Jaime Pugeda

@KovacicMihajlo Agree with everyone on initial management. If decided on stent route, prepare everything for distal embolization management. Suggest no aggressive post dilation fo stent if adequate stent expansion on IVUS.

2:00 AM, big STEMI. Patient hemodynamically stable What would you do?

@GEICC3 @thiele_holger @agtruesdell @SCAI @adityadoc1 @GreggWStone @DavidLBrownMD @DrAmirKaki @perc_surgeon @mmamas1973 @KPujdak Presuming patient wants revasculzrization, would optimize first, document CT surgery response. If declined for CABG , would do LAD with iabp support. Potentially stage the rest.

60y M, AMICS (anterior MI) SCAI shock C, lactate 3min/L, BP 95/55 on norep 0.1mcg/Kg/min, LVEDP:50mmHg. Bedside echo: EF:30% antero-apical and inferior akinesia. Impella or ecmo not available (🇧🇷 public health system). CAG pics below + RCA CTO. What would you do? @thiele_holger

@vamshi_gade_md @mmamas1973 @drandrewsharp @nolanjimradial @djc795 @RodrigoBagur @SVRaoMD @MohanedEgred @ajaykirtane @cardioPCImom @jmahmed @ncurzen @Pooh_Velagapudi @mirvatalasnag @jedicath @Drroxmehran @GreggWStone @drrashid05 @mbmcentegart @rwyeh @perc_surgeon @omendiz @sbrugaletta @fischman_david @DocSavageTJU @Hragy @ShaziaTHussain1 I think the same about “nailing the ostia”. However if truly 90 degree angle and no left main, i do stent the ostia and intentionally protrude into left main by 1-2mm of i can. Lots of IVUS.

Young male, fit and well, acs admission. What is your management plan? @drandrewsharp @nolanjimradial @djc795 @RodrigoBagur @SVRaoMD @MohanedEgred @ajaykirtane @cardioPCImom @jmahmed @ncurzen @Pooh_Velagapudi @mirvatalasnag @jedicath @Drroxmehran @GreggWStone @drrashid05

@Obisht IVUS guided( for size) cutting balloon.

How to dilate this ostial CX in-stent-restenosis ???

@BagaiJayant @MohanedEgred @Obisht @evandrofilhobr @HadyLichaaMD @aspergian1 @perc_surgeon @KambisMashayek1 Had 2 similar cases. Above all recommendations failed. I ballooned the distal LM to modify somehow ostial circ plaque and, by luck, it worked. Of course there is the risk of shutting down the vessel.

Unable to wire ostial lcx, calcified plaque in distal LM deflected pilot xt and pt2 wires into ramus, tried 120 supercross as well. No luck with diff shapes and MC supportI. Ideas? @MohanedEgred @Obisht @evandrofilhobr @HadyLichaaMD @aspergian1 @perc_surgeon @KambisMashayek1

@mandeep_mayo We have been succesful with ELCA of the thrombus in a similar case. But we did not stent the proxinal vessel as the size was 7-8mm by IVUS.

Catheter-directed lysis followed by thrombectomy with Export catheter, 5mm DES stent. Distal embolization dottered with a balloon. Acute stent thrombosis the next day.

@lorenzo2509 Excellent result. I always thought the 2.15 burrs require 9F!

@Ravi_Hira_MD Ravi, we could not have done it without the Post Malone playlist!

11 CTO cases this week - back breaking work but so rewarding. Topped off with an RCA CTO uncrossable lesion that required laser and stingray stick and drive with Astato 20. @jgpugedamd

@jcspratt @Ravi_Hira_MD @A_N_Mahmoud_MD @MichaelMegalyMD @momermd @MarwanSaadMD @mmamas1973 @RhianEDavies1 @shishem @sbrugaletta @DLBHATTMD @ESC_Journals @rwyeh Agree. My most difficult dissection cases where I couldnt pass a stent, I was only able to deliver them because I counterintuitively used roto.

@A_N_Mahmoud_MD @MichaelMegalyMD @momermd @MarwanSaadMD @mmamas1973 @Ravi_Hira_MD @RhianEDavies1 @shishem @sbrugaletta @DLBHATTMD @ESC_Journals @rwyeh Would be great to put to bed the nonsense talked re dissection being a CI to rotational atherectomy: historical & inaccurate. IVL is a great step forward, but rota still preferable for uncrossable lesions