Rodrigo V. Wainstein, MD, PhD

🔥BREAKING: FASTEMI is out! POCUS changed management in 14% of STEMI cases + 97% NPV for mortality. Fast, reproducible, no delay to PCI. Huge honor to work with @Babar_Basir and all our amazing team! @SCAI @EAPCIPresident @PCRonline

87M | LVEF 20% | CTO LAD&RCA Admitted w/ decomp HF → 10d HF optimization 💉 Pre-PCI: CPO 0.58 | CI 1.8 | MAP 65 | PCWP 10 Single Access Impella CP → Fielder XTA → Rotablator → Wolverine → DCB+2 DES (IVUS) 🫀 CPO↑0.7, off pressors → Impella out 🏥 Discharged 36h post-PCI

@aspergian1 @jedicath 😂😂

@jedicath Didn't ask

Female with newly diagnosed critical AS. Accepted for TAVR. Has bad lungs. TAVR team asks for pre TAVR of this RCA

@SripalBangalore Excellent case demo @SripalBangalore! I like the concept of #precisonPCI, but the AngioFFR (Medis QFR) that I’ve with had some limitations and correlation with invasive FFR was not ideal. That being said pinched side branch w/o symptoms or ecg changes are not worrisome for me

14. What if we remove all the guess work? Here is the post PCI AngioFFR of distal LAD (just distal to the stents 0.92) and D2. No RA/OA, no guess work as to whether you left behind any physiologically significant stenosis even in the side branches. #precisionPCI

4/ The incidence of abnormal FFR in the side branch with angiographic significant stenosis after MV stenting varies between 27% to 52%. 1. Koo et al. 2005. 27%. 2. Ahn et al. 2012 (for DS >50% QCA). 28.4% 3. Kang et al. 2013 (for DS >50%). 32% 4. DK CRUSH VI trial. 52% @SVRaoMD

@KPujdak @sbrugaletta @rotamonster @evandrofilhobr @agtruesdell @Babar_Basir @LAzzaliniMD @BaoGTran @marioiancardio @TWilsonMD Thx Krzysztof. It happened when tackling the mid RCA lesion after the second bend which is more angulated, but the run technique was pristine with very mild speed lowering

@sbrugaletta @GEICC3 @rotamonster @evandrofilhobr @agtruesdell @Babar_Basir @LAzzaliniMD @BaoGTran @marioiancardio @TWilsonMD Yes, but I believe this occurred only during burr extraction. The observation seems too basic for Rodrigo to mention — he’s far too experienced to make such a fundamental mistake, IMHO 😀

Extremely tortuous RCA. After a few short runs w/ RotaPro 1.5 the burr disconnected from the driveshaft. Luckily wire was not damaged and kept the burr from embolizing distally. Not sure why it happened. Any thoughts on the potential mechanism for this complication? @rotamonster

@BaoGTran @rotamonster @evandrofilhobr @agtruesdell @Babar_Basir @LAzzaliniMD @marioiancardio @KPujdak @sbrugaletta @TWilsonMD I was very reluctant also! But IVL and OPN were not available. Case was performed in a public health system hospital and RotaPro was donated as part of a educational program from Boston

@GEICC3 @rotamonster @evandrofilhobr @agtruesdell @Babar_Basir @LAzzaliniMD @marioiancardio @KPujdak @sbrugaletta @TWilsonMD That is wild. I have never seen that before. Nice results. I would’ve been very reluctant to Rota with that tortuousity

The day has come! Have I ever thought of the day in which I would say that #AI based softwares are better for #IVUS guide #PCI optimization? I would dare to say that is safer to let the "machine" do the assessment of #stent expansion than the #doctor authors.elsevier.com/a/1lWfe5XJLHAR… @news_hart @TCTMD @CRT_meeting @PCRonline @sjorge4 @Ortega_Paz @sbrugaletta

@Babar_Basir @agtruesdell Two of the greatest minds in global interventional cardiology. Both incredibly bright, polite, and humble. I'm lucky to know you both and look forward to seeing you again

Nearly 10 yrs of friendship! To all the new fellows, you’ll take care of a lot of patients, hopefully contribute to advancements in science but hopefully you’ll be lucky enough to meet some great people along the way! ⁦@agtruesdell⁩

@sbrugaletta @mirvatalasnag @PCRonline @ColletCarlos @JEscaned Makes sense! Previous paper shows that Ivus is actually a better tool for calcium detection than OCT

IVUS is the winner. happy to see that very few are still angio-based. CT will be coming. and surprise about OCT...the ability to measure Ca thickness is not enough? @PCRonline @ColletCarlos @JEscaned @mirvatalasnag

Just out in @arqbrascardio! We applied the #VExUS score — originally for heart failure — to patients with STEMI. 🫀 A simple bedside tool with strong prognostic value! 📄 abccardiol.org/wp-content/upl… @guilhermehtelo @guilhermehtelo @GEICC3 @saadi_marina

@LAzzaliniMD @BSCCardiology @pmachado_gui @esbrilakis @yadersandoval @crfheart @TCTMD @PCRonline @EAPCIPresident @SCAI @evergesa Totally! Game changer device for uncrossable lesions

@GEICC3 @BSCCardiology @pmachado_gui @esbrilakis @yadersandoval @crfheart @TCTMD @PCRonline @EAPCIPresident @SCAI @evergesa Did you feel the difference? Free wiring is much easier, even halfway through CTOs.

Honored to present a case of HRPCI with Impella at the MCS session of the SBHCI 2025 congress. Thank you for your input Ajay! @ProtectedPCI

@evandrofilhobr Thx Evandro. Weaning in the cath lab based on RHC assessment. Pos PCI CPO 0.7, MAP 70 and no pressors or inotropes

Great job!👏🏻👏🏻 How was the MCS weaning?

@aspergian1 @jl35wilsonMD @Hragy @JEscaned @perc_surgeon @djc795 @KambisMashayek1 @KAlaswadMD @EAPCIPresident @mirvatalasnag @alaide_chief @KateKearney4 @DrSethdb @ABiomed @TheNarulaSeries Yes! Diagnostic angiogram was done Monday and PCI yesterday to make sure that heart team assessment was performed and inform consent obtained

@jl35wilsonMD @GEICC3 @Hragy @JEscaned @perc_surgeon @djc795 @KambisMashayek1 @KAlaswadMD @EAPCIPresident @mirvatalasnag @alaide_chief @KateKearney4 @DrSethdb @ABiomed @TheNarulaSeries Just wondering if it was considered and was there time for informed consent

62yo man, NSTEMI, EF:21%, Mean PA: 35mmHg, PCWP:20mmHg, CPO: 0.56. @ProtectedPCI w/ Impella CP for LM/LAD last remaining vessel. Impella was absolutely essential as the patient lost arterial pulsatility during vessel manipulation. Amazing performance of the device

@aspergian1 @Hragy @JEscaned @perc_surgeon @djc795 @KambisMashayek1 @KAlaswadMD @EAPCIPresident @mirvatalasnag @alaide_chief @KateKearney4 @DrSethdb @ABiomed @TheNarulaSeries Thx Jack! Low CPO, but MAP 65mmhg, no pressors & normal lactate. Pre & Post PCI RHC was very helpful to wean from the MCS in the cath lab. Post PCI PCWP:18 ,CPO:0.7, no pressors or inotropes. Surgical assessment was formally done and contraindicated due to poor distal targets

@GEICC3 @Hragy @JEscaned @perc_surgeon @djc795 @KambisMashayek1 @KAlaswadMD @EAPCIPresident @mirvatalasnag @alaide_chief @KateKearney4 @DrSethdb @ABiomed @TheNarulaSeries Gr8 save and use of MCS! No mention of shock but CPO of 0.56 makes me wonder. If "stable" (no shock, no ongoing ischemia, etc) did you consider CABG in this younger patient? Were there collaterals to a dominant RCA?

@realarainmd @OPCILive @ziadalinyc Excellent thread! Congrats

Did you see the jiggle? Thoughts about an eruptive calcified nodule. A 🧵 At @OPCILive this past week, @ziadalinyc shared a case involving an eruptive CN. In his inimitable (and purposefully provocative 😂) style, he asked the audience if we could see the haziness ‘jiggle’. @DrAllenJ was the perfect foil for the conversation (and the voice of the audience) - and said: “No, we don’t!” Hopefully the case will be up for viewing soon. But here are some thoughts…

@evandrofilhobr RFR/FFR not reliable in this case bc there’s probably a myocardial bridge distal to the lesion. OCT would be ideal. Noticed that you are using Eagle Eye IVUS. Chromaflow could’ve helped to identify plaque erosion/rupture. IMHO if imaging confirms plaque accident we better stent

➡️ So here’s the dilemma: Would you revascularize a non-flow limiting high-risk morphology lesion in the setting of ACS? Is physiology misleading or it plays a role in the final take? Anatomy over physiology ? Are we missing the point — or preventing overtreatment? 📷 ISCHEMIA, PROSPECT I/II, COMBINE OCT-FFR, DEFINE-FLAIR in perspective.

34-year-old male, s/p hypertension, admitted with onset of chest pain that resolved after initial measures. Following diagnosis of ACS (non-ST elevation MI). Mild troponin increase . EKG above. Follow the 🧵. 🔍 Curious to know how you would handle this case?