

The University of Pennsylvania School of Medicine, 215-662-9951

Drug Eluting Stent Taxus fails to show superiority

From the European desk of Medical Device Daily, the results of the Syntax Study presented at the congress of the European Society of Cardiology has left cardiologists scratching their heads and stent manufacturers searching for a believable spin. In the end, the Syntax Study failed to show non-inferiority for DES (Drug Eluting Stents) vs open Coronary revascularization.

The study involved the Taxus stent from Boston Scientific with a primary endpoint of death, stroke or myocardial infarction

Source