Dr. Tony Das addresses below-the-knee interventions

Calls for development of devices to traverse long total occlusions

Interviewed by Primacea Data Solutions at VIVA10, Dr. Tony Das suggests that long balloons may provide means for getting through long lesions.

Transcript of Dr. Das' insights regarding challenges in below-the-knee interventions (slightly edited for readability)

"The critical outcome in below-the-knee interventions is wound healing and the speed at which that happens. Most of the trials have looked at limb salvage, which is the end point that the patients care about—is their limb on or not?.

"The other question is 'do we really care about patency?' In the past, because patency has been so low in the below-the-knee interventions, we really haven’t focused on it. I think if we had the ability to have a procedure where patency was paramount, we probably would see that would healing would be much faster and better. The combination of patency along with wound healing would be the best possible outcome.

"The real key to device development in the below-the-knee territory is getting devices to successfully traverse long total occlusions. These are typically diffuse or occlusive, usually calcified, lesions, and the success rate is determined by the ability to get through the vessel. So good wires, especially stiff, torqueable wires, or devices which get through total occlusions while staying in the intraluminal space are needed. This is not a territory like the SFA where a subintimal approach is probably as good. This is an area where long balloons, potentially balloons that don’t require stenting, potentially drug-eluting balloons, might make a big difference. The key is getting through long lesions successfully, tracking in the lumen without going subintimal, and then following with a result that does not require a prosthetic stent."