First ever
#alphavac
done at Ascension St. John hospital for the removal of 3x4 cm right atrial mass attached to permacath/RA free wall. No perfusion/ECMO needed. Manually aspirated. Skin-to-skin 30 mins case. 250 filtered and given back. Ebl 50 cc.
60 y/o male with ALS, passed out the minute he woke up! In ED, SBP 82 mmHg. Echo in Resusc with blown-out RV -> Fluids and dopamine. CT with obstruction of both PA. CT to device time: 15 minutes. SBP 120 after thrombectomy. 1st massive rxd that way
@Ascension_MI
Here is your
#nanocrush
appreciation tweet. Ivus guided using
@BIOTRONIK_News
Orsiro stents with excellent results. Carina MLA 11 mm2! Step-by-step tweetorial tomorrow
Fresh back from
#CTO2020
👩 with intermediate-high risk PE and impending Resp failure. CT with saddle and right main PA occlusion. Some
@InariMedical
t-24 suction and blood flow restored to right lung. O2 requirement are down.
Congrats to my team
@st
. John Hospital for performing the first PE mechanical aspiration procedure using the
#FlowTriever
device for the 1st time in michigan! Pt in her 40’s acute cor pulmonale with submassives PE that occluded the right Main PA. CI 1.5. mRA 22! Felt 👍 after!
Here is your
#nanocrush
appreciation tweet. Ivus guided using
@BIOTRONIK_News
Orsiro stents with excellent results. Carina MLA 11 mm2! Step-by-step tweetorial tomorrow
Pleased to perform the first CAT-12 Lighting system aspiration of an acute DVT in Michigan
@Ascension_MI
! Great results (aspirated all the way from pop to IVC! With less than 200 cc blood loss!). Looking forward to using it in PE as well...Torqueability is a great advantage too.
80 yo 👵🏻w/ severe AS and LVEF 20% with 80% rock in her prox/ostial LAD. Ivus won’t cross ➡️Csi x 3 runs at 80k➡️ivus won’t cross even after NC dilation. 3.0
@ShockwaveIVL
did the job! 3.0x33 in post dilated with a 4.0 NC. 112% expansion! First in
@Ascension_MI
!
50 y/o male with inferior STEMI with culprit being prox/ostial RCA s/p IVUS guided DES PCI a year ago. comes back with recurrent symptoms. cath shows 95% stenosis ostially. Here is the IVUS after first procedure and repeat on follow up. What's your diagnosis?
80 yo male with recurrent ISR of two layer mid lcx. OCT with severe fibrolipidic NIH. 2nd stent didn’t expand tissue. S/p laser 50:50 followed by NC
@22
atm! 115% expansion!
@mmamas1973
@drandrewsharp
@ziadalinyc
@toreyj01
37 🧔🏿 former 🏈 player referred for 2nd opinion re: refractory HF. EF now 5-10% diagnosed in 2013; 2003 with GSW that almost "missed his ❤️". Told he has NICMP and aneurysmal LCX on cath at time of diagnosis. Now with predominantly RHF sxs: ascites and LE edema. What do you see?
79 yo with nstemi and hx of 19 yo svg to lad with heavy thrombus burden. Cat-rx for thrombectomy followed by ivus guided des! No filter. Done in 10 mins. 2.1 mm2 of clot removed!
#ImageFirst
#penumbra
#catrx
Ever wonder what happens to a PE when it’s chronic and large! Great multidisciplinary care by our service,
@SaraHegabMD
at HFH Pulm HTN and the fantastic surgeons at
@UMich
Cardiothoracic surgery to help this 40 yo man with Systolic pa of 90 down to 45 mmhg after endarterectomy!
The more OCT/IVUS I do of ISR cases, the more I realize that PTCA for ISR or restenting, without modifying the underling NIH/Neoathero, is the single dumbest thing we do as interventional cardiologist!
The hardest part about quarantining is that sense of isolation. Day
#4
without being able to hug your family 😞. Covid sucks! Thankful that my symptoms were only a “bad flu”. No smell or taste! ? Delta vs wuhan.
#fullyvaccinated
#itaintover
.
#besafe
Saddle PE with delays presentation due to
#COVID19
...no problem! We even used the new spiffy control unit from EKOS that allow us to use bilateral in one machine...
Radial dry closure! Thanks to the
#R2P
sheath by
@terumobct
, we performed dry closure of a 14 french arterial access from the right wrist! This way we maintained
#radialfirst
benefit to ant stemi even when case was complicated by shock. Pt did very well with LV recovery at 45%
I think we all love to parade our clot haul on
#cardiotwitter
(myself included) but we have to pause and assess the effects of stiff catheters prying open TV and constricting RV movement, leading to PEA arrest Been seeing a trend of bad outcomes with RV:LV> 2.0. Thoughts?
The beauty of
#imagefirst
Intv using
#Coregisteration
is the ability to study the lesion, select the right tools to minimize complications and
#know
the size and length of where to land to have the best outcomes while saving contrast!
Another adventure in the world of Attallah vs. the clot! lol. 47 y/o with CP on/off, not on ASA, now with NSTMI and ongoing chest pain. Off to the lab. Large thrombus burden (about 30+ mm on IVUS). Two runs of Pneumbra CAT-rx, followed by IVUS guided DES. Time: 15 mins.
Honored to be taking over for
@agtruesdell
as the section chief for intravascular imaging in Current Cardiovascular Imaging Reports. In the spirit of "vox populi", we want to hear from you about what topics to review. So far we have IVI in bifurcations, PAD, venous intervention.
86 yo Wm old cabg all natives occluded presents with nstemi and progressive shock. Taken to lab cpo 0.41 w! Culprit svg to lad. Impella first then pci. Off pressors by end of case. Cpo at end 0.91 wats. 14 French occlusive, placed extracorporeal fem-fem and perfused leg! 👌
In life there are superheroes and there are legends and then there is Dr. Magdy Yacoub! My son, the future Dr. Attallah got to meet the reason why his dad pursued cardiology for the first place! Thank you Dr. Yacoub for everything that you and what you stand for!
#privileged
So as many of you have guessed correctly this is a case of ISR 2/2 to Late acquired stent malapposition (LASM). This diagnosis wouldn't have been possible unless you
#Imagefirst
. But is that that simple. Let's see...
50 y/o male with inferior STEMI with culprit being prox/ostial RCA s/p IVUS guided DES PCI a year ago. comes back with recurrent symptoms. cath shows 95% stenosis ostially. Here is the IVUS after first procedure and repeat on follow up. What's your diagnosis?
Dr. John Simpson, the da Vinci of interventional and peripheral intervention going down memory lane! Message: never give up and learn from your failures.
There is an anterior stemi...
And there is a covid anterior stemi.
And there is an anterior covid stemi in a pt with NICMP with EF of 15%.
Due to embolism!
my first
#biradial
CTO, and probably
@Ascension_MI
first here as well! 55 s/p CABG with occluded SVG to RCA (cannot be visualized), CCSIII and viability in inferior wall. Can't do
#safefemoral
due to morbid obesity (350 lbs). Multiple CTO in prox, micro channel in mid and distal.
77👵🏻with Resp failure requiring bipap with submassive PE. 100% occlusion of right main PA on ct and heavy clot burden. S/p
@InariMedical
flowtriever to right with establishment of flow and EKOS to left due to angular ion. Came in 99% on 15L high flow. Out of the lab 95% on RA!!!!
Great first experience with
@sis_medical
OPN balloon. Pt initially with stage B ACC/AHA shock (CI 1.6 and Wedge of 34), temporized and brought in for high-risk PCI of under expanded LM stent and subtotaled LCX-OM (likely culprit). IVUS revealed two layers of stents in mid-segment
Since its introduction almost two decades ago, the crush technique for coronary bifurcation stenting has undergone a significant and constant evolution. This paper reviews the technical aspects and outcomes of the variants of the crush technique.
Sobering talk by
@djkereiakes
on how an IC can come to losing Everything! Radiation safety, occupational hazards and exposures should no longer be forgone and accepted risks! No other profession accepts disability of its members as a forgone conclusion!
The consequences of no imaging can be quite punishing! For those citing “cost” prohibition...let me tell you that an ivus cath is a lot cheaper than an impella, Shock admission and prolonged CCU stay.
This is why many including myself strongly believe intravascular imaging should be considered for almost every PCI. Case done 1 week ago. Now presents with ant wall STEMI secondary to stent thrombosis and shock requiring MCS. Imaging is always actionable.
#imagealways
So...we dediced to let imaging dictate the procdure. Two ivus runs one from each branch showin pseudoaneurysm at bifurcation with clot; Multiple areas of plaque ruputre. Upfront two stent via
#nanocrush
with excellent results including a very pretty carina!
#imagefirst
is not just for coronary intervention. It’s a valuable in peripheral intervention as well. 60 yo 👵🏻 with RC3 Claud x 2 weeks. Grossly abnormal abi. Angio underwhelming, however ivus revealed acute plaque rupture with thrombus, treated with oct guided Pantheris and pta
Presented today at
#ACC24
:
In the DanGer Shock trial involving patients with STEMI and cardiogenic shock, mortality at 6 months was lower with mechanical circulatory support with a microaxial flow pump than with standard care alone. Full trial results:
Probably one of the coolest I have done with the assistence of
@toreyj01
. Severe vasculopath with terrible illiacs s/p multiple intervention, with refractor HF due LIMA compromise. We did brachial cut down courtesy of Jim (>2000 cutdowns) and directly cannulated A&V.
#lostart
.
Really cool to have if you work with fellows! It saved an earlier projection and all my fellow had to do is follow the mark to engage. Pretty neat
#azurion
74 y/o previous PCI of the prox LAD LM at that time IFR -; IVUS with dLM nodule but adequate lumen. 6 months later progressive anginal sxs. Nodule eruptive MLA down from 7.5 to 6.7ish and %stenosis 71 with heavy plaque burden. Utilized
#shaveandshock
w/
@csi360
and
@ShockwaveIVL
85 functional yo m with recurrent nstemi‘s and new systolic failure seemed high risk by surgery 2/2 prior cva and ckd 3, with known severe calcific left Main, lad and lcx dz. sp impella assisted, ivus guided, Csi atherectomy and des with reconstruction of entire left system!
For the millionth time..Dont put anything less than a 3.5 mm stent in the prox LAD of any human who weighs > 70Kg!
#imagefirst
to get correct answer. 2.5 mm stent in prox LAD is a crime against humanity!
New case at 77yo 👵🏻progressive angina.Anterior ischemia.LVEF 60%.
#CTO
at mid LAD. 1st diagonal with severe and long prox stenosis. severe lesion at Cx. 2nd procedure.. PCI to LAD. DES 2x15 at diag and 2.5x34 at LAD. After PCI 600 mg Clopi…already on ASA
In the spirit of
#CTOConnect
and
#CTO2021
here is a nice LCX CTO...100% intraluminal crossing with
#pilot200
, followed by descalation to a SION blu and IVUS guided DES pci.
Join
#PenVascularLIVE
on Thursday, August 13 at 8 pm EST, for a case-based discussion on real-world coronary & peripheral thrombus applications hosted by Drs.
@bkolskk
,
@AntoniousAttall
, & Chris Metzger. RSVP here to join the conversation: .
#CardioTwitter
3.5 hrs on a massive PE that failed lytics After PEA arrest! RV akinetic, dropped 5 gm of Hgb since AM! to the LAB with SBP of 70 mmHg -> CI 1.3! mech thrombectomy of 100% occluded R/ L main Pain, followed by PTA and massive transfusion; likely RP.
#fudge
. SBP up 140. Breathe!
Allez, le scanner
#COVID19
du jour : femme, la trentaine, syndrome grippal.
2 PCR par écouvillonage négatives !!
3e PCR sur crachat : positive.
Conclusion : quand le scanner est typique, croire le scanner et surtout pas la PCR +++