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Manos Brilakis
Приєднався 29 жов 2011
Sensei Podcast Episode 89: Göran Olivecrona
Insights on how to learn CTO and complex PCI by Dr. Göran Olivecrona from Skåne University Hospital, Lund, Sweden
Переглядів: 114
Відео
Case 255: Manual of CTO PCI - Retrograde through an occluded SVG
Переглядів 89822 години тому
A patient with prior CABG presented with angina and was found to have a distal RCA CTO with occlusion of the SVG-PDA. The RCA CTO had a blunt cap, length of approximately 25 mm, and diffusely diseased distal vessel that was filling via epicardial collaterals from the OM and LAD. A primary retrograde strategy was selected because the distal vessel was diffusely diseased. A Gladius Mongo was adva...
Sensei Podcast Episode 88: Khalid Tammam
Переглядів 494День тому
Insights on how to learn CTO and complex PCI by Dr. Khalid Tammam from International Medical Center, Jeddah, Saudi Arabia.
Case 172: Manual of PCI - Double bifurcation
Переглядів 2,1 тис.День тому
A patient was referred for PCI of a double bifurcation lesion: (a) LAD diagonal bifurcation and (b) bifurcation of the diagonal into a superior and an inferior branch. Coronary physiology with a pressure wire and AngioFFR was performed showing a long lesion in the LAD and a more focal lesion in the diagonal. The superior diagonal branch did not have significant stenosis, hence provisional stent...
Sensei Podcast Episode 87: James Choi
Переглядів 26214 днів тому
Insights on how to learn CTO and complex PCI by Dr. James Choi from the Presbyterian hospital in Dallas, Texas.
Case 171: Manual of PCI - The uncrossable lesion
Переглядів 2,6 тис.14 днів тому
A patient with exertional angina was found to have a severely calcified distal RCA lesion that could not be crossed by any balloons and was referred for repeat PCI attempt. The RCA was engaged with an AL1 8 French guide catheter. We were unable to cross the lesion with a guidewire, despite using a microcatheter and multiple wires with different bends at the tip. Eventually we used a Sasuke dual...
Sensei Podcast Episode 86: Raj Chandwaney
Переглядів 28421 день тому
Insights on how to learn CTO and complex PCI by Dr. Raj Chandwaney from the Oklahoma Heart Institute, Tulsa, Oklahoma.
Case 254: Manual of CTO PCI - CART
Переглядів 1,8 тис.21 день тому
A patient with prior CABG surgery was referred for PCI of a native RCA CTO due to recurrent failure of the SVG-PDA. Coronary CT angiography was done prior showing the proximal cap to be at the takeoff of an acute marginal branch, length of 34 mm, and calcification at the proximal cap and within the occlusion segment. A primary retrograde approach was used with a Pilot 200 wire advanced through ...
Sensei Podcast Episode 85: Pierfrancesco Agostoni
Переглядів 48028 днів тому
Insights on how to learn CTO and complex PCI by Dr. Pierfrancesco Agostoni from HartCentrum, ZNA Middelheim, Antwerp, Belgium.
Case 253: Manual of CTO PCI - IVUS guided puncture
Переглядів 2,1 тис.Місяць тому
A patient was referred for PCI of an LAD CTO. The LAD had an ambiguous proximal cap, length of approximately 25 mm with diffusely diseased distal vessel that was filling via septal collaterals from the RCA. An IVUS was inserted in the diagonal branch clarifying the proximal cap ambiguity. IVUS-guided puncture succeeded in crossing the proximal cap. After advancing a Corsair XS into the occlusio...
Sensei Podcast Episode 84: Sergey Furkalo
Переглядів 359Місяць тому
Insights on how to learn CTO and complex PCI by Dr. Sergey Furkalo from the National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev, Ukraine.
Case 252: Manual of CTO PCI - Rota-Tripsy for a heavily calcified CTO
Переглядів 2 тис.Місяць тому
A patient presented with exertional dyspnea due to a RCA CTO and a mid LAD lesion. He underwent an unsuccessful attempt for RCA CTO recanalization and was referred for a 2nd attempt. He had a mid RCA CTO with heavy calcification, clear proximal cap, short length of ~10 mm, diffusely diseased distal vessel and a PDA filling via an epicardial collateral through the diagonal branch. Antegrade wiri...
Sensei Podcast Episode 83: Jeffrey Moses
Переглядів 403Місяць тому
Insights on how to learn CTO and complex PCI by Dr. Jeffrey Moses from Columbia University, New York.
Case 170: Manual of PCI - Covered stent did not work
Переглядів 3,4 тис.Місяць тому
A patient was referred for PCI of the right coronary artery and the LAD. The RCA had a severe, heavily calcified distal lesion. Equipment delivery to the RCA lesion failed through radial access despite using a guide extension. After changing to femoral access with an 8 French AL1 guide and a guide extension a balloon could be delivered to the RCA lesion but the lesion was balloon undilatable. T...
Sensei Podcast Episode 82: Thomas Hovasse
Переглядів 341Місяць тому
Insights on how to learn CTO and complex PCI by Dr. Thomas Hovasse from the Institut Cardiovasculaire Paris Sud, Paris, France.
Case 251: Manual of CTO PCI - RCA with tandem CTOs
Переглядів 1,9 тис.Місяць тому
Case 251: Manual of CTO PCI - RCA with tandem CTOs
Sensei Podcast Episode 81: Elliot Smith
Переглядів 311Місяць тому
Sensei Podcast Episode 81: Elliot Smith
Case 169: Manual of PCI - The 3.5 mm stent
Переглядів 3 тис.2 місяці тому
Case 169: Manual of PCI - The 3.5 mm stent
Sensei Podcast Episode 80: Stefan Harb
Переглядів 4672 місяці тому
Sensei Podcast Episode 80: Stefan Harb
Case 168: Manual of PCI - CT and FFRangio guided PCI
Переглядів 1,5 тис.2 місяці тому
Case 168: Manual of PCI - CT and FFRangio guided PCI
Sensei Podcast Episode 79: Jacopo Oreglia
Переглядів 2852 місяці тому
Sensei Podcast Episode 79: Jacopo Oreglia
Case 167: Manual of PCI - CTO PCI techniques for a wire uncrossable lesion
Переглядів 2,6 тис.2 місяці тому
Case 167: Manual of PCI - CTO PCI techniques for a wire uncrossable lesion
Sensei Podcast Episode 78: Brian Jefferson + Taral Patel
Переглядів 3132 місяці тому
Sensei Podcast Episode 78: Brian Jefferson Taral Patel
Case 250: Manual of CTO PCI - Retrograde via ipsilateral epicardial collateral: tip in to the rescue
Переглядів 1,9 тис.2 місяці тому
Case 250: Manual of CTO PCI - Retrograde via ipsilateral epicardial collateral: tip in to the rescue
Case 249: Manual of CTO PCI - Left main CTO PCI
Переглядів 2,5 тис.2 місяці тому
Case 249: Manual of CTO PCI - Left main CTO PCI
Sensei Podcast Episode 76: Mario Iannaccone
Переглядів 4893 місяці тому
Sensei Podcast Episode 76: Mario Iannaccone
Case 248: Manual of CTO PCI - Micro Rx
Переглядів 2,4 тис.3 місяці тому
Case 248: Manual of CTO PCI - Micro Rx
Sensei Podcast Episode 75: Salman Allana
Переглядів 1,2 тис.3 місяці тому
Sensei Podcast Episode 75: Salman Allana
Case 166: Manual of PCI - Physiology-guided PCI 1
Переглядів 1,9 тис.3 місяці тому
Case 166: Manual of PCI - Physiology-guided PCI 1
Thanks for the excellent case presentation.
thank you
Nice case. Is CART feasible in this case? Thank you
Thanks for these great videos, Some retrograde approach videos have not been uploaded in playlist.
What a pleasing beautiful case
Thank you
Thank you
How come you change to the pilot 200 retrograde rather than sticking with the gladius MG in the PDA?
Excellent case.In case of severe lesion not moderate one, do you still relay on FFR for strategy planning? Thanks
If lesion is very severe angiographically I do not use FFR as it is almost always positive - post PCI FFR can be useful even in such cases though.
Great conversation thanks to both of you. I was in the same meeting in Türkiye 🇹🇷 if I am not wrong the case was presented by Prof. Dr Şevket Görgülü which was about closing Vessel with a distrupped baloon
nice case , I have a couple of questions if I may: First: Would it be safer to avoid ballooning the superior diagonal branch beforehand? second:2.25 is too small a stent to put in LAD, isnt it?
Good points - Agree that not predilating the SB is preferable to minimize the risk of dissection. Also agree re:stent sizing but it is usually better to start with a smaller stent and postdilate to larger diameter than start with a larger stent that may cause distal edge dissection.
I went to ijcto Hyderabad, really hoping to meet you there. 😢
Why did you place 3 mm stent proximally and ask for 3.5 mm stent distally? also,did you post dilate proximal stent to 3.5 mm?
Are you sure lad stent was 2.25 mm.what stent do you use that can go upto 3.5 from 2.25 mm?also,did you post dilate distal part of stent?
Yes, stent can be postdilated to 3.5 mm.
Thanks for the excellent case presentation.
Excellent job Caution is needed when pressure wires are advanced through MB stent to check pinched side branches, especially in some case of high calcium burden at bifurcation (even after stenting) these pressure wires can easily get stuck leading to unpleasant complications. I would always use FFR Angio after stenting as it was perfectly mentioned here
Nice result. But are you concerned for Ostial pinching of superior branch?
Yes but decided to not do additional ballooning as the patient was asymptomatic and the branch had TIMI 3 flow.
@@manosbrilakis will angio ffr can help here.?
It seems like there is some compromise on the ostium of the upper branch of diagonal. Do you think in the future it May cause problem?
Good point - this is definitely possible - it can often be challenging to strike a balance about what is "enough" or not.
Do we have to see from another angle how much we protruding into lad when we implanting first stent?
Great cases as usual Manos. My only point is about the LAD stent, you chose 2.25 mm diameter. POT with 3.5 will lead to over expansion . The ONYX 2.25 goes up 3.25. I would have used a larger diameter and deployed at lower pressures then post dilated accordingly.
I agree with your opinion about stent size and need IVUS or OCT to confirm the proximal stent is good apposition.
This looks like 2.75 stent. Not 2.25
May be Onyx Frontier as Onyx Frontier 2.0--2.5 mm expand up to 3.5 mm
Great point!
Many advocates the use of OCT for bifurcation stenting, especially for making sure the proper SB strut wiring before 2nd kissing balloon..what is your view on that? Thank you
Absolutely! Intravascular imaging is extremely useful in bifurcation PCI.
Left atrial branch is missing now, right?
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What is grenadoplasty?
Inflation of a small balloon (usually 1.5 - 2.0 mm) at high pressure until it ruptures. The rupture may modify the plaque and facilitate subsequent equipment advancement.
What if atherectomy also failed?
Options include laser, various plaque modification balloons, extraplaque wire crossing.
@@manosbrilakis Sir if we went from around the lumen and after ballooning and we faced a rupture? What will be our options. Graft stents would be hard to deliver.
@@farukakturk5388 Good question: equipment delivery is much easier in the extraplaque (subintimal space). Balloon and stent sizing should be more conservative in the extraplaque space and high-pressure balloon inflations avoided.
@@manosbrilakis Thank you very much. I appreciate for your kind response
" You shall not Cross"--- Mano- "Oh, yes I will!"
Thanks for sharing.
Thank you sir, had your retro wire ended in subintimal space, doing a reverse cart in a single guide would have been difficult. Would you have used ping pong guides? Any solutions for doing a reverse cart in a single guide?
Thanks sir .. very nice and interesting 👏👏
Good case sir
Excellent case
Prof. Brilakis, how exactly was your technique with the PDA? It was not a crush, right? Did you place the stent with a little Protrusion, wired through the struts that protruded and modeled them onto the main vessel? Would there not be a Kissing necessary?
Would like to know cost of the procedure?? Well done case
Thanks
I thought venture catheter has angle and for lcx.
Thanks for the excellent case sharing.
Wow
Thanks sir
Thank you for the great case Professor. Is there a risk of thrombi showering into the native vessel from the coiled SVG graft Professor?
No
Is it mandatory to occlude the SVG?
@@apurvavasavada383 no but if there’s significant competitive flow from the graft the risk of stent thrombosis is higher, theoretically. No data. Just anecdotal experience. On the downside it removes a conduit to fix a CTO in the future. IMO depends on the degree of competitive flow.
Thanks
Meglio robert redford
Si puo fare di piu
Che noia
❤
May he Rest in Peace.
Excellent demonstration
Amazing sir
Great case as usual , Sir
Very nice presentation as usual, May I ask is it ok using a Gaia 2nd in Anterior Stemi at minute10: 42 ?
It is definitely not common, but can sometimes be used in complex cases
Thanks for the educative case presentation.