Ocelot & Pantheris Systems for treatment of Bilateral SFA/Popliteal CTOs
Image-Guided Diagnostic and Therapeutic Treatment
Edward Pavillard, DO Vascular Surgeon
Pottstown Memorial Medical Center
Pottstown, PA
A 53-year-old male presented to Pottstown Memorial Medical Center in Pottstown, Pennsylvania, with rest pain and claudication in both legs.
The baseline angiograms showed multiple occlusions: long, bilateral SFA CTOs and on the left side, CIA/EIA CTOs. The SFA occlusions reconstitute at the popliteal (FIG 1).
(FIG 1) and (FIG 3)
Dr. Edward Pavillard decided to treat both legs with the Ocelot and Pantheris systems. The Ocelot catheter uses OCT intravascular imaging to facilitate intraluminal crossing of total occlusions, while the Pantheris provides real-time OCT intravascular imaging to guide targeted removal of diseased tissue during directional atherectomy. In the right leg, first Dr. Pavillard used an Ocelot to successfully cross the SFA CTO, followed with lesion excision using a Pantheris 7F atherectomy catheter. The OCT imaging permitted him to identify and excise eccentric diseased tissue, which is collected in the Pantheris nosecone for removal from the vasculature. OCT guidance allows for atherectomy of disease while avoiding damage to healthy tissue (FIG 2), which was important since angiography does not always show the eccentricity of the tissue clearly. Dr. Pavillard completed treatment in the right leg with balloon angioplasty. Due to the targeted disease cutting facilitated by the Pantheris catheter, post-atherectomy stenting was not warranted.
Two months later, the patient returned for treatment of the CTO in his left SFA. Dr. Pavillard used the Ocelot MVRX, Avinger’s most aggressive image guided CTO recanalization catheter, to cross the SFA CTO and followed with insertion of the Pantheris 8F system to debulk the diseased tissue. Real time imaging during CTO crossing and atherectomy allowed for substantial luminal gain before following up with vessel dilation using a specialty balloons.
CONCLUSION
Lumivascular imaging with the Ocelot and Pantheris catheters allowed successful crossing of bilateral CTOs without disrupting healthy vessel tissue, as well as excision of only the necessary plaque. When the patient came back for a 6-month check-up, vessels in both legs were patent and all symptoms of claudication had resolved. Ocelot and Pantheris guided treatment of the bilateral SFA CTOs provided great results without necessitating the placement of stents.
(FIG 3) (FIG 4) (FIG 5)