Severe calcified, eccentric CFA lesion in non-stenting zone is one of the toughest case for EVT. I would like to introduce you to a novel flossing method “Crossvac” which enables us to reduce eccentric calcification, gets enough lesion modification, and would even make it possible to avoid stenting.

1. “Crossvac”
- A new aggressive flossing strategy
Dept. of Cardiology, Tokyo General Hospital, Japan
Yukihiro Yamaguchi, Hideyuki Takimura Reiko
Tsukahara, Toshiya Muramatsu Masatsugu
Nakano, Noriko Amaike
Mami Kawano, Emi Tajima, Yosuke Komatsu
Complex Cardiovascular Therapeutics 2019 - My Best Case Competition

2. CCT2019
COI Disclosure
Yukihiro Yamaguchi
The authors have no financial conflicts of interest to
disclose concerning the presentation.

3. ・Severe calcified, eccentric CFA lesion in non-stenting zone is
one of the toughest case for EVT.
・We use a new flossing technique “ “ which
enables us to reduce eccentric calcification, gets enough lesion
modification, and would even make it possible to avoid stenting.
Introduction
Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

4. Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

5. Rt. SFA proxysmal, 6Fr Brite® Tip Sheath Lt. FA, 6Fr Destination 45cm

7. GW：Jupiter FC
MC：Corsair Armet®
(60cm)
)

8. Filtrap® 3.75Fr
(Φ 8mm)

9. Crosser®

11. New strategy “Crossvac”
“ Crossvac” = =“
= Crosser + EVAC 6Fr. OTW aspiration catheter 60cm
Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

12. New strategy “CROSSVAC”
Calcification
Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

19. Crossvac
Crossvac +
3mm Balloon
Crossvac +
5mm Balloon
6mm
Cutting Balloon

20. Debris of calcification
inside Filtrap®
Operation time
: 1 hour 36min

21. Device summary
Rt. SFA proxysmal
 6Fr short sheath
 GW: Jupiter FC
 MC: Corsair Armet (60cm)
 Crosser®＋E-VAC 6Fr
 IVUS
Lt. FA
• 6Fr Destination
• Filtrap® 3.75Fr (φ 8mm)
• Balloon (3*40mm)
• Balloon (5*40mm)
• Cutting balloon (6*20mm)

22. n 12
Age[y.o.] 80.9±8.8
Female 3 (25.0%)
BMI 23.4±2.7
Hypertension 10 (83.3%)
Dyslipidemia 10 (83.3%)
Diabetes Mellitus 3 (25.0%)
Hemodialysis 1 (8.3%)
Cre [mg/dl] 1.3±1.5
Critical limb ischemia 2 (16.7%)
Pre ABI 0.6±0.2
Clinical data in our hospital
n 12
Target lesion
CFA 5 (41.7%)
SFA 3 (25.0%)
POP 4 (33.3%)
CTO 9 (75.0%)
Lesion diameter[mm] 5.8±1.0
Lesion length[mm] 46.3±17.7
Post balloon diameter [mm] 5.6±0.5
DCB 6 (50.0%)
Study design: Retrospective study, non-ramdomized
Term: between September 2018 and May 2019
Subject: EVT for calcified lesion with CROSSVAC, 12 cases 12 legs
Patients and lesion characteristics:
Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

23. Results
0
5
10
15
20
25
30
Pre Crossvac Post Crossvac Post POBA
P<0.01
P<0.01
[mm2] Minimum lumen area (mm2)n 12
Technical success 12 (100%)
Angiographic success 12 (100%)
Complication 0
Primary patency at three
months
12 (100%)
IVUS findings
Distal lumen reference area
(mm2)
28.1±16.4
Distal lumen diameter (mm) 6.2±1.4
Dept. of Cardiology, Tokyo General Hospital, JapanCCT 2019 My Best Case Competition

24. SUMMARY
・“Crossvac” is useful to reduce eccentric calcification, and get a enough
lesion modification.
・E-VAC can help straightening curved vessels, so it make crosser® work better.
・Lower risk of bleeding complications is expected.
CCT 2019 My Best Case Competition Tokyo General
Hospital

25. Term: between September 2018 and May 2019
Subject: EVT for calcified lesion with CROSSVAC, 12 cases 12 legs
Retrospective study, non-randomized
• Patient and lesion characteristics
• EVT strategy
• Technical success rate
• Angiographic success (<20% residual stenosis)
• IVUS findings
• Primary patency at three months post procedure
Subject and Methods