Editorial | CIRSE 2012 Summary | Which Medical Device

CIRSE 2012 in Lisbon was one of the best IR conferences I’ve been to. The programme content was excellent coupled with a great location and good social events.

I spent a bit of time in the exhibition hall seeing what devices were either new, innovative or looked like I could use in my practice. Here are some that caught my eye:

1.   The Boston Offroad is a competitor to the Cordis J and J Outback device. It is said to aid re entry into the true lumen during subintimal angioplasty. It works by inflating a small (5.4mm) conical balloon in the subintimal space which preferentially inflates towards the true lumen. A mico catheter lancet is then advanced through into the true lumen and a 0.014” wire is then inserted through this giving access into the true lumen. I am told the price will be comparable to the Outback device.

2. Along with the Offroad, Boston were showing the Truepath device for crossing CTOs. This is a small 0.018” wire with a diamond coated tip that rotates at 13,000 rpm to allow you to drill through heavily calcified lesions. There are audible alerts to tell you when it has started drilling and when it has encountered excessive resistance. I saw a short video demonstration on the Boston stand at CIRSE.

3. There is currently a considerable interest in renal denervation with at least 30 new devices in development. 2 that have recently come to market are the Covidien OneShot system and St Jude EnligHTN system. The OneShot has a spiral shaped electrode wrapped around a balloon allowing a spiral ablation with one application whilst the balloon is inflated. The St Jude EligHTN has 4 asymmetrically placed electrodes on a cage that expands to opposed the renal artery wall. This is a multi ablation technique requiring the electrodes to be energised sequentially. I am told that this will be modified in future to allow simultaneous ablation at all 4 points. The Medtronic Symplicity system is also being modified to allow multi ablation and Medtronic have just published a series of 9 cases using the new device.

4. Cook were demonstrating the Aprima non vascular access set along with a combined set for PTC and transluminal biopsy of bile duct lesions. This set included a set of spring loaded 5.2Fr flexible biopsy forceps (pic) that looked very useful. I have previously used the Boston Piranha ureteroscopic biopsy forceps (3Fr) through an access sheath which also work very well. Cost and the combined set may well be a deciding factor. Some would see the combined set as an advantage, but others would want the biopsy forceps separate which I believe will be possible.

5. Although my hands are steady (most of the time) my eyes are perhaps not quite as good at close focus as they once were. The Bowtie from Merit Medical is one of those small, simple and clever devices that Merit are known for. The device fits easily onto the end of a sheath or catheter allowing a 0.018” wire or smaller to easily be inserted into the sheath in one go. Simple, no doubt cheap, but I think would need to be routinely included in a pack for me to use it. Here’s a short video clip I took at CIRSE showing how it works.

6. The Surefire micro catheter infusion system (Surefire Medical) has recently been launched in Europe and was FDA approved in June 2012. This is essentially a micro catheter with an expanded tip that will collapse under pressure of forward flowing blood but expands to act as a valve to prevent back flow during infusion of therapeutic agents. The catheter is 3Fr taking a 0.018” guidewire and will go through a 4Fr sheath. It looks like it may have significant potential to help deliver targeted therapy minimising non target embolisation and tissue toxicity.

Phil Haslam, Editor-in-Chief, Which Medical Device

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