Social Media Marketing Case Submission
Submit your case details, device performance notes, and supporting media with confirmation of social media consent.
Submission Information
Your name
*
First Name
Last Name
Account name
*
Account number
*
Site of Service
*
Please Select
Hospital
OBL
ASC
Physician
*
First Name
Last Name
Specialty
*
Please Select
IC
IR
VS
Which CROSSLEAD Wire(s) were used?
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CROSSLEAD Pro 035
CROSSLEAD Pro 018 Straight
CROSSLEAD Pro 018 Pre-shape
CROSSLEAD Pro 014 Straight
CROSSLEAD Pro 014 Pre-shape
CROSSLEAD Penetration 0.018" Straight
CROSSLEAD Penetration 0.018" Pre-shape
CROSSLEAD Penetration 0.014" Straight
CROSSLEAD Penetration 0.014" Pre-shape
CROSSLEAD Tracker Straight
CROSSLEAD Tracker Pre-shape
Patient and Case Context
Patient Relevant Medical History
Reference Vessel Diameter (RVD)
*
Lesion Morphology Classification
Calcium Burden
*
Please Select
Severe/Severe-Circumferential
Moderate
Mild
Other
Lesion Composition
*
Please Select
Dense fibrous caps
thrombotic/soft plaque
mixed
Lesion Length
Anatomical Complexity
Acute-angle bifurcation
Severe ostial lesion
Extreme vascular tortuosity
Other
If other, please explain:
Procedure Details
Access / Approach
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Antegrade
Retrograde
Bidirectional
Other
Lesion Location
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Aorta
Iliac
Femoral
SFA
Popliteal
AT
PT
Peroneal
Pedal
Other
Lesion Crossing Details
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Wire crossed subtotal occlusion
Wire crossed chronic total occlusion (CTO)
Intraluminal crossing
Subintimal crossing with re-entry
Other
If other, please explain:
Device Performance and Narrative
Did the wire(s) provide necessary support for device delivery?
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Yes
No
Other
If other, please explain:
Tell us the full story of what happened during the case, including a summary of wire performance:
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Physician thoughts on the CROSSLEAD wire before vs. after the case?
Supporting images and/or videos
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I have received consent that this information can be posted to social media.
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