Dan Memmini

210 posts

Dan Memmini

Dan Memmini

@DMemmini

Husband, Father, Coronary CTO Proctor and Sales Trainer for Teleflex. All tweets represent my views only.

Chicago, IL Katılım Mayıs 2018
369 Takip Edilen317 Takipçiler
Dan Memmini
Dan Memmini@DMemmini·
@realarainmd I have often found short CTOs to be some of the most frustrating and time consuming cases. They trick you into into thinking they are one thing when actually they are something else entirely. Great job going through your algorithm to get success for this pt.
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Salman Arain
Salman Arain@realarainmd·
Beware of the Short CTO! 78 M with new onset angina for 8 mths. PET showed a large area of ischemia in the lat. wall. The CTO here is VERY short. Seemingly favorable for any strategy. It was also soft - we crossed the cap with a Sion. But it took us almost an hour to cross!
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Evandro Martins F. MD
Evandro Martins F. MD@evandrofilhobr·
LAD CTO PCI, calcified CTO body and tortuous micro-channel. Good case of wire escalation and negotiation.
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Dan Memmini
Dan Memmini@DMemmini·
@realarainmd A less gracious person would say “I told you so”. I will just say congrats!!
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Salman Arain
Salman Arain@realarainmd·
Do you remember when you joined X? I do! #MyXAnniversary Here is a fun fact: I joined X exactly one year ago while waiting to hand out Halloween candy! 🤩 Little did I know how much it would become a part of my (almost) daily life.😳😂
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Salman Arain
Salman Arain@realarainmd·
It’s definitely energizing! 😅 I was honored to share the podium with people I admire, and who have taught me. The visceral reaction is understandable. But, some of the things that annoy us at first, become indispensable later in life. Dare I say wasabi and sushi for me?! 🍣 🍱 😋
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Jack Hall
Jack Hall@aspergian1·
Congrats
Tom Wilson@TWilsonMD

@jl35wilsonMD and I are performing the first coroflow testing for patients w suspected CMD! Thank you @AbbottCardio for a successful launch. Vasospasm on patient #2! We are now seeing patients in our clinic/OBL, Black Hills Heart and Vascular Institute!

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Dan Memmini
Dan Memmini@DMemmini·
@evandrofilhobr 2) Careful planning is very important. I also agree there is nothing like seeing a pt who has suffered for years, regain their lifestyle after the successful procedure. Keep up the great work!!
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Evandro Martins F. MD
Evandro Martins F. MD@evandrofilhobr·
Sometimes we must take calculated risks to achieve good outcome — as long as every step is carefully planned. 🔹 Proximal LAD CTO opened retrogradely through patent LIMA. 🔹 Distal LAD collaterals used for RCA CTO retrograde recanalization. When there’s no easy way, build one!
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Dan Memmini
Dan Memmini@DMemmini·
@evandrofilhobr 1) Evandro, as always you have demonstrated the how and the why of CTO-PCI. A wonderful case and I loved how you “tested” the pt’s tolerance of having their LIMA partially occluded.
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Dan Memmini
Dan Memmini@DMemmini·
I cancelled my dashpass as well.
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Dan Memmini
Dan Memmini@DMemmini·
If you would like to keep waiting we’ll issue a $10 credit. What a joke. Customer service is dead. I am taking my business (several orders a week) to Uber Eats.
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Dan Memmini
Dan Memmini@DMemmini·
Door Dash sucks!!! @DoorDash I was a loyal customer for over 5 years. That ended tonight. I placed an order and delivery time kept getting pushed back. After 2 hours I canceled the order. Door Dash’s response: Sorry. This is not our normal level of service.
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Dan Memmini
Dan Memmini@DMemmini·
@msjluu You’re right. That’s exactly the same thing!!
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Dan Memmini
Dan Memmini@DMemmini·
@realarainmd Outstanding tutorial as always! I get asked about you and #hdr every week. Keep up the good work.
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Salman Arain
Salman Arain@realarainmd·
4/ There is a lot more to say. But I will end by suggesting that the MC tip injection is an invaluable maneuver for the #CTOPCI operator! I inject early and I inject often! 🤩 We now have at least 4 types of intra CTO injections: #HDR injection, contemporary Carlino, passive Carlino, and the pullback MC injection. How many of these are you familiar with? Hope you enjoyed the case and I look forward to your comments! 🙏🏼
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Salman Arain
Salman Arain@realarainmd·
A Hard Nut To Crack - A #CTOPCI Saga! Here is the #HDR case from last week - as promised. Our pt. is a 70 y/o woman with an LAD CTO, sig. DOE despite OMT, + AW ischemia. There are several tips, tricks, and hacks here - for all operators. Happy viewing!
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Salman Arain
Salman Arain@realarainmd·
The First Touch #contrast1st Approach The use of contrast for #CTOPCI has learning curve → successful #HDR requires several unique skills: 👉🏼 Optimal cap puncture 👉🏼 A gentle (or ‘shy’) microinjection - as @stefan_harb says 👉🏼 Stain analysis 👉🏼 Mindful and deliberate wiring Experienced operators often perform several injections per crossing - but that may not be everyone’s style. The staining of the vessel can be disconcerting! 👉🏼 I believe a ‘1st touch #contrast1st’ approach may be suitable for new users of the technique. 👉🏼 This means one injection followed by standard wire based approaches - including retro. What do you think? How did you become comfortable with #HDR and #CASE?
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Salman Arain
Salman Arain@realarainmd·
Interesting perspective Alfonso - which I obtained with the assistance of ChatGPT’s translation abilities. 😀🙏🏼 CTO trials have been difficult to conduct (and interpret) for several different reasons. IMHO, the three biggest hurdles have been: 1) inconsistent use of reliable, objective measures of ischemic burden associated with any CTO 2) exclusion of exertional dyspnea (by far the most prevalent symptom) as an indication for #CTOPCI, and 3) emphasis on ‘hard’ clinical outcomes (MI and death) alone in many studies. These factors have led to unrealistic definitions (and expectations) of the clinical value of #CTOPCI. In my practice, I offer #CTOPCI for a very simple reason - alleviate symptomatic ischemia as much as possible. I don’t do it to treat a stress test, relieve a particular symptom, improve the EF, or prolong life. Yes, all of these are welcome benefits of #CTOPCI, but often not guaranteed 👉🏼 which is why the outcomes, as currently measured in most studies, can be so disappointing.
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Salman Arain
Salman Arain@realarainmd·
Actually that is a great option! You won’t be able to get the struts circumferentially - only along the outer rim, but it is all about ‘cracking the ring’ and then stretching it out. An unproven (and perhaps fantastical) advantage of laser + contrast in my mind is that it heats the metal making it more ‘mallelable’(?) in a way that IVL cannot. Thoughts from the ad hoc Stent Ablation Panel? 😀
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