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How I Deal With... SVGs PowerPoint PPT Presentation


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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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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

50% : < 1 micron

45% : 1 – 5 micron

Erytrocyte = 7µ


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)


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)


  • Luge

  • 2.0c laser


  • 5x28 to mid lesion

  • 5.0x20 proximal

  • 5.0x15 Quantum


Peak CK 194


  • 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


  • Continued pain with ECG changes

  • BP 80 systolic


  • 8F HS

  • IABP

  • Luge


  • 2.0c laser


  • Filterwire


  • 4.0x20 distal

  • 4.0x28 prox

  • 4.0 post dilatation


Peak CK 14


  • Mrs DC, 72 years old

  • CABG 1999

    • LIMA-LAD

    • SVG-OM1 and RCA

  • Tn +ve ACS (>2)

  • Infero-lat ST depression


  • Luge

  • 2.0c laser


  • Filterwire

  • 4.5x28 distal


  • 4.5x24 prox

Peak CK 205


Summary

Conventional wire

Debulk with laser

Filter device

Stent – usually BMS, occ. covered


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