Riyaz Charaniya

@naderjo @akbarul @realarainmd @mirvatalasnag @suricardio @SyedYNaqvi1 @abadkhan2002 No.. ST elevation has settled while doing angio.

@riyaz_doc @akbarul @realarainmd @mirvatalasnag @suricardio @SyedYNaqvi1 @abadkhan2002 Please correct me: I don’t see any occlusion though, did the patient have ST elevation while doing this angio?

Recent IWMI.. how do you approach this one.. ..!?? @akbarul @realarainmd @mirvatalasnag @suricardio @SyedYNaqvi1 @abadkhan2002

@realarainmd @akbarul @mirvatalasnag @suricardio @SyedYNaqvi1 @abadkhan2002 50/female, Inf stemi, ef-50%, stable hemodynamics.. no rest angina..

Thank you Riyaz. Can you share more on the MI: STEMI vs NSTEMI vs type 2? Also pt’s profile: sx, hemodynamics, EF? GDMT is a good first step. PCI is tricky, not impossible. I’d consider a very soft wire (e.g., Suoh). My diagnosis: looks like coronary FMD at 1st glance,

@mirvatalasnag @akbarul @realarainmd @suricardio @SyedYNaqvi1 @abadkhan2002 IWMI , more than 48 hrs, no rest pain at present.. Few plaques in the left system. Essentially normal and non - ectatic/ non tortous vessels ..

@riyaz_doc @akbarul @realarainmd @suricardio @SyedYNaqvi1 @abadkhan2002 What does the left system look like? Clinical presentation?

What does this highly mobile mass in LV look like.? Fair LVEF. Non specific chest discomfort in 40y/F.. @Biswaji83036474 @suricardio @DrRajeshG1

@DrIHHashmi1 Exemplary... 👍

Further insight into the case. It was an RCA to RA fistula. Percutaneous closure. Wire crossed from Aorta-RCA-RA-PA. Snared externalised. Device deployed from the Venous side. Successful closure.

A 51-year-old male presented with SOB. Dilated RA, RV severe PHTN. What do you think about it.

@DrIHHashmi1 OPN nc higher pressures works sometimes for such cases.. 0.5 undersized..

Stent ablation of a freshly deployed Stent is a high-risk bailout procedure for a severely underexpanded freshly deployed Stent due to underestimating CN. A case of IVI and rota regret. Disclaimer. Lesion preparation wasn't adequate.

@DrIHHashmi1 How can you say stent fracture? Something on ivus?

Ivus after post-dil. LAD with 4.5 nc at 20 atm and LM 5.0 nc at 16atm. What do you think what had happened? Now what to do?

SCAD or not. 34y male. Newly diagnosed DM. Chest pain. Osteo proximal lad critical stenosis. What do you think, is it SCAD or not?

@realarainmd @abadkhan2002 @jedicath @akbarul @mmamas1973 @mirvatalasnag @suricardio @SareenSaab @SyedYNaqvi1 Sure will do.. thanks for your response and inputs on this case. Always insightful to learn from others experiences..

@riyaz_doc @abadkhan2002 @jedicath @akbarul @mmamas1973 @mirvatalasnag @suricardio @SareenSaab @SyedYNaqvi1 Good outcome thus far. Thank you for the update. Let us know how the patient does and share any pictures the surgeon may take (with the appropriate permissions of course!).

When you encounter something unexpected. Night time primary PCI.. IWMI with CHB.. what next to do? @akbarul @mmamas1973 @abadkhan2002 @mirvatalasnag @realarainmd @suricardio @SareenSaab @SyedYNaqvi1

@spyros_doc Rarely ever used it.. 10-20 mg is what has been used in studies..

@riyaz_doc Great job! Is this your standard dose of TPA IC?

@realarainmd @abadkhan2002 @jedicath @akbarul @mmamas1973 @mirvatalasnag @suricardio @SareenSaab @SyedYNaqvi1 Putting in covered stents were thought of. But length of graftmaster would not be enough and get consumed by aneurysm. So would have to create a DES platform first followed by 2-3 overlapping graftmaster. Lucky to have CHB recover with des and surgeon agreeing for cabg. :)

I see your point. To me the thrombus looks organized, and I suspect there may be more of a mass effect on the laat remaining TL. I would avoid stenting to maximize the patient’s chances of going for CABG. Resolution of the heart block may be a good indicator that PTCA has worked. 🤔

@suricardio @DrRajeshG1 @Biswaji83036474 @akbarul Adult ALCAPA with septal colletrals it is..

45 yr old with chest pain. Interesting echo!! @suricardio @DrRajeshG1 @Biswaji83036474 @akbarul

@DrRajeshG1 Stent..

Will you stent after thrombus aspiration if this result is obtained. Pt couldn’t afford OCT imaging.

@evandrofilhobr Imaging showed fibrous leison.. accelerated neointimal proliferation .. likely balloon injury from index procedure... We did a lmca to lad stent.

Looks like hematoma progression. That’s a very unusual case. Any IV imaging?

@SareenSaab @abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @suricardio @DrRajeshG1 @KardiologieHH Yup.. drug not delivered properly. Accelerated neointimal response to balloon injury..

@riyaz_doc @abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @suricardio @DrRajeshG1 @KardiologieHH Likely damage during DEB as these have long fixed lengths and to avoid the geographic miss to the D1 ostium, a part of the balloon must have been in the LAD causing native vessel damage(prolonged inflation ?hematoma)

CUT & DEB.. !! Done for Diagonal with seemingly good end result.. (other lab) Patient now with angina within a month. !! Ostial lad critical!! What went wrong?? @abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @SareenSaab @suricardio @DrRajeshG1 @KardiologieHH

@KardiologieHH @abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @SareenSaab @suricardio @DrRajeshG1 Did lmca to lad stent .. was a fibrotic leison, likely accelerated neointimal proliferation post balloon injury & inadequate drug from DCB..!?

@riyaz_doc @abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @SareenSaab @suricardio @DrRajeshG1 #Imagefirst to understand pathophysiology! I bet on dissection in prox LAD caused by CB (and DEB) + haematoma after index procedure. This is not atheroslerosis… Please show us how you treated the patient🙏

@abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @SareenSaab @suricardio @DrRajeshG1 @KardiologieHH It was a fibrotic leison, accelerated neointimal proliferation likely post balloon injury to lad .. probably the drug in DCB not delivered properly?!

@abadkhan2002 @mmamas1973 @mirvatalasnag @care4urheart2 @akbarul @SareenSaab @suricardio @DrRajeshG1 @KardiologieHH Index procedure done outside .. wolverine plus DEB only done.. index procedure end result doesn't show any major problems with lad.. we did a lmca to lad with image guidance @suricardio