• CLINICAL INTEREST SECTIONS: Congenital Coronary Peripheral SCAI TAVR Center

  • SCAI This Week
  • July 27, 2012

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    CCI: XCELL Trial Confirms Nitinol Stenting Improves CLI Outcomes

    Data from the XCELL Trial now available in Catheterization and Cardiovascular Interventions (CCI), reports that infrapopliteal nitinol stenting to treat critical limb ischemia (CLI) is safe and effective in improving wound healing, providing pain relief, and promoting amputation-free survival.

    CLI affects close to 30 million people in Europe and North America, with most experiencing pain and ulcers with or without gangrene in the legs. Experts agree that current treatment options should aim to relieve pain, heal ulcers, prevent limb loss, improve quality of life and prolong survival. Previous research, however, show amputation rates are as high 40% in CLI patients in the first year following their diagnosis, with mortality rates approaching 20%. Moreover, prior studies estimate that 160,000 amputations due to PAD are performed each year in the U.S., of which a 25% reduction could save $29 billion in health care costs according to the Sage Group.

    "With the obesity epidemic, we expect the incidence of diabetes to rise as well, and as these patients age this could sharply increase rates of CLI," explains Krishna J. Rocha-Singh, MD, FSCAI with Prairie Education & Research Cooperative in Springfield, Ill. "It is essential that we identify less invasive treatment strategies that are safe and effective in improving vascular disease."

    One promising procedure for improving CLI outcomes is PTA with stenting of the infrapopliteal arteries. The multi-center trial of the "XpertTM Nitinol Stenting For Critically IschEmic Lower Limbs" (XCELL) evaluates the safety and effectiveness of this procedure in patients with CLI. The procedure was evaluated in 120 CLI patients with infrapopliteal lesions of 4-15 cm in length. A total of 140 limbs and 212 implanted devices were included in the study, with 12-month amputation-free survival (AFS), limb salvage, wound healing and pain relief determining the success of the procedure.

    Results reveal that 12-month AFS was 78%. Further analysis confirmed that according to baseline Rutherford classes 4, 5, and 6, the 12-month AFS rates were 100%, 77%, 55%, respectively; freedom from major amputation were 100%, 91% and 70%, respectively. The investigators also determined that the 12-month freedom from major amputation rate and clinically driven target lesion revascularization were 90% and 70%, respectively. Six-month and 12-month wound-healing rates were 49% and 54%, respectively. Moreover, Rutherford class 4 patients had significant pain relief through 12 months.

    "Our XCELL trial findings confirm that infrapopliteal nitinol stenting is safe and effective in treating CLI patients," concludes Dr. Rocha-Singh. "While there were a few major adverse events, such as death, heart attack, or major amputation that occurred in the first 30 days, at the first year post-procedure, limb preservation, wound healing and pain relief rates were excellent." The authors also point out that the 12-month wound healing with nitinol stenting was similar to the more invasive open surgery.

    Download this Study from CCI

    Purchase SCAI 2012 On Demand and View the CLI Symposium From Las Vegas

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    SCAI TRIP Series to Offer Structured Hands-on Simulator Curriculum

    One of the highlights of the upcoming SCAI TRIP programs in Chicago on September 8 and Houston on December 15, will be a structured simulator curriculum with one-on-one faculty interactions.

    "The hands-on simulator curriculum will take participants through the basics of radial arterial access, traversing the arm and chest vasculature, and coronary angiography with standard catheter shapes as well as dedicated radial curves," said TRIP Chicago Co-chair Sunil V. Rao, MD, FSCAI. "Faculty proctors will work with attendees one-on-one to review tips and tricks and help troubleshoot common challenges."

    Of course, this simulator curriculum will just be a portion of this diverse education program that will also include case reviews, a separate nursing / tech symposium, didactic lectures, and more. Best yet, this comprehensive offering is designed for interventional cardiologists, interventional cardiology fellows-in-training and other healthcare professionals (nurses, technologists, etc). whether you are looking to launch a transradial program or looking to pick up advanced skill sets.

    More on SCAI 2012 Fall Fellows Courses

    Download the Preliminary Program

    Find Out About FREE SCAI Membership for Interventional FITs

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    SCAI Offering First-Year Interventionalists 50% Off Membership

    SCAI wants to express its congratulations to all interventionalists-in-training who have completed their interventional cardiology fellowship training program!

    The Society recognizes this is an exciting time in your career, a time when opportunities may be plentiful but resources limited. It may also be the point in your career when you most need to be part of a community, a member of an organization whose members share your values and your goals and which is physician-led by doctors, for doctors.

    With that said, SCAI is offering 50% first year's dues for all new interventionalists!

    Details on This Offer & How It Can Help YOU Launch Your Career

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    Great Time to Take Advantage of SCAI Member Discount on Wiley Books

    It's summertime, and the living is easy with the SCAI Member 25% Discount on Wiley books.

    Need help planning your itinerary for that summer vacation? Then take advantage of the discount on Wiley's Frommers Travel Guides.

    Need help picking up a new hobby or interest? Then peruse Wiley's For Dummies titles.

    Looking for a cardiology text? Wiley.com has those too.

    Whatever Your Literary Needs, Start Shopping Now!

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    eLearning Spotlight: IFI/ICI Continue to Grow With Exciting Additions

    Revised content for SCAI's Interventional Fellows Institute and Interventional Cardiologists Institute eLearning Courses is now online. Visit the site now and join SCAI members and thought leaders in viewing a new modules on acute MI management and transradial catheterization.

    The IFI/ICI curriculum continues to grow with updates by SCAI membership on the latest information on a variety of exciting topics. Stay up to date and consider getting involved to participate as a future contributor for many more upcoming modules.

    Also, be sure to take a look at other exciting offerings from SCAI's eLearning Library including:

    • High-Risk PCI Online Curriculum
    • Peripheral Vascular Disease (PVD) Online Curriculum
    • SCAI 2012 On Demand
    • SCAI's Quality Improvement Toolkit (SCAI-QIT) Webinar Series
    • SCAI Radial Summit Online

    Visit the ICI/IFI eLearning Courses

    View Additional Online Offerings at SCAI's eLearning Library

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    SCAI President J. Jeffrey Marshal Details Legislative Fly-in on Twitter

    With over 800 Twitter followers, @SCAI continues to spread the word about Society publications, advocacy, education and quality efforts beyond it's traditonal audiences.

    We've also added the following twitter accounts: @SecondsCountorg, @SCAI_WIN, @SCAINews. The latest addition is a twitter account for SCAI President J. Jeffrey Marshal, MD, FSCAI @SCAI_Prez.

    During SCAI's recent legislative fly-in, Dr. Marshall tweeted about some of the more interesting moments on Capitol Hill:

    @SCAI_Prez
    I'm among several SCAI members & other #specialtydocs visiting Capitol Hill this week to discuss issues with Congress. http://bit.ly/MWlvwY

    @SCAI_Prez
    We R focused on 4 points at #specialtydocs conf: SGR, IPAB, medical liability reform, & meaningful quality improvement. http://bit.ly/MWlvwY

    @SCAI_Prez
    Honored & excited to introduce Georgia Congressman Dr. Tom Price at #specialtydocs conference today. http://bit.ly/NduDfO

    @SCAI_Prez
    @RepTomPrice says US innovation being stifled by govt red tape. #Specialtydocs, engage in political process to preserve innovation for pts.

    @SCAI_Prez
    Why #specialtydocs must stand up for innovation: 5 yrs to get #TAVR approved in US; 47 countries ahead of us w this life-saving innovation.

    @SCAI_Prez
    We need medical liability reform becuz defensive medicine wastes billions of $ & it's not good for our patients. @RepTomPrice #specialtydocs

    @SCAI_Prez
    @RepTomPrice on liability reform: Guidelines from #Specialtydocs societies will protect drs & limit frivolous lawsuits that drive up costs.

    @SCAI_Prez
    Advocating 4 patients' access to quality care w SCAI colleagues Joe Babb, Ted Bass, Charles Chambers, Marc Schweiger, Tom Tu. #specialtydocs

    @SCAI_Prez
    On DES variation study: study should generate hypotheses, not practice models. Too many limitations for conclusions. http://bit.ly/Mf8qKL

    @SCAI_Prez
    This AM, I'm at the #specialtydocs conference hosted by the Alliance of Specialty Medicine. See what we're focused on: http://bit.ly/MWlvwY

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