Dr. Michael Lichtenberg discusses the identification and angiographic characterizations of PAD dissections and how IVUS enhances visualization and treatment decision making.
with this presentation, I would like to give you some insights how you can use Iver's to identify that section and maybe how to treat that sections. So, based on an geographic characterization off the sections, we have different scores available the most use course than N H L B ice cores You can see here. I think this is very unknown, but with this course, you really can't see inside the bloomin and you don't know how to treat these sections. In the individual patients, you see the different characteristics off these, uh, dissections here. Typical class D spiral dissections. So the question is, what is inside the looming? Do we have troubles? Do we have on obstruction a significant obstruction off the legions? This is hard to predict just on angiography. So with angiography, we do not learn enough. Um, if our therapy strategy is correct and we have to raise the questions, do we can get more information using Iver's? They're sections are very frequent and often severe. We know that the sections can impact our outcome, especially if that section with class D or higher is left behind and can really and significantly lower Patton. See rates. Based on this Kobayashi dissection grading scale, we definitely need to treat dissections, especially here is shown with Group C. They're sections, as just stated impacts clinical outcome after prober, so there is a clear need to learn more about their sections and to treat it. Mechanical support is still needed below the knee, and we know that especially post PTR below the knee. We saw a lot of the sections, but it's very hard to predict severity off the sections below the knee because there's a lot of bone overlap or different views. Different angle ations on Andrew graph. It needs to be performed. This means we need a lot off contrast. We needed a lot of radiation exposure to really learn on angiography how to treat it. The sections. The sections can be very easily seen with Ivers, especially if you add chroma flow. As you can see here on this example, there is a severe dissection, and there's a flow behind that. The sections here is even a severe dissection with the trauma information on it. That means we need to do something here. It was hard to predict just on Androgel. Here's some more examples on the sections which were not seen on angiography. You can see here with Kromah, flow the flow behind that this section and you see that a significant resting knows this Waas um left here. So there is a clear indication for maybe, uh, prolonged balloon angioplasty or even a stand implantation. You see how this section flap looks like with the chroma flow. And here you see the section on the right side also on this example with Cuomo Cuomo flow. This is a typical case example. I've this post aspirational art director me and the corresponding iris images demonstrates a looming gain at the expense off advantage, er injury on Andrew. We did not see the advantage chur injury. So advantage, er injury means that we need to do something here with prolonged angioplasty or even stand implantation. Yes, a typical that section post directional art director me the correspond ending Ivers image and demonstrates looming gain at the expense off creating at the sect. Here. This is a typical pasta irritable artery after Pogba angioplasty and you see there is something going on in the vessel. But what is it? Is it dissection is a Trumbo's is rester noses. I've This could help us to guide here the therapy And after prolonged angioplasty here and implanting some tack devices, we could resolve the dissection, which is seen on the right side. The idea section grading system was recently published by Nicholas Shamas. This is the first and only, um, the section grading system which we have available. And this combines the death and extent off post intervention dissection. Here you see the use off the idea section grading system, death after the section and here the extent off this section. So this helps you to really great to the section after angioplasty. There are six at that section. Grades mentioned within this paper. As you can see here, the severe um, that section grades are C one and C two. Within this paper, he found 4 to 6 time more dissections than on angiography. So significant mawr diagnostic value four. I was over angiography and he also could show that the severity off the sections was much higher than with angiography. So this case study shows you the value of fivers just on NGO. You couldn't see any dissections. IBIs using the idea section grade showed us five different that section areas, and this definitely impacts our therapy. So our post Post art director me in this patient, we saw some slide that section and a proximal part here a one, a one, but even a severe one sc one dissection in the more distal part. And after angioplasty, you can see that the sections improved a little bit from C one to be to and even though to a one. So I've This could help us with prolonged balloon angioplasty toe get therapy. And we could definitely lower the extent off that section based on Angelo. And I was together then. And to predict the better outcome for this patient here in terms off Peyton C. Thank you.