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Dr Imran Hanif Hashmi Profile
Dr Imran Hanif Hashmi

@DrIHHashmi1

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interventional cardiologist

Lahore, Pakistan
Joined May 2021
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
What do you think about this LAD?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Valvular pulmonary stenosis. Balloon valvuloplasty. PPG dropped from 100mmHg to 24mmHg.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
What do you think about coronary anatomy in this case? Which one has tight stenosis? Is this one LAD or RCA?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Everything was fine till post-dilation and then...... Adrenaline surge..
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
11 months
Cause of no-reflow not always in coronaries. Pay attention to guide position and engagement. Guide cath-induced acute AI. Hemodynamics compromise, no reflow. Improved by guide repositioning.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
Inf STEMI. Mid PDA tight lesion. Pre dil. Check injection while stent positioning and then......
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Reverse wiring. 70y male. Diffuse disease. Lcx severe diffuse disease. ACS, LAD diagonal difficult angle. Surgical turn down by CS at heart team discussion. RCA distal diffuse disease. Blocked balloon tech failed. Reverse wire successful.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
Young female with inf STEMI. Normal other vessel. RCA huge thrombus. Manual aspiration cath failed to aspirate. Don't have Penumbra or Angio Jet.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
Young male, ACS late presentation. LCX total thrombotic occlusion. LAD was mid/distal subtotal occlusion. RCA CTO with multiple bridge collaterals. How much to do?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Distal balloon anchor in the same vessel to facilitate stent delivery. 85 y old male, ant STEMI. Total proximal lad occlusion. Lms calcification and angulation. Balloon crossed easily, but stent didn't. Guide support, buddy wire failed. No side branch anchor available.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Oops. Be care full while injecting through GE Catheter.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Coronary-cameral fistulae.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
22 days
Young male. Large ASD. The posterior superior margin is quite deficient. RV dysfunction. PASP 90mmhg. Left to right shunt. 34 mm device. LUPV deployment failed. RUPV deployment. Device occlusion test for 30min. No hemodynamics deterioration. Device released.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Echo bubble study in the extracardiac shunt. HPS.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Mid-RCA CTO. Short segment. Carlino. Pilot 200 crossed easily. Distal side branch wire perforation. Vicryl suture embolization via MC into side branch. Successfully sealed.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
ACS, late presentation. Got initial treatment at some peripheral centre. What do you think about this diagonal? Upfront 2 stents or Provisional.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
Anamolous/ Accessory bronchial artery from LCX or coronary artery to branch pulmonary artery connection. Lcx and lad were fixed. My thoughts were accessory bronchial artery from LCX.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
30 y old female. 3 months pregnant. Ant STEMI. Previous h/o four spontaneous abortions. What do you think about it.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Thrombus embolization during primary PCI.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Part 2. What I did. After heart team discussions. It was decided to do percutaneous closure so the VSD device was implanted. There was some residual shunt. Pt improved dramatically. Off inotropes on the next day. Stable hemodynamics.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Post MI VSR. Rare nowadays but still happens. Used to see 4 to 5 pt per year. The deadly complication with higher mortality.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
What do you think about it. Iatrogenic LMS dissection. LMS plaque repture and ulcer.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
Support issues. Functional CTO. AL، AR, hockey stick failed to provide adequate support. MC wasn't able to follow the wire. The whole assembly disengaged. JR tried with GCC but unfortunately, 6f GCC hasn't crossed the axillary bend. Finally, the Side branch anchor did the job.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
Small calibre vessels in elderly pt is always a challenge especially if it's bifurcation. Hybrid DES and DCB. DES in MV and DCB in side branches diagonal and OM. Linear dissection in diagonal and om with timi III flow after DCB. Decided to accept the results.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
How would you handle this LAD/ D. 0.1.1.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
How to handle this LAD, D1& D2. One important thing to mention there is a small coronary cameral fistula from the distal lad to LV visible at the end of the cine. This can create confusion as wire perforation after intervention.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
18 days
Difficult scenario to deal with. Young male with severe chest pain. ST elevation in III, avr, V1 and ST depression in all other leads. Would like to hear from colleagues, how to handle this.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Part 2 What I did. Proximal cto was functional crossed easily with pilot 50 & MC. Parked in diagonal. The other one was true cto. Gaia 2 and 3 failed. CP 12 used to puncture the cap. De escalate to gaia 3 but SI. CP 12 used to re enter. Predil, stent, post dil. Timi III flow.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
Valvular PS in 9 y old boy. PPG dropped from 90mmHg to 15mmHg after PPBV. An 18mm balloon was used.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
Airmail stenting..
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
POT PUFF sign. A good predictor of stent expansion. Isn't it?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Almost 24y old Starr Edward valves. DVR in 1999. Still Looking perfect.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
78y old female. CCS III angina. Complex lcx om bifurcation lesion. Angulated OM. 1.1.1. Managed with nano crush.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
4 months
When JR wasn't required...
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
11 months
Radial artery pseudoaneurysm. US-guided compression. The transition from slow flow to early thrombus to layered thrombus to organised thrombus.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Don't want to see it again.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Poor's man scoring balloon. Critical ostial stenosis RCA. Predil with 2.5 and 3.0 NC balloons while keeping another wire to create cuts. Good lesion preparation stent expansion.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Contrast modulation for instent CTO. Morbidly obese pt. Pci to rca 2018. Now NSTE ACS. MC tip injection to identify the cap. Gaia 3rd to puncture the cap and MC engaged. 1cc contrast injection. Pilot 200 crossed easily due to contrast-induced microchannels.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
What do you think about this LAD? A young male presented with Ant STEMI. ST V1 to V4. Shifted for PPCI. Found this. How would you treat this pt.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Medina 0.0.1. LMS bifurcation. Difficult anatomical subset. S/p renal Transplant 4/22 PCI to RCA OSH 12/21. Now CCS III. Otimized GDMT still significant symptoms. What would you do.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 month
Always love to see such a beautiful splitting of commissures.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
AVR in 2000 Starr Edward. Now severe MS. Pliable valve. NYHA III-IV. PTMC Reverse loop. Significant sub-valvular disease. Pulled back carefully to avoid sub-valvular inflation. 28mm Inoue. Satisfactory final results.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Radial artery perforation and dissection. Guide cath razor effect. Initially, external compression with BP cuff above the systolic pressure. It was still there, then a combination of balloon temponade and external compression did the job.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Acute inf STEMI. Culprit lcx. Non Culprit LMS, LAD. Ischemic MR, LVF. Ppci to lcx. Slow reflow. Shifted to the ICU. Staged PCI LMS, LAD and ivus guide optimization of lcx stent. During index admission.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
A young male precisely 32y old. Ant STEMI. Recurrent VF. How would you proceed? 1 direct stenting. 2 pre-dil and stenting. 3 aspiration then stenting. 4 aspiration/predial deferred stenting. If stenting then 1 ostial nailing. 2 cross-over.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
ACS,recurrent VT, hypotension. LAD sub total. RCA CTO. Both fixed. Short Extreplaque segment of proximal stent. Can't stretch it more.
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4
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
25 days
Ant STEMI at midnight. What would you do in such a scenario? 1 Provisional or 2 Upfront 2 stent strategy. Just curious to know if is there any impact of late working hours on the bifurcation strategy.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Reverse wiring for angulated OM with high grade stenosis.
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3
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
JSBKT for LAD, D. POT, DOT, KBI. TAP initially looks good but too much protrusion of the side branch stent. Converted to reverse crush. KBI, Re POT.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
What would be your preferred strategy for this LAD/D1. 1 Provisional. 2 upfront 2 stent. 2a DKC or it's variants, micro, mini or nano. 2b culotte or its variant DK culotte.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Another example of contrast modulation. Mid lad cto. Ipsilateral septal to septal collaterals. 74y old female. AF. Cap engaged with MC. 1cc contrast. Pilot 200 crossed easily.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Cauliflower LAA.
2
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
6 months
Distal RCA cto. Retrograde carlino to puncture the distal cap. Followed by RCART.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
9 months
What would you do?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Large ASD. 30mm device. Deployment from RUPV.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Inf STEMI. Anomalous RCA. Failed to canulate from RRA with JR4,AR1, AR2, AL1, MP, XB3, JL3.5. Switched to RFA. Was able to locate with AL2 non-selective injection.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
Elderly female 40kg wt. Surgical turndown. Rca function cto. Lad true cto. Became hypotensive after the diagnostic cath.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
84y/f underwent CAG via 6F femoral route. Hemostasis was secured with manual compression. In CCU, she developed hypotension and massive Ant. Abdominal wall hematoma. Her groin was clean. Shifted back, did SFA stick, and took the femoral shot. What do you think what had happened
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
Surprised to find this much hard, hypertrophic IAS. 48y old male, previous PMBV 19y ago now re stenosis and re PMBV. IAS stained with contrast and then pushed hard, drilling to puncture and even had to push harder to pass the mullen sheath. Not sure why it is.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
70-year-old hypothyroid obese female. Ongoing chest pain. How much would be enough for this pt?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
6 months
Functional CTO or acute occlusion.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
What do you think? A 55-year-old female presented with acute SOB.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
11 days
Third inflation did the job. What do you think about systolic compression at the distal balloon segment?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
7 months
VSR closure with single disc ADO type device. 82y old female. CS, distal septal VSR. 20/22 mm single disc device deployed
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
4 months
Buddy cath tech for pulmonary balloon valvuloplasty. Critical PS, severe TR. Very difficult wire crossing. Glide wire Critical but MP 5, 4 f failed to follow. Glide cath crossed to stabilize TV & PV. 2nd MP crossed exchanged with stiff wire then Sequential balloon dilation
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Young male with inf. STEMI flow restored with wiring without predilation Now what would be your preferred strategy in this case. A. Direct stenting. B. Predilation then stenting. C. Thrombus aspiration then stenting.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Toughest PS have ever seen. Gradual balloon dilation, 10x 40 mm, then 16x 40, and finally 20x40 mm but unable to dilate despite maximum pressure.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
An interesting case. PTMC in pt with dextrocardia. Did this case about 10y ago. A question from colleagues/ friends. How many PTMC in dextrocardia have you seen/done. I did only one and have been waiting for another one. Pls share your experiences.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Jailed balloon tech. To rescue the side branch. Tortuous LAD. Extreme angulation at lesion. 2nd septal large size important vessel. Difficult wiring. Jailed 2.0 x 10 mm balloon in septal at 4atm while stent deployment. Finally timi III in septal and LAD.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Huge LA. 2nd procedure. Ist PTMC in 2014. Restenosis. Now 2nd procedure. Reverse loop tech for MV crossing. Low TSP.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Follow up of pt post-VSR device closure at 3 weeks. Now LAD has some flow so decided to fix it. LV angio mild residual shunt. Stable device. RHC PA 26/12/26 LV 103/36/03. CO 8L CI 5L Qp/Qs 1.5 Asymptomatic. Decided to continue GDMT. next FU at 6 weeks.
8
13
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Subclavian coronary steal. Post CABG pt. Recurrent admissions with HF and syncope. Occluded svgs. Left Subclavian CTO. Retrograde filling via vertebral.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 month
What do you think about deployment depth? Good enough or too deep. Mild PVL.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
Post CABG. Multiple hospitalisations after CABG. EF dropped from 50 to 30/35%. Patent grafts but.....
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
6 months
How and how much?..
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
TVD, cabg refused. After pre dil somehow wire and guide disengaged. Ostial dissection. Aw failed. Bailout retrograde wire to engage the true ostium. Stented to heal the ostial dissection. Fu no further extension of dissection. Remained stable. Asymptomatic at several months FU.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Bi cuspid AS and PDA in young adult. Simultaneously BAV and PDA device closure.
1
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Part 2, what I did. Depending upon ivus findings decided to fix it from LMS to LCX. Predil 3.5 NC. Stent 4.0, POT 5.0, DOT 4.5, KBI 4.5/3.5, Re POT 5.0. Ivus guided
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
11 months
Anomalous RCA. Above STJ on the left side.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
6 months
Recanalized CTO or multiple intra-plaque channels, RCA, LAD and OM. Effort angina III. Fair LV EF.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Parallel wiring. 1st one was sub intimal.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
4 months
Large ASD secondum. Deficient aortic rim. 24 mm device. Descend from LUPV failed to capture the aortic rim and prolapse in RA. Recaptured. Clockwise rotation and deployed. Perfect landing.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
Large PDA with severe PHTN. 30 min device occlusion test. PAP increased from 96 mmHg to 106 mmHg. AO pressure remained the same at 110/60mmHg. Sat dropped from 94% to 82%. PVR 8 wu. Decided to retrieve the device.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Rewarding intervention in terms of immediate outcomes.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Indentation at distal segment of inoue balloon during PMBV is suggestive of severe sub valvular disease. (Fluoroscopic sign)
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 month
What do you think 0.0.1 or 0.1.1. How to handle this. Inverted TAP. Provisional. Culotte. DKC.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Wire manipulation in tortuous LAD. 80y male, ACS. Tortuous radial and subclavian. Iliac and aortic tortuousity. Xb failed. JL4. Wire in lcx to stabilize. Difficult wire crossing in proximal lad first crossed in septal balloon dottering then pull and crossed in LAD.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 months
FU of the case. Started with LCX/ OM stenting. Did DCB to mid, distal LAD. After these encouraging results decided to intervene in the RCA as well in the same setting. AR2, HS, Lima and JR guide used. TPLP MC, pilot 200, Gaia 2nd wire. Timi III flow achieved.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
11 months
Interesting. What do you think?
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
9 months
Severe AS, 76 y/F. TAVI. Evolut 23. Post dil Severe Valvular AI. Stuck leaflet. TAV I TAV. Coronary protection. Final acceptable results.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Bovine aortic arch.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
5 months
26y old female pt with uncontrolled HTN despite maximum anti-HTN drug therapy.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 month
What you do think about the J CTO score of this RCA? I, 2 or 3. How to approach.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
3 months
Severe diffuse disease. Surgical turndown. Lad total occlusion. DCB to the mid, distal lad. Plan to have angiographic FU at 6 weeks and staged PCI to RCA. Would like to hear from colleagues These angiographic results are Acceptable or not.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
PMBV in 10y old child. Prevalence of RF/RHD is horrible in our part of world. Not a one case frequently used to do it in 8, 10, 12 y old children. Must be eradicated by. Extensive primary prevention programme. Training and education of GPs. Awareness program. Media conpaign.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
CTO mid rca. Initially looks ambiguous proximal cap. Dual injection short cto with intraplaque channel. Crossed easily with fielder wire. Final good results.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
6 months
F/U of the case. PJ wire used with MC. wire manipulation was done Multiple times due to multiple channels. Fine found the right channel. Distal true lumen confirmed with pressure from MC and tip injection.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
1 year
What do you think about the severity of this MR.
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@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
56y old female. 39kg wt. SOB fc III, IV symptoms. Large ASD secondum. 29x25x24. Deficient aortic rim. Sufficient other rims. 30 mm amplantzer device deployed.
5
7
44
@DrIHHashmi1
Dr Imran Hanif Hashmi
@DrIHHashmi1
2 years
Chicken wing LAA.
6
6
47