Dr.M

Interventional Cardiologist, National Heart Institute, Kuala Lumpur. Days I'm not at my real job, I'm an imaginary Astronaut

[Salman Arain @realarainmd]

Did you see the jiggle?

Thoughts about an eruptive calcified nodule. A 🧵

At @OPCILive this past week, @ziadalinyc shared a case involving an eruptive CN.

In his inimitable (and purposefully provocative 😂) style, he asked the audience if we could see the haziness ‘jiggle’.

@DrAllenJ was the perfect foil for the conversation (and the voice of the audience) - and said: “No, we don’t!”

Hopefully the case will be up for viewing soon. But here are some thoughts…

[Kambis Mashayekhi @KambisMashayek1]

We are deeply saddened by the passing of our esteemed colleague and dear friend, Dr. Dimitri Karmpaliotis. Dimitri was not only a world-class interventionalist, but also a visionary thinker, a generous mentor, and a tireless advocate for better patient care. @CtoEuro

[Bilal Iqbal @DrBIqbal]

Introducing the CRISP technique….

Coils are frequently used for therapeutic graft closure to reduce competitive flow following native vessel intervention. Stable deployment of coils can be challenging with a risk of migration/embolization particularly if the graft is patent and free of significant disease and tortuosity. Sometime over-sizing the coils helps but doesn’t abolish risk of embolization. To address this we describe a novel CRushed In-situ Stent Plug (CRISP) technique with strategic deployment and fashioning of a partially crushed stent in the graft to serve as a scaffold plug to hold coils and prevent distal embolization. Would welcome your thoughts and feedback.

https://t.co/mmmcwg4Xzg

#Cardiology #cardiotwitter #PCI #complexPCI #CTO #CTOPCI #CRISP #JACCCaseReports

@JACCJournals @Can_CTO @CtoEuro @SanjogKalra @DrDarshanDoshi @KambisMashayek1 @RinfretStephane @KovacicMihajlo @AgostoniPF @mornei2011 @swissCTO @A_B_Hall @SmithElliotjs @YbarraLuiz @dautov_MD @ammozid @MohamadAlmutawa @BElbarouni @jcspratt @tomkaier @AnjaKsnes @RajaHatem @LAzzaliniMD @jedicath @Laserrman @FaroucJaffer @MohanedEgred @stefan_harb @BostonEdney @AHRavandi @DrIHHashmi1 @ogoktekin @OpolskiMP @K_DeSilva @KVM83 @FaurieBenjamin1 @MichaelMegalyMD @ignamatsant @agtruesdell @ziadalinyc @rickytiago @sharmaine0206 @aspergian1 @realarainmd @MauroCarlino3 @yassersadeknhi @MdM_Ochiai @SarahFairley7 @mbmcentegart @GlenAprile

[Tsutomu Fujita MD @Laserrman]

LAD #CTO #HDR #TDHDR #MHA #singleaccess
TDHDR with ST→PC punctured→HDR→#starrysky→XT non tip buckled→2nd HDR→XTnon tip was buckled at same point→3rd HDR→Sionblack→TL→GW is in all IP
CB failed→stent

@realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

[Michael Megaly @MichaelMegalyMD]

This year I am late in #my_4_slides on my most important takeaways from #CTO2025

Lots of great stuff and I will start with the intriguing #CTO #PCI techniques I will try in 2025.

1-HDR presentation by @realarainmd
He explains it perfectly, his cases on X are enjoyable.

In a very simple way
1-Stick the cap (a few mm)
2-Advance MC- pull wire while dripping contrast (prevent air trapping in the MC)
3-Inject slowly <0.5 cc
4-Analyze and decide next steps

If intraplaque staining, nontip Fielder XT. If extraplaque, move down your algorithm (stick again or use other techniques)
#cardioX #accfit

[Tsutomu Fujita MD @Laserrman]

#CTO #HDR #TDADR
How to do #TDADR/

Special lecture for @MSundarajoo @SCVC2023

[Salman Arain @realarainmd]

An #HDR Pictorial - Part 1

This was a very educational case. The evolution of the stain is as important as its angiographic appearance.

I have captured 8 🔑 moments!

Here is ‘my take’…

[Lorenzo Azzalini @LAzzaliniMD]

First line #HDR (puncture with GN3, contrast 💦, then ‘no tip XT’ according to sacred scriptures 📖) ➡️ subintimal stain.
I ask the HDR Oligarchs why it didn’t work ❓
(Then easy bailout retro, 1 stent, 🔪🎈 to decompress distal hematoma)
@realarainmd @Laserrman @MauroCarlino3

[Tsutomu Fujita MD @Laserrman]

#CTO #MHA #HDR #IVI #DCB
LAD cTO→PJWs do not cross→PC puctured byG2→#HDR
→DXcross→Sionblack with DLC→LAD #HDR→XT crossed→#IVUS #OCT →IVI shows IP tacking and stain→#CB and #DCB

@realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

[Dr.M @MSundarajoo]

@Laserrman Thank you very much Sensei @Laserrman Dr Fujita for all the guidance and teaching. I truly appreciate the opportunity 🙂 #TDADR #HDR #SCVCstyle

[Tsutomu Fujita MD @Laserrman]

The #CTO experts from SCVC invited international fellows to #TDADR dinner. The participants enjoyed discussion on CTO and authentic Japanese cuisine at the same time. What a great evening!
Welcom @MSundarajoo to learn #SCVC style #cto

[Tsutomu Fujita MD @Laserrman]

https://t.co/GpOMvCTitI

#TDADR #BASE #CT0 Congrats @VRejeki28

[Shoichi Kuramitsu, MD, PhD, FACC, FJCS, FSCAI @SKuramitsu0511]

RotaとIVUSにフォーカスしたPCI workshop、ROVUS123
、無事に終了😃

The two-day PCI workshop "ROVUS123," designed for Asian physicians to learn the fundamentals of Rotablator and IVUS, was successfully held. I look forward to seeing you all again!

@Laserrman @SCVC2023 @rotamonster

[Tsutomu Fujita MD @Laserrman]

RCA #CTO like. #Lotusroot Bailout #TDADR
UB3→EP→TDADR→get TL but GW leave out from TL with mistaken procedure→ Re TDADR→swap sionblack to PD→Go EP→Re Re Re TDADR→Get IP not TL→#TDAW→Get TL→Stenting #CB fenestration.

Repeated #TDADR destroys IP ,makes #TDADR more difficult.
How to negotiate GW from IP to TL with #TD

@realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

[Dr.M @MSundarajoo]

@Laserrman Excellent case, a lot of learning points. Thank you for the teaching, Sensei! @Laserrman

[Tsutomu Fujita MD @Laserrman]

Interesting case #CTO Post CABG, Triple #CTO
UB3→HDR→EP or Cloud storms→sionblack KWT→Tip injection EP stains→KWT→#TDADR→swap sionblack→2nd CTO with calcification→#TDAW with UB3→swap sionblack→TL→But EP stains on PD(3rd #CTO)→UB3 crossed with #stain guide→distal TL

#Contrast has made us successful.

@realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

[Ignacio J. Amat @ignamatsant]

Proud to have performed a retrograde CTO of LAD through right epicardial colateral for OMG meeting in Cordoba😍
Thanks to @MPAOSS @OjedaOjeda18 @lmteruelg
@JuradoRomanAl @sjorge4 @stamdos
@MLCTOAcademy @LAzzaliniMD @ahmedelguindy @Retrograde_CTO @RinfretStephane @secardiologia

[Tsutomu Fujita MD @Laserrman]

@OptimaCTO #TDADR #CTO
Presentation made by @tadano98 for #Optima about #TDADR
@DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct #CardioTwitter @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva
#MedTwitter @evandrofilhobr @MichaelMegalyMD @asaadnakhle @shimokoshimike. @SCVC2023 @girishviswa @baijazvascular @ErwMulia @jbspadoni @GTawade84 @drAliyor #cardiotwitter @PCRonline @SCAI @ikki1127 @CtoEuro @BabliakD @SPyxaras @JuradoRomanAl @JiunnWen_Lin @MLCTOAcademy @shci_sec @drdharmarajk @sapporohunt @ogoketekin #CarduiTwitter #CTOPCI

[Evald Høj Christiansen @h_evald]

How would you treat a perforation in a bifurcation core?
No effect of prolonged balloon occlusion

[Pierfrancesco Agostoni @AgostoniPF]

Istanbul, 19-21/9/2024
@CtoEuro congress, joined with @ctoessentials!
https://t.co/oRoGc4VLJB
Feel free to submit your CTO-related scientific abstracts, but also interesting educational CTO cases or relevant CTO-related complications!
I will see you there!
@KambisMashayek1