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How I Deal With... SVGs

How I Deal With... SVGs. Simon Redwood St Thomas’. No Conflict of Interest to Declare. Mr PM, 55 years old CABG 1993 SVG – LAD SVG – OM2 8F LCB. How should we tackle this?. Laser Catheter. 0.9, 1.4. 1.7. 2.0 mm diameter. Particle Size post 308 nm ablation. 5% : > 5 - <12 micron.

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How I Deal With... SVGs

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  1. How I Deal With...SVGs Simon Redwood St Thomas’

  2. No Conflict of Interest to Declare

  3. Mr PM, 55 years old • CABG 1993 • SVG – LAD • SVG – OM2 • 8F LCB

  4. How should we tackle this?

  5. Laser Catheter 0.9, 1.4. 1.7. 2.0 mm diameter

  6. Particle Size post 308 nm ablation 5% : > 5 - <12 micron 50% : < 1 micron 45% : 1 – 5 micron Erytrocyte = 7µ

  7. Saline Infusion Protocol In order to obtain an optimal contact between catheter tip and lesion it is mandatory to implement the saline infusion protocol. 15-20 ml saline bolus after each contrast injection 15-20 ml saline flush during every laseractivation (5 sec)

  8. Saline Infusion Images taken from the DVD: Critical Limb Ischemia, New Techniques For Complex Interventions, Prof. Dr. Giancarlo Biamino - Dr. Dierk Scheinert (Herzzentrum Leipzig) Michael Jaff, MD (Lennox Hill, NY)

  9. Luge • 2.0c laser

  10. 5x28 to mid lesion • 5.0x20 proximal • 5.0x15 Quantum

  11. Peak CK 194

  12. Mr JN, 64 years old • CABG 1988 • LIMA – LAD • SVG – RCA and “LCx” • Tn +ve ACS • Anterolat ST changes • LIMA – LAD normal • SVG – RCA occluded

  13. Continued pain with ECG changes • BP 80 systolic

  14. 8F HS • IABP • Luge

  15. 2.0c laser

  16. Filterwire

  17. 4.0x20 distal • 4.0x28 prox • 4.0 post dilatation

  18. Peak CK 14

  19. Mrs DC, 72 years old • CABG 1999 • LIMA-LAD • SVG-OM1 and RCA • Tn +ve ACS (>2) • Infero-lat ST depression

  20. Luge • 2.0c laser

  21. Filterwire • 4.5x28 distal

  22. 4.5x24 prox Peak CK 205

  23. Summary Conventional wire Debulk with laser Filter device Stent – usually BMS, occ. covered

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