1/2 Dec-Jan #LeftMain 🫀Chronicles continue. Advanced age. Cardiac arrest. NSTEMI. Moderate LV dysfunction. Severe LM bifurcation dz. Outside Hospital xfer post-recovery for PCI…

1/3 Advanced age. Near-normal EF. Refractory angina. Calcified 🪨 LM proximal through distal bifurcation (Medina 1,1,1) dz and calcified 🪨short LAD CTO (images below): referred for PCI after Heart 🫀Team evaluation…

1/2 Ostial-thru-mid RCA calcified 🪨CTO: referred to our Team after prior failed attempts. Started Retro surfing 🏄‍♂️ but no suitable Septals (primarily telephone 📞 cord epicardial collaterals). Pivoted to AWE. Got subintimal purchase with P200👍…

1/3 Welcome to 2025🥳. NSTEMI. Acute Systolic Heart Failure. Moderate LV Dysfunction. Diagnostic angiography below (Severe LM bifurcation Dz and RCA CTO: with IABP insertion and Hospital xfer)…

1/3 Advanced age. Severe LV Dysfunction. Acute Systolic Heart Failure. NSTEMI. Diagnostic angiography below (Severe LM bifurcation and multi-vessel CAD: with IABP insertion and Hospital xfer)…

👍I’d say there is (at least) equipoise here (with IVI-guidance/optimization and dz not involving the trifurcation) re: #PCIvsCABG (LM Megatron DES: 5.3 mm distal to 6.0 mm ostial [with already-in-place IABP: removed post-PCI]): 🔗 www.jacc.org/doi/10.1016/...

Happy Holidays 🕎🎄Friends…

👍#CiCU Holiday Cheer: IYKYK😜…

1/2 👍”Never walk into a Cath Lab you (and your patient) can’t walk out of”: Clinical expert consensus document on bailout algorithms for complications 💥 in percutaneous coronary intervention: 🔗 pubmed.ncbi.nlm.nih.gov/39627466/…

👍Pretty amazing history (of grit and innovation) in our field 🫀here…

👍 Fun quit chat with #ScottNelson #FastWave: www.fastwavemedical.com/news/intervi...

Great to participate (even if remotely) in #ICI2024👍: icimed.org…

ACS. Severe LV Dysftn. Acute HF. Mod-Sev AS. Critical LM dz (and RCA CTO). Prohibitive PAD for MCS. So: “rapid-fire” POBA with Epi/NorEpi gtt (with 60-sec loss of pulsatility) followed quickly by (less eventful) PCI/DES and final IVUS 👁️ optimization: 🔗 pubmed.ncbi.nlm.nih.gov/36423996/…

Mixed Cardiogenic-Vasodilatory ⚡️🫀💥 Shock: Current Insights and Future Directions: www.sciencedirect.com/science/arti...

Holiday 🕎🎄#CTOPCI planning meeting 🎸🥁🎷…

Who uses Protamine post-PCI in the Cath Lab 🤷‍♂️? Currently using for all CTOs (after coronary gear removal) and all elective Impella high-risk PCI (after device removal). What do others do? 🔗 pubmed.ncbi.nlm.nih.gov/37172213/%E2...

👍 Happy 🦃🇺🇸🍁 Thanksgiving 2024: founders.archives.gov/documents/Wa...

1/2 ACS. Moderate LV dysftn. Acute systolic HF. LM into LAD calcified sub-total occlusion (and moderate LCX dz). Extreme BMI. Impella-assisted, IVUS-guided 👁️ PCI (via new Single-Access sheath), Rota 💎, DES (3.2-4.2mm LAD/4.6mm POT LM). Pre-Close + Post-Close Perclose closure…

New: 3 different user-friendly @SCAI Shock ⚡️🫀💥 MCS e- Book viewing options: PDF, on-line, and off-line👍: 🔗 scai.org/short-term-m...

5 Pericardiocenteses over the last week (random 🤷‍♂️). My technique/approach: patient up at 30-45 degrees, sub-xiphoid, Echo and Fluoro, micropuncture, agitated saline injection, drain through radial sheath, suture sheath, foley anchor on drain. What’s your technique?…

1/2 HydroDynamic (CTO) Contrast Revascularization: 🔗 onlinelibrary.wiley.com/doi/10.1002/...

Intra-Coronary Imaging 👁️ for Complex Lesion Subsets (and ideally for all-comers): academic.oup.com/ehjimp/advan...

1/2 Theme of the Day #1: Jailed Balloon 🎈technique for bifurcation PCI (this one WITHOUT side branch comprise [see Figure 1 in Article): 🔗 pmc.ncbi.nlm.nih.gov/articles/PMC85……

Referral after (rightly) halted ACS RCA PCI (Guide dissection): nearly resolved by repeat CTA days later. Return for IVUS 👁️ guided PCI, Rota 💎 stent-ablation (200k RPM/240 sec) and de novo calcium 🪨 modification, IVL ⚡️(3.5mm), and final re-line ostial-distal DES (4.0-4.3mm)…

👍 Starting fresh…under clear blue skies 🦋…

First post. Palate cleanser. #BruceCockburn 🎸🎤 show with the Family last night👍…