Case Reviews

Shockwave Javelin: Severe TPT Stenosis, AT & PT Occlusion Case Review with Dr. Lendel

In this Shockwave Javelin case review, Dr. Vasili Lendel, Interventional Cardiologist at Arkansas Heart Hospital, Little Rock, AR, reviews a clinical case involving a patient with severe tibial peroneal (TP) trunk stenosis and anterior and posterior tibial occlusions, before diving into a Q&A discussion about Shockwave Javelin.

Case Summary

Patient background:

  • 79-year-old male with a history of paroxysmal atrial fibrillation (PAF), hypertension, chronic kidney disease and type II diabetes
  • Resting pain; symptoms remained refractory despite maximal medical and physical therapy
  • Computed tomographic angiography (CTA) showed occluded anterior tibial (AT) artery, severe stenosis of the TP trunk with occluded posterior tibial artery (PT)
    • Renovascular disease (RVD): 2.5 – 3 mm
    • Lesion length: 120 mm

Treatment algorithm:

  • 6 Fr 90 cm sheath
  • 0.014″ guidewire was advanced into the distal PT
  • Unable to advance 0.014 support catheter
  • Shockwave Javelin was chosen to help cross and modify the calcified lesion

Treatment:

  • Unable to cross the distal cap using Gaia next 3 and Astato XS 20 wires
  • Shockwave Javelin was replaced for 0.018″ Crosswalk
  • Retrograde access was obtained via distal PT artery using ultrasound
  • Antegrade catheter was cannulated using retrograde Sion black wire
  • Shockwave Javelin brought to distal cap and treated with the remaining pulses
  • Subsequently, the artery was treated using 2.5 x 80 mm Shockwave E8, followed by 3 x 200 Armada balloon

Result:

  • Brisk flow in the posterior tibial and medial plantar arteries without flow-limiting dissection

Dr. Lendel is a paid consultant of Shockwave Medical. The thoughts and views expressed are of their own opinions and do not necessarily represent Shockwave Medical.

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