ISET 2018: Live Cases from Miami Cardiac and Vascular Institute

MCVI live cases provide a range of virtual insights on planning and procedures.

By Brenda Silva

As ISET 2018 continues, attendees in Hollywood Beach were afforded the benefit of viewing live cases being presented further south at Miami Cardiac & Vascular Institute (MCVI). The cases offered virtual learning by way of treatments tailored to individual patient conditions and needs. Moderator James Benenati, MD, introduced the cases to a panel that provided ongoing commentary and opinions on the cases and therapies as they were being shown.

Beginning the live cases from MCVI, the first case focused on a 56-year-old man who presented 10 months ago with femoral occlusion and was treated with stent therapy as a Rutherford class 3 case. A question was raised by the panel about the existence of a thrombus and if an additional related procedure was necessary prior to stent placement. However, surgeons at MCVI didn’t see any evidence that would affect the stent insertion.

Dr. Benenati polled the panel about their opinions about alternative therapies, such as laser atherectomy catheter options, and panelists agreed that the extent of the occlusion would ultimately dictate the most applicable therapies that offer the greatest possibility for success. Concerns about long-term patency were also raised, considering the status and location of the stenosis, with a question about whether or not it would be recommended to put the patient on some sort of anticoagulant post-procedure.

While the surgeons continued with the first case, a second live case was shown in another MCVI surgical suite. The case evidenced valvular heart disease in an 86-year-old man with multiple comorbidities, dyspnea on exertion, and severe aortic stenosis s/p, 21 mm. The procedure showed the advancement of the valve and Confida guide wire, and concerns about the gradient of 35+ were raised in association with surgical cracking. A 23-mm True Flow balloon was chosen to continue, prior to cracking, which was deemed necessary based on the higher gradient. After cracking, the gradient decreased but was still deemed too high; however, additional dilation attempts decreased the gradient to 11 and 14.

In a third surgical suite, the last case presented was of an 81-year-old man with Rutherford 5 critical limb ischemia, L-SFA occlusion, and an ischemic ulcer on his heel. The patient had an RLE intervention the previous week and was treated successfully with balloon angioplasty. Using a 6Fr destination sheath, interventionalists chose to puncture the patient collaterally, going around the horn versus using an antegrade approach. Posing the question to the panel on choosing a stent or drug-coated balloon as the final treatment – panelists were split and cited the benefits for using both options; however, onsite MCVI surgeons chose to use a stent as the best therapy to eliminate the patient’s occlusion.