SECOND EDITION Wednesday 26 April 2023
12 CX Round-up
Trial updates offer insights on sirolimus in CLTI patients The peripheral arterial and chronic limbthreatening ischaemia (CLTI) session yesterday afternoon provided delegates with a consensus update and insight into potential advances in this area. The sirolimus drugcoated device section of the session provided updates on three belowthe-knee (BTK) studies, as well as insight into a real-world experience of sirolimus-coated balloon versus conventional balloon angioplasty for CLTI. Attendees also responded in real time to the statement ‘sirolimus is the answer’—the poll results showed that a plurality of audience members who answered the poll agreed with the statement. These delegates in favour of the motion comprised 56% of respondents, whereas 44% of respondents believed sirolimus was not the answer. Peter Gaines (Sheffield, United Kingdom) opened the session, offering attendees an update on the SELUTION4BTK trial of a sirolimus drug-coated balloon (DCB) in BTK arteries. Following Gaines came Edward Choke (Bukit Merah, Singapore), who spoke about his centre’s experience comparing sirolimus DCB and conventional balloon angioplasty in patients with CLTI. Ramon Varcoe (Sydney, Australia) took over from Gaines at the podium, to present the 12-month results from the SWING BTK multicentre study, evaluating a sirolimus DCB. Rounding off this section of the afternoon’s programme was Marianne Brodmann (Graz, Austria), with an update on the RESOLV study, which is evaluating a bioabsorbable sirolimus-coated scaffold for BTK treatment.
Latin America comes to CX 2023 LEADERS IN VASCULAR disease from Argentina, Brazil and further afield came together for the inaugural CX Meets Latin America session, taking place on Tuesday morning in Mezzanine 10. Session chair Bruno Freitas (Leipzig, Germany) was joined by an international panel of moderators including Luiz Furuya (Sao Paulo, Brazil), Frans Moll (Utrecht, Netherlands) and Sophie Renton (London, United Kingdom), who oversaw a vibrant session taking in the latest perspectives from Latin America on topics spanning aortic and peripheral procedures. Freitas opened the session with a presentation covering complex multilevel chronic limb-threatening ischaemia, in which he opened the toolbox to offer technical tips to overcome challenging scenarios. Results of an in-situ fenestration technique for preservation of the left subclavian artery in the endovascular repair of acute aortic syndromes were delivered by Andre Pinheiro (Bahia, Brazil), followed by a case report from Tony Furuie (Sao Paulo, Brazil) concerning ipsilateral iliac branch repair
using a looped wire—what he described as a precannulated gate technique. Later in the session, Mariano Castelli (Buenos Aires, Argentina) spoke on predictors of type IIIa endoleak after endovascular aneurysm repair (EVAR) with an anatomic fixation endograft, after which Luiz Furuya (Sao Paulo, Brazil) delivered a presentation on a bridged stent for fenestrated EVAR (FEVAR) and branched EVAR (BEVAR), addressing the question ‘Is there really a difference between them?’ Castelli delivered the penultimate presentation, which focused on FEVAR with a physician-modified endograft after previous failed EVAR in an emergent setting. Finally, Freitas considered current evidence and technical insights on intramural haematoma and penetrating aortic ulcer. All presentations were punctuated with audience participation and discussion, and the session closed with a roundtable discussion on all topics addressed.
Bruno Freitas
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Aortic device conformability: Adapting to the anatomy for better clinical outcomes
that after implantation of an IBE there is a significant increase in motion,” he reported. “In general, the more straightforward your anatomy is, the more probable it is that your device will During one of yesterday’s satellite symposia at CX, speakers addressed the “key endure,” Heyligers remarked. Then again, he noted factor” of conformability in the endovascular repair of multiple vascular pathologies. that the more adapted the system is to the anatomy, the more likely it is to translate into good outcomes, irst to address the audience, Michele Antonello Conformable Device] is the only endograft that has irrespective of the anatomy. The IBE is a “proven (Padua, Italy) argued that true conformability can such robust data coming from a real-life registry.” solution” in this regard, he said in summary. reduce the risk of distal sine in the endovascular Later in the symposium, Jan Heyligers (Tilburg, Giovanni Pratesi (Genoa, Italy) also spoke during repair of type B aortic dissection (TBAD). Speaking to Netherlands) addressed the question ‘Does the session, sharing his insights on the impact of CX Daily News ahead of CX, Antonello remarked that conformability have an impact on the outcomes of conformability on the outcomes of endovascular repair conformability is a “key factor” in device selection, endovascular repair of iliac limb performance?’ In an of abdominal aortic aneurysm (AAA) with angulated and especially so in relation to TBAD as the aorta is interview with CX Daily News, Heyligers remarked infrarenal necks. more “fragile” in this pathology. “Theoretically,” the that conformability is important in treating iliac In endovascular aneurysm repair (EVAR), Pratesi presenter explained, “the less you try to modify the pathology since the flow and curvature of the iliacs are told CX Daily News, conformability is “intrinsic” to anatomy of the aorta, the less the endograft will shock challenging. “We are aiming to have a device that is how a stent graft adapts to a patient’s anatomy and can the adventitia.” conformable to the anatomy.” improve procedural outcomes. Antonello explained that the GORE® TAG® According to Heyligers, there are During the symposium, Pratesi discussed Conformable Thoracic Stent Graft with ACTIVE differences in conformability in the iliac three-year follow-up data from the European CONTROL System “keeps the curvature of the arch branch devices (IBDs) available on the multicentre EXCeL registry on the of the aorta” and stays in the position to which it is market. “There are some devices that GORE® EXCLUDER® Conformable AAA moved. This has the effect of reducing the possibility are stiffer than others,” he explained, Endoprosthesis with ACTIVE CONTROL of trauma to the aortic wall, Antonello noted. In noting that the GORE® EXCLUDER® System, noting how it adds to the long-term addition, Antonello detailed that there is a theoretically Iliac Branch Endoprosthesis (IBE) seems evidence from numerous trials and registries lower risk of a new dissection created by the TAG to be the most conformable to the actual worldwide that support the efficacy of all Conformable Device than with a standard device. anatomy, based on his clinical experience Gore conformable devices. Data from the GREAT Registry of a real-world with the device. The indication to treat challenging Postoperative population have shown that the TAG Conformable Heyligers detailed that he and anatomies within the Instructions for Use angio-CT Device has a low distal sine rate of 4% in chronic his team have researched the Gore (IFU) is “undoubtedly” an advantage of the showing true TBAD aortic dissection patients, Antonello endograft in tortuous anatomy. He GORE EXCLUDER Conformable Device, lumen expansion and optimal communicated with the audience at CX. The results shared, for example, that in one study Pratesi remarked. In particular, he explained, visceral perfusion from this study are “particularly good,” he shared with they implanted 17 IBEs and conducted the device allows for the treatment of short after thoracic this newspaper, citing low incidence of three events: electrocardiography (ECG)-gated as well as severely angulated necks, offering endovascular neurological complications, new endoleaks and new computed tomography (CT) analysis pre- aortic repair with the capability to treat anatomy previously dissections created by the endograft. “I think [the TAG and postoperatively. “We have learned considered unsuitable for standard EVAR. the GORE TAG. #CX2023
Image courtesy of Michele Antonello
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