Leung Calvin

Appreciate the question. Current data in coronary use very limited; wire perforation may be better tolerated, while risk spikes when it goes unnoticed and devices follow. Perhaps, in addition to controlled wire manipulation with 3D techniques, confirm distal true-lumen position before any device, and consider IVUS to ensure the wire isn’t too close to the adventitia side before any atherectomy- could be key to safety in this technique.

@drcleung Very nice. Can you provide depth on the perforation risk, especially concerned about wire penetrating the vessel outward on deflection when you cross the distal wall of the module.

Excellent demonstration ARCADIA technique for Calcified Nodule in #PCI by Dr Kiwamu Sudo: doi.org/10.1016/j.jacc… And our editorial comment - Intra-Calcium Modification: New Promise for Calcified Nodule in PCI? : doi.org/10.1016/j.jacc…

The CLARP is for retrograde wire only. It will be useful for operators that wish not to think of the mental picture every time. For antegrade wire it will be just like using the JR4 guide . Great point ! Personally I image the cross section, looking from the shaft of wire toward the tip (which work for both antegrade and retrograde ) to determine the wire rotation direction.

More thoughts on Directed Reverse CART An important aspect of the technique is CLARP: Clockwise → Left Anterior, Right Posterior. The beauty of it is this: anyone who has ever engaged an RCA with a JR4 has used CLARP!🤯 It is instinctive for any cardiologist in the cath lab.

Definitely agree. When retrograde wire created large subintimal or periwire space, retrograde wire control is lost and any attempt for directed reverse cart will be difficult without wire control and penetration. This 3d reverse cart will work best when retrograde wire peri-wire space still preserved . Rotate wire only once to direct a high penetration wire and first attempt puncture for highest success.

@realarainmd The one missing piece is the large retrograde subintimal space, so in order for this to work we need very gentle retrograde dissection which I am not used to, but def worth trying

Here is a great way to hone and apply #3DW in #CTOPCI. The parallax method makes #3DW less cumbersome! Almost intuitive. 😀

Directed Reverse CART is the perfect scenario to apply the OVERLAP VIEW #3Dwiring concept in #CTO. Point retrograde wire tip precisely at balloon with a single wire rotation! (3D reverse CART) see more at @AsiaInterv : doi.org/10.4244/AIJ-D-… @KambisMashayek1 @realarainmd @dautov_MD @Laserrman @esbrilakis @sandeep_jalli @BarberoUmberto @ungureanuclau20 @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Carl01196478 @K_DeSilva @DrJMHill @AntonisPavlidi3 @RajanRehan23 @AishSinha1

Presenting our new methods of bifurcation stenting in TCT 2025: IM-CRUSH ✅7F guide compatible with Altaview ✅real time IVUS guidance ✅minimal protrusion into LM carina ✅adequate ostial coverage #bifurcationstenting #pci #imcrush #Tct2025 @drcleung

@Laserrman @KambisMashayek1 @realarainmd I am looking forward to that ! Thank you so much

@drcleung @KambisMashayek1 @realarainmd Thank you for sharing. I will introduce a somewhat different method of 3D wiring in #EssentialCTO2025

Grateful to present this angio3D wiring in #EUROACTOS meeting this year, and good to hear many interested that email me for the ppt. See this video showing how to rotate fluoroscopy to find the overlap view quickly! doi.org/10.1016/j.jacc… @KambisMashayek1 @realarainmd @sandeep_jalli @BarberoUmberto @SasseMark @ShariqShamimMD @KovacicMihajlo @AhmedHatata90 @Laserrman @dautov_MD @GwendolynY23762

RCA #CTO #HDR Pilot200→#HDR→non tip XT→#HDR→sionblack Careful analysis of #stains observed during #HDR and passive injection is critically important. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

3D Wiring Demystified. Or, I think I get it! Thanks to the links and diagrams sent or suggested by @Laserrman and @evandrofilhobr, and the videos by @CtoDemon and Sensei Okamura, I think I get it! I should also credit @DrPravinKGoel and @drcleung for their well written papers and videos! 🙏🏼 Let me consolidate my ideas and I will get back to you! Not today, but soon.

Euro CTO CLUB @CtoEuro with @KambisMashayek1 ,@AgostoniPF , @drcleung, Chan YH & Jo Dens.

Grateful to join the CTO Club in Nagoya, Japan, and participate in the APCTO club live case session. An incredible experience learning from CTO experts around the world!

@drcleung @MichaelChiangCS An improved way for minimal stent protrusion in doing bifurcation stenting- Real-time IVUS guided minimal crush (IM-CRUSH) - 7F guide compatible (Altaview, Terumo ) -only minimal SB stent protrusion, subsequent delivery of crush balloon is smooth

🆕 in Early View: Real-Time IVUS-Guided Minimal CRUSH for Bifurcation Stenting: The IM-CRUSH Technique ▶️hubs.ly/Q03j3PNJ0 @RonnieCB_Ho @drcleung @DLBHATTMD #cardioTwitter #cardioX #cardiology #interventionalcardiology

This year I am late in #my_4_slides on my most important takeaways from #CTO2025 Lots of great stuff and I will start with the intriguing #CTO #PCI techniques I will try in 2025. 1-HDR presentation by @realarainmd He explains it perfectly, his cases on X are enjoyable. In a very simple way 1-Stick the cap (a few mm) 2-Advance MC- pull wire while dripping contrast (prevent air trapping in the MC) 3-Inject slowly <0.5 cc 4-Analyze and decide next steps If intraplaque staining, nontip Fielder XT. If extraplaque, move down your algorithm (stick again or use other techniques) #cardioX #accfit

More protocol driven best practices with Impella linked to better CS survival. Timely support is key. #AHAJournals @drcleung ahajrnls.org/3Dpt2G3

Delighted to share our Concise Summary on management of Calcified Coronary Artery disease using Contemporary Calcium Modification Devices. Nicely Summarized by Dr @Jakeyeungyk sciencedirect.com/science/articl…

Excited to share the first outcomes of #CardiogenicShock treated with #Impella in Hong Kong! Discover how protocol-driven best practices are linked to improved survival. doi.org/10.1161/JAHA.1… On behalf of the QEH cardiac team. Grateful to Dr. Michael Lee, @BillONeillMD, Dr Esmond Fong, @MichaelChiangCS for their invaluable support. @Babar_Basir @HFHCardioFellow @RonnieCB_Ho @JonathanGSung @APSCYoung @apsc_office @JAHA_AHA @TCTMD @AHAScience #MCS #shock #cardiogenic

Online first @JACCJournals Double kissing shockwave lithotripsy - a novel approach to tackle calcified aortic coarctation kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2… #coarctation #IVL #Shockwave #kissingshockwave