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Congrats Ken Masdjedi with your PhD -advancements coronary physiology #ffr #iFR #vFFR #dPR @CathlabN @ErasmusMC @drnvanmieghem @jescand @BernardBruyne @nielsroyen

Announcing #IVUS #CHIP trial for #highrisk #complexpci patients with #IVUSguidance @PCRonline @TCTMD @ErasmusMC @hect2701 @mirvatalasnag @KambisMashayek1 @JEscaned @sbrugaletta @RinfretStephane @esbrilakis @CathlabN

H.Kroon et al compared largest #TAVR #TAVI group to date with/without #CerebralEmbolicProtection bit.ly/2FdKaNy @PCRonline @TCTMD @hect2701 @mmamas1973 @dmylotte @nicolo_piazza @didier_tchetche @pauldub67 @DrPascalMeier @escardio @DFCapodanno #cardiotwitter

@joostdaemen presenting our #Cathsuite platform ( pci database/ automatic FU/ CEC) at #europcr @CathlabN @pauldub67 #cardiotwitter @PCRonline @TCTMD @escardio @mmamas1973 @hect2701 @DrPascalMeier @ErasmusMC

@pauldub67 @DFCapodanno @sbrugaletta

@ErasmusMC @CathlabN fellows at #europcr (K.Masdjedi,J.Ooms,M.Tomaniak, K.Ameloot)#cardiowtitter @hect2701 @DrPascalMeier @mmamas1973 @PCRonline

@hect2701 @pauldub67 @DFCapodanno @EuroInterventio @DrPascalMeier

R.Diletti presenting @ErasmusMC / @CathlabN #FFR Search 2 yr data #europcr @pcronline #cardiotwitter @TCTMD @escardio

Good luck Paula Scarparo with #FFR after #PCI #EuroPCR ‘s got talent @CathlabN @hect2701 @pauldub67 @DFCapodanno @SABOURETCardio @sbrugaletta @erasmusmc @mmamas1973 #CardioTwitter

@jim_vascular 2019. N.van Mieghem/ P. de Jaegere presents @CathlabN Live Case from @ErasmusMC - Evolut R 23 in Perimount 21 bioprothese @PCRonline @TCTMD #CardioTwitter @pauldub67 @mmamas1973 @hect2701 @sbrugaletta @dmylotte @ajpeace74 #tavi #tavr

Congrats Eric Boersma @ErasmusMC , you are now officially #WorldClass , thank you for mentoring / teaching #ThoraxCenterEMC teams to the top ! #cardiotwitter #cardioed @mmamas1973 @DrPascalMeier @sbrugaletta @pauldub67 @escardio @PCRonline @TCTMD @ajpeace74 @rbcasado @hect2701

@evandrofilhobr @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO Thanks for your comment. The epicardial came from the LAD and the wire was a sion.

@CathlabN @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO Where epicardial came from? LAD? Wich wire did u chose for epicardial?

4/ #Tweetorial - Shift to #retrograde to correct #antegrade complication @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO We done our best to add extra comments to each tweet. We hope that the case is clearer now and we are grateful for this suggestion. For us this was a good learning experience to share our knowledge. The next case will be smoother.

@RinfretStephane @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO Tks a lot for your comments. Indeed the case was quite complex and difficult to follow. Your suggestion for additional comments for each tweet is great and we will gladly provide extra comments later this evening.

1/ #Tweetorial - R.Diletti - Management #CTO #ostial #perforation with J-CTO 3) @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @sbrugaletta @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO After fixing the perforation, we reattempted the retrograde approach this time successful.

9/ #Tweetorial Return retrogr w fast advancement knuckle wire @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @sbrugaletta @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta @hect2701 @EuroCtoClub @MLCTOcourse @OptimalCTO Besides the steps described in the slide , we also re-advanced a knuckle wire in the retrograde MC to provide stability due to tendency of jumping back into the epicardial( tortuosity).

8/ #Tweetorial -Strategy after tip-in technique @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta @hect2701 #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta @EuroCtoClub @MLCTOcourse @OptimalCTO Retrograde MC was not advancing due to severe tortuosity, obviously failing to reach the RCA ostium and preventing externalisation with RG3. Therefore we decided to use the "tip -in" technique (catching with the tip of the retrograde wire ,the lumen of the antegrade MC)

7/ #Tweetorial neo-ostium created >tip-in techn w anteg micro-cath @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta @EuroCtoClub @MLCTOcourse @OptimalCTO With antegrade contrast injection we still see extravasation of contrast despite MC plugging the perforation.

6/ #Tweetorial - Knuckle wire > no micro-catheter advancement @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @sbrugaletta #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO Wiring of epicardial went easy , here after followed with a Caravel MC. The MC couldn't advance further due to severe tortuosity , same also for earlier used wires. We therefore used Gaia 2 wire (to create minimum dissection) +knuckle wire to safely advance up to the ostium.

5/ #Tweetorial - R.Diletti - Retrograde wire escalation (Gaia 2) @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO We decided to use the epicardial collateral to retrogradely create a neo-ostium in order to seal the perforation.

@lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline @EuroCtoClub @MLCTOcourse @OptimalCTO We tried to follow the wire with the MC but it became stuck in the calcium. We retracted the wire and attempted the #Carlino technique and discovered that contrast was in the pericardium (we didn't save this run, sorry guys).

3/ #Tweetorial #CTO - difficult #wire pullback, #microcatheter stuck in calcium @lorenzo2509 @cghanratty @jcspratt @KambisMashayek1 @esbrilakis @GreggWStone @RinfretStephane @pauldub67 @mmamas1973 @PCRonline #CTO2019 @EuroCtoClub @MLCTOcourse @OptimalCTO