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BackTable / VI / Podcast / Episode #312
Which Dissections Matter, and How to Treat Them
with Dr. John Phillips
In this multidisciplinary episode, guest host and vascular surgeon Dr. Krishna Mannava interviews interventional cardiologist Dr. John Phillips about when and how he treats dissections after balloon angioplasty in peripheral vasculature.
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BackTable, LLC (Producer). (2023, April 17). Ep. 312 – Which Dissections Matter, and How to Treat Them [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. John Phillips
Dr. John Phillips is an interventional cardiologist with OhioHealth in Columbus, Ohio.
Dr. Krishna Mannava
Dr. Krishna Mannava is a vascular surgeon and medical director at Vive Vascular in Columbus, Ohio.
Dr. Aaron Fritts
Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.
Synopsis
Since arterial dissection is a known and common complication of balloon inflation, Dr. Phillips emphasizes the importance of distinguishing between dissections that are flow-limiting and need to be treated, and those that are not flow-limiting. The dissection can be evaluated by measuring pressure gradients and intravascular ultrasound (IVUS). If the dissection flap arc is greater than 180 degrees, Dr. Phillips generally considers it to be flow-limiting. Next, he will determine plaque composition in the area of the dissection. If it is calcified or long, he will deploy a woven nitinol stent. If he needs to target a more specific area that is not calcified, he will use the Tack Endovascular System.
The doctors discuss more details about the Tack system. It is a scaffold system that was created specifically for use in dissections after balloon angioplasty in narrowed vessels. The deployment of multiple small devices contributes to an overall lower metal burden than a stent would introduce. The system also has an adaptive and overlapping sizing platform to address dissection in different vessels in the same procedure. Since the Tacks are only meant to scaffold the dissection flap, they do not exert as much radial force as a stent does. This is the reason why Dr. Phillips generally avoids using it in heavily calcified areas. Dr. Phillips also answers submitted audience questions regarding the indications, technique, billing, and education opportunities for the Tack system. Overall, he encourages practitioners to get in touch with their local sales representatives for more information, and brings up the possibility of remote proctoring in the future.
In terms of follow up care after balloon angioplasty and Tack placement, Dr. Phillips prescribes dual antiplatelet therapy for three months and possible switches to monotherapy afterwards. This is the same regimen as he prescribes for patients with stents. Additionally, surveillance duplex appears similar in patients with Tacks and stents.
Resources
Tack Dissection Repair Device:
https://www.usa.philips.com/healthcare/product/HCIGTDTCKESYSTM/tack-endovascular-system-dissection-repair-device
Dr. John Phillips Twitter:
https://twitter.com/midohiovascular
Transcript Preview
[Dr. Aaron Fritts]
I kept hearing over and over, "Well, our docs just leave it and they'll reassess it later." In my mind, I'm like, "I don't know when's later. You either get it done now or don't do it, frankly." Just be aware that they're expensive. If you're going to do them for the first time, try a couple of simple dissections, get a feel for it. Don't be putting in 15, 20 of these things in because that's not going to help anybody, but use them judiciously, then you'll be all right.
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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