CLTI Round Table: Strategies for Patient Acquisition and Treatment
In this informative and in-depth session, renowned vascular specialists and interventionalists come together to explore advanced strategies for managing critical limb-threatening ischemia (CLTI) and complex tibial and pedal artery disease. Moderated by Dr. John Rollo, the discussion features expert contributions from Dr. Misty Humphreys (UC Davis), Dr. Constantino Pena (Baptist Miami), and Dr. John Corl (Cincinnati), who share their insights on techniques for challenging cases involving heavily calcified vessels and non-healing foot ulcers.
Cutting-Edge Treatment Approaches
Dr. Humphreys highlights her use of the latest balloon technology, including Shockwave E8, which facilitates treating entire tibial segments with long, subnominal inflations—often exceeding three minutes—aimed at optimizing vessel compliance. She emphasizes the importance of thorough pre-procedure planning, including sizing and physiologic assessments like pedal acceleration time, toe pressures, and transcutaneous oxygen measurements, to guide treatment decisions and improve healing outcomes.
Case-Specific Strategies
The discussion delves into case-specific strategies, particularly focusing on targeting the most promising arteries, such as the anterior tibial artery, and considering collateral flow and angiosome principles to maximize tissue perfusion. Panelists discuss when to treat multiple vessels versus a more conservative approach, stressing that treatment should be tailored based on physiologic data, wound status, and patient risk.
Shockwave Javelin
Challenging cases are examined, especially those with heavily calcified lesions where crossing may be difficult. The panel introduces Shockwave Javelin, a calcium modification tool that uses forward-shifted ultrasound energy to crack calcified plaque and facilitate successful balloon crossing. They share practical tips on crossing strategies, sheath and wire selection, and the benefits of retrograde access when antegrade approaches fail.
Dr. John Rollo, Dr. John Corl, Dr. Misty Humphries, and Dr. Constantino Pena are paid consultants of Shockwave Medical. The thoughts and views expressed are of their own opinions, and do not necessarily represent those of Shockwave Medical.
Shockwave IVL: In the U.S.: Rx only. Prior to use, please reference the Important Safety Information for more information on indications, contraindications, warnings, precautions and adverse events.
Please contact your local Shockwave representative for specific country availability.
