Paul O'Connor

@SDhandMD @ChengaziMD @smbracewell @t_intheleadcoat @saherssabri @kmadass @drochohan @IR_Doctor @IRKhalsa @laronecampbell @drvarshana @drcostantino1 @MoonJustaniah @theblanketdog @JuliusChapiro @linemonkeymd This was a fun one! Finally got the drain out after a little glue embo

@ChengaziMD @smbracewell @t_intheleadcoat @saherssabri @kmadass @drochohan @IR_Doctor @IRKhalsa @laronecampbell @drvarshana @drcostantino1 @MoonJustaniah @theblanketdog @JuliusChapiro @linemonkeymd Yes but even without stent I wouldn’t be too worried about an iatrogenic leak in a nonobstructed system, if that were the case. Just think of all the bile ducts you snag in various perc liver interventions. Prolly worth showing some of these cases! Not as cool as yours tho

What’s the diagnosis here ? S/p #chole How can you help #Irad? @saherssabri @kmadass @SDhandMD @ChengaziMD @drochohan @IR_Doctor @IRKhalsa @laronecampbell @drvarshana @drcostantino1 @MoonJustaniah @smbracewell @theblanketdog @JuliusChapiro @linemonkeymd

@maninbsir @SIRspecialists Thx. Thrombin would work well but US view of pseudoA wasnt ideal. I chose glue for visualization under fluoro. Tiny bit of nontarget embo during initial injection, probably inconsequential…goal was to stabilize him for surgery

@p_oconnor1 @SIRspecialists Great case. Whats the advantage of using glue vs thrombin? ..Was there some glue extending into some of the other branches in that video?.

Direct percutaneous nbca glue embolization of a massive pulmonary artery pseudoaneurysm. Patient w/history of lung cancer treated with radiation presenting with massive hemoptysis. Credit to my awesome tech Rigo for putting this together. #irad @SIRspecialists

@ChengaziMD @Flavius_IR @SIRspecialists Pseudo came off pretty proximal and i think would taken dozens of coils and embolization of a large portion of right PA to get good control. Also, pt was having active hemoptysis!! So glue was my first choice!

@Flavius_IR @p_oconnor1 @SIRspecialists That’s a pretty large sac to fill with coils, which would be pricey and hard to determine if done to completely. Nontarget embo more of a concern in AVM, in pseudo less so no?

@ChengaziMD @SIRspecialists Thanks! Ultrasound access was so key! The effusion and consolidation from hemoptysis allowed me to see it easily. I used 5:1 glue with slow steady injection via echotip needle

@p_oconnor1 @SIRspecialists Amazing case! Nice you were able to see the pseudo with US for access. What was your glue dilution?

@DegenAnon6969 100 oz coaster :)

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@antony_sare @SIRspecialists @SDhandMD I thought about using a sniper micro catheter for temporary balloon occlusion but didn’t want to run into issues with fitment in the guide catheter since the OD is slightly larger compared to a truselect. I may try it next time

@p_oconnor1 @SIRspecialists @SDhandMD Could you have used a balloon for embolic protection? Why use coils?

Temporary coil protection of the cystic artery during right lobar Y90 for multifocal HCC. 7F guide cath via #transradial access and two TruSelect microcatheters. @SIRspecialists #irad @SDhandMD

@ec2904 @SIRspecialists @SDhandMD Thanks! Just to avoid the unlikely event of prophylactic cystic artery embolization pain

@p_oconnor1 @SIRspecialists @SDhandMD Very clever.Have you seen a lot of cholecystitis after lobar Y90 or are you trying to reduce post procedure pain?

@rkryu @SIRspecialists @SDhandMD @SidpadiaIR @aravindarepall1 @DanSzeMDPhD @danbrownIO I gave 3,000 units more on top of the radial cocktail. Two vial injection so coil was up for about 20-25 minutes

@MRAkid @SIRspecialists @SDhandMD We’ve had a couple of patients develop abdominal pain with cystic coil embo during y90 mapping

@rkryu @SIRspecialists @SDhandMD @SidpadiaIR @aravindarepall1 @DanSzeMDPhD @danbrownIO Coil deployed and after removed. 3 x 4 mm Concerto did the job well

@ramposham @SIRspecialists @SDhandMD 👍🏼

@p_oconnor1 @SIRspecialists @SDhandMD nice. 7Fr JR4?

@smbracewell @SIRspecialists @SDhandMD Yup, Pulled the coil into the micro catheter and disposed of like the y90 delivery catheter.

@p_oconnor1 @SIRspecialists @SDhandMD Very slick. I’ve done two micros through a 6fr destination sheath tuohey borst for similar methodology in BRTO. Did you just reasheath the coil?

@kabiitohassan @_backtable @SDhandMD @SIRspecialists @PIHHealth Just a zoom 71

@p_oconnor1 @_backtable @SDhandMD @SIRspecialists @PIHHealth U use two distal Aspiration Catheters ? On

R MCA occlusion with atypical presentation of left hemiballismus brought to hospital quickly with 1 pass thrombectomy (BADASS technique). POD 1 MR DWI completely clean. <45 min door to reperfusion. #stroke @_backtable @SDhandMD #irad @SIRspecialists @PIHHealth

@kabiitohassan @_backtable @SDhandMD @SIRspecialists @PIHHealth BAlloon guide cath+ Distal aspiration cath+ Distal Aspiration+ Stent retriever

@p_oconnor1 @_backtable @SDhandMD @SIRspecialists @PIHHealth What is the BADASS technique?

@DonGarbettMD @_backtable @SIRspecialists @SIRRFS @bonesz @MRAkid @ReNewVascular My go to catheter is Sim 2 formed in the ascending aorta.

Radial to visceral not always simple even after thousands of repetitions. Used a 5fr TIG here with an angled glide to make the turn. @_backtable @SIRspecialists @SIRRFS @bonesz @MRAkid @ReNewVascular

@SDhandMD @ashkan_1670 @FadiSaab17 @HadyLichaaMD @SriniTummala @AmputationSuck @michaelcsiah @VenuVadlamudiMD @bonesz @keithppereira I prefer groin because I like to debulk as much as possible with CAT7 etc before committing to lysis. I dont see an issue with the vert if you have heparin and tpa running .

@ashkan_1670 @FadiSaab17 @HadyLichaaMD @SriniTummala @AmputationSuck @michaelcsiah Nice!!! Always love fresh ideas. I’ve thought of this too but worry about catheter/sheath across right vert for a long time. I know tpa & heparin going but still heart palpation inducing lol. Thoughts? @VenuVadlamudiMD @bonesz @p_oconnor1 @keithppereira

Set up for overnight thrombosis from radial approach in ALI #CLIfighters @FadiSaab17 @HadyLichaaMD @SriniTummala @AmputationSuck @michaelcsiah who is a good candidate?

@ReneLizola @InariMedical @SDhandMD @MountSinaiIR @PIHHealth F/U CTV- renal vein cleared out with initial thrombectomy 👍🏼

@p_oconnor1 @InariMedical @SDhandMD @MountSinaiIR @PIHHealth Anything done for that renal vein thrombus?

Young patient with massive filter related thrombosis & severe pain/phlegmasia cerulea dolans treated with @InariMedical T24 flowtriever from popliteal v access. Pain resolved 15 minutes after case. Forgotten 10 yr old filter 👎🏻 @SDhandMD @MountSinaiIR @PIHHealth #irad