Peripheral angioplasty Overview, Hardware

Peripheral angioplastyOverview, Hardware

Frijo Jose A

Vascular Access

• Relatively disease-free, without signi Ca• Over a bony structure, if possible• Angle of entry- 30⁰-45⁰• If access vessel-small/potentially diseased-

micropuncture tech preferred

Vascular Access sitesRetrograde Common Femoral Artery Access

•Common access site used for peripheral diagnostic angiography and intervention•Prevent injury to the less diseased extremity

Vascular access sites•Contralateral femoral retrograde access :

•Internal iliac stenoses are best treated from a contralateral approach•SFA,PFA- lesions located within the CFA/involve SFA/PFA ostium -•Proximity to arterial puncture site, Bifurcation anatomy of CFA•Also allows treatment B/L disease with a single arterial puncture

Vascular Access siteAntegrade Common Femoral Artery Access:

•Required for infrainguinal proced•Approx 3cm CFA lies betw ligament & FA bifurcation •Inorder to access CFA, skin entry- prox to ing ligm •Access too close to F bifurc –inadeq working room to selectively cath SFA

Vascular access sitesIpsilateral popliteal retrograde access:

•Useful in SFA occlusion with failure to cross from contralateral or antegrade•Ostial SFA/CFA lesions may also be approached via PA in acute angled terminal ao bifurc•CI- aneurysms of PA, pathology of popliteal fossa- Baker’s cyst

Brachial Artery Access

• Pref access for visc arterial [CA, SMA] interventions• PC approach at BA can lead to a ↑compli rate

– UL arts – smaller, prone to spasm – A small hematoma- Could lead to brachial plexopathy

• Itv req >6F sheaths/smaller pt→open approach preferred

• Left BA access pref over Rt- can avoid carotid origin• A micropuncture tech should be used for all PC BA

intervention

Wire selection

• Many-Teflon/silicone :Some- hydrophilic• Hydr-stenosd/torturous+angle tip–Glidewire– Can be used for crossing tight lesions and can be

advanced independent of a guidewire• 014,018,025,035,038-for initial access,

038:18g needle, 018:21g needle

Estimated distances from FA access

Guidewire-Lesion Interaction

• Floppy portion moving in a linear • Floppy portion piles up prox to lesion—no chance to

cross- backup,redirect,if straight tip→steerable• Floppy tip bent with min R—Cautiously adv wire-

once crossed, wire should straighten- advancing a “buckledup” wire- force→embolization

• Floppy tip “buckledup” with R—backup,redirect,adv -dissect,embolz,wire damag

Catheter ( diagnostic/ guiding)

Length depends on location for usinga) abdominal aorta = 60 to 80 cm length

b) BTK,carotid or subclavian areas 100 to 125cm length

Polyethylene- ↓coef friction, pliablePolyurethane- softer, even ↑pliable→ tracks wires betterNylon- stiffer, can tolerate ↑flow rate- amenable to angioTeflon- stiffest- used mainly for dilators & sheaths

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• 4F IMPRESS Simmons 1 Catheter 65cm..038• Side Ports:N/A• Catheter Shape:SIMMONS 1• French Size:4

• 5F IMPRESS Simmons 2 Catheter 65cm..038• Side Ports:N/A• Catheter Shape:SIMMONS 2• French Size: 5

SOS Omni selective catheter

• Soft, atraumatic, Super-radiopaque tip • Reforming in desc thoracic aorta – below great vessels

rather than transverse arch –safety• The catheter should be pulled from the desc ao into

abd ao with a floppy guidewire “leading,” sometimes with a rotating motion

• The soft, flexible atraumatic tip can be placed deeper into the artery (>1 cm), ↓chance of “catheter kickout.”

• The shaped tip allows the guidewire to flick into the origin of the RA

Omni Flush Angiographic Catheter• Designed as a single catheter to perform flush

aortography, B/L“run off” studies of lower extremities and to cross ao bifurcation with ease for C/L diagnostics in interventional procedures.

• Super-Radiopaque tip• Reforms and maintains shape—even under injection

pressure—with less catheter whipping, resulting in less vessel wall injury

• Less contrast reflux than other flush catheters, thus resulting in lower total contrast dose

Accesses and Selective Guiding Catheters for Some Basic Interventions

Carotid Artery1.First choice access—either FA2.Alternative access—left BA3.Selective catheter—Right carotid: H1,Simmons,Vick;Left carotid : angled glidecath,H1,Simmons

Subclavian Artery1.First choice—either FA2.Alternative access—ipsilateral BA3.Selective catheter– angled Glidecath,H1,Simmons,H3

Celiac or SMA1.First choice—either FA2.Alternative access—left BA3.Selective catheter—RIM,Chuang-C,Chuang-3

Renal Artery1.First choice—contralateral FA2.Alternative access—left BA3.Selective catheter—C2,RDC,Sos-omni

Infrarenal Aorta1.First choice —either FA2.Alternative access—left BA3.Selective catheter—omni-flush,RIM,C2

Superior Femoral Artery1.First choice—contralateral FA2.Alternative—ipsi retro FA for run-off; ipsi antegrade for interv3.Selective catheter—Berenstein,Kumpe,Vertebral

Tibial Arteries1.First choice—contralateral FA2.Alternative—ipsi retro FA for run-off; ipsi antegrade for interv3.Selective catheter—Kumpe,Vertebral

Kumpe catheter

Guiding Catheter vs Sheath

• The use of a guide or sheath is determined by operator bias

• Sheaths are designed with a simple diaphragm or a hemostatic valve, guiding catheters always require hemostatic valves be attached

• During intervention, the guide catheter or sheath should be placed near the lesion to provide for better visualization and improved support

Balloons

• In selecting a balloon, the following criteria should be considered: a) Guidewire ( 0.014“, 0.018“, 0.035“) b) over the wire (OTW) or monorail system c) shaft length

• 0.014“ balloon system is usually for carotid, vertebral, renal, infrapopliteal arteries

• 0.035“ balloon system for subclavian, innominate, aortoiliac, superficial femoral artery

• 0.018“ balloon system also in SFA, infrapopliteal, depends on what the operator prefers

Law of Laplace• Circumfer force/tension (T) exerted on wall of

an inflatd balln ~P within balln & R (T=P×R)• Balln twice R of a smaller balln- twice wall T

for given inflation P→D kept constant, T on wall of balln will ↑linearly with ↑inflatn P

• Larger ballns -require ↓P than smaller ballns to generate substantial dilating forces

• Larger vessels (Ao) require ↓P to dilate & rupture

• Balloon cath with a D matchng outflow vessel beyond lesion

• Balloon length should be > lesion• Balloon centered on lesion & inflated slowly• Inflation maintained for 20s- deflated-

reinflated 3 inflations of 20s

Subintimal angioplasty• Hydrophilic wire not passng• Carefully adv into subintimal plane- if not

spontaneously, gentle inflation of balloon at edge of the plaque

• Wire traversed the lesion subintimaliy• Hydrophilic catheter or other re-entry device

passed OTW to guide it back into lumen• Standard angioplasty of subintimal plane

performed, with stent placement

Femoropopliteal Artery Intervention

Subintimal angioplasty

Stents• The types of stent used in peripheral interventions:

a) Balloon-expandableb) Self-expandablec) Stent graft

Balloon-expandable stents

• Require positive pressure for expansion• Typically rigid with high radial force• Size of the balloon-expandable stent equals to

the size of the reference vessel diameter• Ideal for immobile parts of the body-ie,

subclavian, renal, mesenteric, iliac arteries and at ostial locations

Self-expandable Stents• Deployed in vessels that are flexible or twist during

movement of neck, shoulder or leg – carotid, axillary, superficial femoral artery, popliteal artery

• Nitinol - best flexibility and memory• Stent compressed over a delivery cath & covered

with sheath• Stent deployment achieved by pulling back the

sheath • Stent diameter should be 1-2mm > ref vessel D→

adeq stent apposition

Self-expandable Stents• Some degree of foreshortening- to be taken into

account when choosing • More difficult to place with absolute precision• Generally comes in longer length than BES • Their ability to continually expand after delivery

allows them to accommodate adjacent vessels of different size

StentsDemonstrating the Nitinol self-expandable stent deployment

Stent Grafts

• Used to exclude aneurysm, treat perforations when prolonged balloon inflation failed

• Wallgraft and Viabahn are two options

Decision between SE or BE stents in Iliac Lesions

• Balloon expandable– Aortoiliac bifurcation– Common iliac– Calcified lesions– Chronic occlusions (?)

• Self expanding– Vessels flexible/twist

during movement – Tortuous vessels– Distal external iliac

artery– Contralateral approach– Long diffuse lesions– Aortoiliac bifurcation

(long lesions)

Techniques

Retrograde Iliac stent placement

Techniques

Cross-over technique

• A patient’s complaint of low back pain during balloon inflation may be a warning sign of adventitial stretch, which may occur before aortic rupture

Femoropopliteal Artery Intervention

• Balloon size & length matched to the size ( ~5-6mm) & lesion length( ~40- 300mm) of SFA

• ↑ angiographic results may be accomplished with prolonged inflation times ( 3-5 minutes)

• Dissections are commonly seen after balloon dilation ( due to heavy calcification)

Femoropopliteal Artery Intervention

Stentimplantion ( always SX-Stents):

• Sizing the SX- stent ~ 1mm > SFA• Postdilation with 5.0-6.0 mm diameter balloon

• Popliteal artery -> avoid stent = high risk of stent compression or fracture

Infrapopliteal Interv

• Knee-to-foot patency of one of the three branches is usually sufficient to prevent critical lower-limb ischemia

• Claudication is rarely the result of isolated disease of the infrapopliteal arteries

• Re-stenosis after intervention in these vessels is typically the highest among the lower limb sites

• Obstructive disease in these arteries is often occlusive, diffuse and complicated by heavy calcific deposits

Infrapopliteal Interv- wire selection

• Only atraumatic 0.014“ / 0.018“ guide wires should be used-0.014“ prefered due to vessel diameter

• Type selection ( floppy, medium,stiff) will be driven by the type of disease

Infrapopliteal -Balloon Angioplasty

• Low profile balloon with high pushability and trackability to easy cross the lesion

• Flexibility in small collateral branches • 0.014”/ 0.018" wire compatibility• Diameter 1.5mm-4.0mm• Long (20-210 mm) to reduce procedure times

and dissection

Long balloons (210mm/ tapered)

•Reduced risk of dissections ( no balloon overlap)

•Total intervention /revascularization time significantly shorter

•Reduced X-ray dose for patients, operators as well as for the assistants

Infrapopliteal- Balloon Angioplasty

Renal artery stenosis

• Usually occurs in the proximal 2 cm

• ~75% of lesions are caused by atherosclerosis

• Lesions can be single or multiple, unilateral or bilateral (~25%)

• Diameter: 6.0-6.5mm for men

5.5-6.0mm for women

• Length 3-7 cm

Renal artery-Equipment Diagnostic

• Wires– 0.035” for catheter

placement

• Diagnostic catheter

Intervention• Wires

– 0.014”– 0.035” for catheter

placement• Guiding Sheath• Guide Catheter• Balloons ( 0.014”

compatible)– Low profile– Undersized for pre-

dilation• BE-Stents

Reanal artery stenting

1. Catheter or sheath placement 2. Guide wire (0.014“) insertion. Rosen wire has soft

curled end- ideal- prevents perforating small renal branch vessels

3.Stent placement -> as soon as the tip reach the lesion GC is pulled back into the Aorta

4.Stent deployment, proximal struts should protrude 1-2mm into the aorta

5. Flaring the ostium of the stent ( optional), opens the way for re-intervention and covers the plaque in the aorta

Subclavian PTA• Femoral access used except for TO/severely

angulated – BA preferred• LSCA – FA- direct take-off : RSCA because of its

angulated take-off from inno A- ipsi BA• Ostial RSCA, FA can protect the right CCA• Total occlusions- combined approach• Usually pre-dilated with a slightly undersized balloon• BES sized 1:1 with ref D• Ao-ostial lesions - stent protrude (1–2mm) into Ao • BES - Ao-ostial locations• SES- long segment/more flexibility needed/lesions

beyond IMA→external compression

• COOK

Catheters• Slip-Cath Beacon Tip Catheters• Beacon Tip Torcon NB Advantage Caths• Torcon NB Advantage Catheters

• CXI Support Catheters

• Beacon Tip Royal Flush Plus High-Flow Catheters

• Royal Flush II Nylon Catheters

Slip-Cath Beacon Tip Catheters

• Hydrophilic Coating• Enhanced radiopaque Beacon tip• Sixteen stainless steel wire braid imparts 1:1

torque control to catheter tip & ↑pushability• Nylon material resists softening during

prolonged catheter manipulation

Slip-Cath Beacon Tip Catheters

Beacon Tip Torcon NB Advantage Caths

• Enhanced radiopaque Beacon tip• Gradual transition of radiopaque Beacon tip to

catheter shaft• Sixteen stainless steel wire braid• Nylon material

Torcon NB Advantage Catheters

• Sixteen stainless steel wire braid• Nylon material• Short, flexible atraumatic catheter tip

• Beacon Tip Royal Flush Plus High-Flow Catheters

• Royal Flush II Nylon Catheters

CXI Support Catheters

• For use in small vessel/superselective anatomy for diagn & interv procedures, incl peripheral use

• Low profile from tip to hub ensures smooth transition through small vessels

• Shaft's polymer material offers desired flexibility• Braided SS entire length -pushability• Hydrophilic coating• Embedded radiopaque markers -size the vessel

segment length

• ATB ADVANCE PTA Dilatation Catheter• Advance 14LP• Advance 18LP• Advance 35LP

ATB ADVANCE PTA Dilatation Catheter

• Designed for iliac, renal, popliteal, infrapopliteal, femoral and iliofemoral

• Also intended for postdilatation of balloon-expandable peripheral vascular stents

• 40,80,120

Advance 14LP

• Low Profile • Provides the trackability and pushability to reach

even the most remote infrapopliteal lesions• Hydrophilic coating on balloon and distal shaft,

along with a smooth tip transition• Maintains super-low profile after inflation• 4 Fr sheath compatibility for all sizes• 20 to 200 mm in 2, 2.5, 3, 4 mm D• 170

Advance 18LP

• Low Profile PTA Balloon Dilatation Catheters• Super-flexible tip• Advanced rewrap technology• 80,135

Advance 35LP

• first 8 mm x 8 cm 5 Fr sheath• Low-profile design tightly tapers to the wire• Double-lumen D-shaped design allows rapid

inflate/deflate• 80,135

Amplatz Stiff Wire Guides

• The wire guide has a stiff shaft and a gradual transition to a very flexible distal tip– TFE Coated Stainless Steel-035,038: 145,180,260-

straight– TFE Coated Stainless Steel with Heparin Coating-

035: 145,180,260-straight• 8cm-flexi tip

Amplatz Extra-Stiff Wire Guides

• The increased inner diameter of the wire guide coil allows utilization of an extra-stiff mandril while maintaining tip flexibility.– TFE Coated Stainless Steel-025,035,038:

80,145,180,260-straight & curved: 300-straight– TFE Coated Stainless Steel with Heparin Coating-

035: 80,145,180,260-straight & curved

Amplatz Ultra-Stiff Wire Guides

• The increased inner diameter of the wire guide coil allows utilization of an ultra-stiff mandril while maintaining tip flexibility.– TFE Coated Stainless Steel-035,038: 80,145,180-

straight– TFE Coated Stainless Steel with Heparin Coating-

035: 145,180-straight• 8cm-flexi tip

Roadrunner Extra-Support Wire

• Complex diagnostic/interventions where extra support needed for cath exchange/manipulation of devices

• Heavy-duty nitinol alloy mandril provides support while imparting 1:1 torque response to distal platinum spring coil tip

• Angled tip facilitates directional control• Lubricious TFE coating -low coefficient of friction• 014,018• 180,270,300

Cope Mandril Wire Guides I

• Stainless Steel• Platinum coil ↑visualization and an angled

floppy tip for precise directional control• 018• 40,60,100,125• Standard taper-7cm coil

Cope Mandril Wire Guides II

• Nitinol mandril kink resistant and provides 1:1 torque control

• Platinum coil ↑visualization and an angled floppy tip for precise directional control

• 018• 60,100,125• Standard taper-7cm coil, short taper-7cm coil

Rosen Curved Wire Guides

• The heavy-duty mandril, 2 cm flexible tip and tightened “J” configuration

• TFE Coated Stainless Steel-035: 80,145,180,220,260

• TFE Coated Stainless Steel with Heparin Coating-035: 145,180,260

The Graduate Measuring Wire Guides

• Used to determine accurate sizing of vessel lumen prior

• Gold radiopaque markers delineate 25 cm in length for precise measuring accuracy.

• Six distal markers are spaced 1 cm apart.• Four proximal markers are spaced at

5 cm increments.• 035• 145,180

Reuter Tip Deflecting Wire Guide

• Used with Reuter Tip Deflecting Handle for curving or deflecting catheter tips during selective and superselective angiography

• Facilitates catheter tip movement by controlling the deflection of the wire guide tip within catheter lumen

• Distal tip of wire guide must never extend beyond tip

Double Flexible Tipped Wire Guides

• Permits alternative use of both ends of wire guide, depending on procedural needs

Zilver 518

• Vascular Self-Expanding nitinol Stent- iliac arteries

• Recomm 5.0 Fr sheath/7.0 Fr guiding cath• Accepts .018 inch wire

Zilver 518 RX

• Vascular Self-Expanding Nitinol Stent – Rapid Exchange-iliac

• Recommended 5.0 Fr sheath/7.0 Fr guiding catheter

• Accepts .018 inch diameter wire guide.

Zilver 635

• Vascular Self-Expanding Nitinol Stent • Recommended 6.0 Fr sheath/8.0 Fr guiding

catheter size• Accepts .035 inch diameter wire guide

• TERUMO

• Guiding Sheaths (5-8 Fr)Pinnacle Destination

• 5-8 F• 45,65,90• Hydrophilic coating• All dilators are 0.038" wire compatible

glidewire

Peripheral Guidewires(0.032"-0.038")

Standard GlidewireShapeable Tip GlidewireLong Taper GlidewireStiff Shaft GlidewireStiff Shaft Long Taper Glidewire1 cm Taper GlidewireJ-Tip GlidewireBolia Curve GlidewireGlidewire Advantage™

Small Vessel Guidewires(0.018"-0.025")

Glidewire Standard and Shapeable TipGlidewire GT Super-SelectiveGlidewire Gold

• Hydrophilic Coated Catheters• Glidecath (4 Fr)-65,100,120-038• Glidecath XP (5 Fr)-65,100-038 (↑flow rate)• Glidecath (5 Fr)-65,100-038

• Microcatheters

• Progreat™ (2.4 Fr, 2.7 Fr)- 110/130- OD:0.97/0.9=2.9/2.7 -ID:0.57/0.65

• Progreat™Ω (2.8 Fr)- 110/130- OD:1/0.93=3/2.8 -ID:0.7

• ABBOT

Veripath Peripheral Guiding Catheter

• Three-Layer Construction• 50 cm length• 5 catheter shapes• 6,7,8 F• 014/018

• Hi-Torque Steelcore Peripheral Guide Wire• Hi-Torque Spartacore Peripheral Guide Wire• Hi-Torque Supra Core Peripheral Guide Wire• Hi-Torque Versacore Guide Wire System

• Hi-Torque Steelcore Peripheral Guide Wire

Hi-Torque Spartacore Peri Wire

• Excellent .014" Support with Superb Steerability and a Soft Shapeable Tip

• Core-to-tip design• High-support.014" stainless steel shaft• MICROGLIDE Coating• PTFE Coating up to distal 7 cm• Available in 5 and 10 cm Intermediate

Segment Lengths

Hi-Torque Supra Core Peri Wire

• One-to-one torque response designed for exceptional steerability

• MICROGLIDE coating• Radiopaque tip designed for visibility during

guide wire placement• 035" shaft• Soft Shapeable tip

Hi-Torque Versacore Guide Wire

• Torqueable wire for deliverability through tortuous or challenging lesions

• Soft shapeable tip designed to for lesion access

FoxCross .035 PTA Cath

• D-(3-14 mm), L-(20-120 mm), and cath L (50, 80 &135 cm)-OTW

• 50,80,135• 5-7 F• Guide wire compatibility: 035• Nylon Polymer• JETCOAT coating

Fox sv PTA Catheter

• OTW designed for challenging small vessel procedures

• Range of BTK and SFA sizes (2-6 mm) 90,150• Sheath Compatibility:4F for all sizes• Guide wire compatibility:.014"/.018"

Fox Plus PTA Catheter

• Low Profile• Compatible with a 5 French sheath up to 7mm

balloons.• Excellent rewrapping• Shaft Technology-Adv shaft technology dual

lumen - Rapid inflation and deflation• JET coated shaft, tip and guidewire lumen.

Reduces friction and facilitates access and crossing of target lesions

Jostent Peripheral Bare Stent System

• SS Bare balloon-expandable stent• Rec min sheath size: 1F >balloon• Slotted tube with closed cell design• Six in one:

Every bare stent expandable to 6 different DPost-adjustment of stent size possible

• Standard version: 4-9 mmLarge version: 6-12 mmLength: 12-58 mm

Omnilink Elite Peripheral Stent System

• Iliac• compatibility with 6F sheaths across all sizes• Cobalt Chromium

Absolute Pro LL Peripheral Self-Expanding Stent

• 035• designed to treat longer SFA lesions• 120,150

Xpert Self-Expanding Stent

• 4F compatible -speci designed for small vessels

• Peri vessels from D 2-7 mm• 018• Nitinol• low strut profile• Conformability

• BOSTON SCIENTIFIC

Amplatz Super Stiff Guide Wire

• For stiffness, strength and stability during catheter placement and exchange.

• Diameters: 0.035", 0.038"• Lengths: 145cm,180cm, 260cm• Tips Styles: Straight, J, Short• Core Material: Stainless steel• Coating: PTFE

Magic Torque Guide Wire

• Magic Markers spaced at 1cm increments designed for enhanced visualization and excellent torque control to meet the challenges of difficult anatomy

Diameters: 0.035"• Lengths:180cm, 260cm• Tips Styles: Straight (shapeable)• Core Material: Stainless steel• Coating: Glidex Hydrophilic Coating (tip)

Meier Guide Wire

• Stiff shaft engineered for excellent support, while flexible tip is designed to reduce the risk of vessel trauma during diagnostic and interventional procedures including AAA endovascular graft procedures.

Diameters: 0.035"• Lengths: 185cm, 260cm, 300cm• Tips Styles: J, C• Core Material: Stainless steel• Coating: PTFE

Platinum Plus Guide Wire

• Designed for negotiation of tortuous anatomy and contralateral approaches. Also available in short taper configuration for access in anatomy with short distal

Diameters: 0.014", 0.018", 0.025"• Lengths (cm): 60, 145, 180, 260, 300• Tips Styles: Straight – Long or short taper• Core Material: Stainless steel• Coating: Glidex Hydrophilic

Thruway Guide Wire

• Designed for excellent performance in acutely angled vessels, such as renals and other peripheral interventions

Diameters: 0.014", 0.018"• Lengths (cm): 130, 190, 300• Tips Styles: Straight, J• Core Material: Stainless steel• Coating: Silicone

Sterling ES Balloon Dilatation Cath

• 0.014" balloon cath• Ultra-low profile balloon • Both OTW and rapid exchange platforms• .017" tip entry profile• 140

Sterling SL Balloon Dilatation Cath

• now in long lengths for below-the-knee - specifically designed to meet the challenges of infrapopliteal procedures

• 014,018• available in both Over-the-Wire and Monorail

platform• 90,150

Sterling Balloon Dilatation Catheters

• Breakthrough 4F Profile• Both Over-the-Wire and rapid exchange• 40,80,135• Specifically designed for use in renal and lower

extremity arteries

Sterling Monorail Balloon Dil Cath

• Breakthrough 4F Profile.• carotid, renal and lower extremity• 40,80,135

• Renegade HI-FLO Microcatheter

• Express LD Iliac Premounted Stent System• 035

• Express SD Renal Monorail Premounted Stent System

• 014/018• Low profile; 6F guide catheter-compatible up

to 6.0mm

• WALLSTENT Endoprosthesis• recapturable even when up to 87% deployed

• CORDIS

EMERALD Guidewires

• Fixed-Core, PTFE Coated Wires• 025,035,038• 150,180

PTA DilatationCatheters

PALMAZ Bal-Exp Stent (unmounted)

• Closed cell• SS• Stent D (Expanded) 4-8mm• Stent L (Unexpanded) 10,15,20,29,39mm• Sheath Introducer 6F, 7F

Self-Ex: S.M.A.R.T. CONTROL Iliac

• MicroMesh Geometry, Segmented Design• Nitinol• Stent D 6-10, 12, 14mm (should be 1-2mm >vessel D)

• 80,120 cm• Maximum Guidewire .035"• Sheath Compatibility 6F (6-10mm), 7F (12-

14mm)• Guide Compatibility 8F (6-10mm), 9F (12-14mm)

Self-Ex: PRECISE Carotid Stent System

• MicroMesh Geometry, Segmented Design• Nitinol• Stent D 5-10mm• 135cm, Over-the-Wire• Maximum Guidewire .018"• Sheath Compatibility 5.5F (5-8mm diameters), 6F

(9-10mm diameters)• Guide Compatibility 7F (5-8mm diameters), 8F (9-

10mm diameters)

Self-Ex: PRECISE PRO RX Carotid Stent

• MicroMesh Geometry, Segmented Design• Nitinol• Stent Diameters 5-10mm• 135cm, Rapid Exchange• Maximum Guidewire .014"• Sheath Compatibility 5F (5-8mm diameters), 6F

(9-10mm diameters)• Guide Compatibility 7F (5-8mm diameters), 8F (9-

10mm diameters

OUTBACK Re-Entry Catheter

• Enables fast, simple true lumen re-entry without need for IVUS

• Low profile, 6F sheath compatible• Highly visible "L" and "T" markers- Orient re-

entry cannula towards true lumen easily, eliminating need for IVUS

The cannula (large black arrow) is deployed and the 0.014–in. guidewire (small black arrow) advanced through it. The nose cone (large white arrow) has the radio-opaque ‘‘LT’’ orientation marker. Catheter shaft (small white arrow)

• BIOTRONIK

Cruiser Guide Wire

• 0.014“• L: 190 cm• Tip Shape: Straight and J

Cruiser-18

• Hi-support Guide Wire • 0.018”• Stiff: 195 cm and 300 cm

Medium: 195 cm and 300 cm

Passeo-18

• Balloon Catheter 0.018” / OTW• Hydrophobic patchwork coated balloon

ensures a smooth crossing through tortuous vessels and across high grade stenosis whilst minimising the risk of slippage during inflation experienced using hydrophilic coated balloons

Passeo-35

• Balloon Catheter 0.035” / OTW• Hydrophobic patchwork coated balloon

ensures a smooth crossing through tortuous vessels and across high grade stenosis whilst minimising the risk of slippage during inflation experienced using hydrophilic coated balloons

Elect Explorer

• Balloon Catheter 0.014” / Rx• EFT (Enhanced Force Transmission) increases

pushability whilst coating improves trackability and crossability

• Dedicated and unique dimensions for treatment of infrapopliteal disease.

Dynamic

• Balloon-Expandable Stainless Steel Stent 0.035” / OTW

Dynamic Renal

• Balloon-Expandable Cobalt Chromium Stent 0.014” / Rx

Astron

• Self-Expanding Nitinol Stent 0.035” / OTW

Astron Pulsar

• Self-Expanding Nitinol Stent OTW• Dedicated and unique dimensions for

treatment of diseases of femoral and infrapopliteal arteries.

Thank You…