Andrew Holden (Auckland, New Zealand) and Peter Schneider (San Francisco, USA) discuss the Tack Endovascular System (Intact Vascular) and its impact on below the knee and above the knee procedures at the Charing Cross Symposium 2019. Schneider talks about the “limitations of the current clunky stenting paradigm” and how the Tack Endovascular System – which was recently given pre-market approval by the FDA – provides a benefit by “returning control of the procedure to the operator” with its ability to provide focal dissection repair (or spot stenting). Holden meanwhile discusses how the adaptive sizing of the Tack will help overcome injury caused by “aggressive oversizing” with self-expanding stents. He also touches on the TOBA BTK trial, an early safety and feasibility study for tibial arteries. In this study Holden says that primary patency, which is normally around or below 50% at 12 months, increased with the use of the Tack Endovascular System to around the 80% mark with the use of Tack device. This video is sponsored by Intact Vascular.