Neel Parikh, MD

Interventional Cardiologist, Director Cardiac Catheterization Lab, Piedmont Medical Center

[Neel Parikh, MD @NeelParikhMD]

@realarainmd @rajivxgulati @SripalBangalore @Hragy @agtruesdell @ihtanboga @DocSavageTJU @nyalborgesmd @TWilsonMD @skat_ct @stefan_harb Excellent result. Did her EF improve?

[Neel Parikh, MD @NeelParikhMD]

@realarainmd @SripalBangalore @rajivxgulati @DrBIqbal @evandrofilhobr @Bernard_TW_Wong @rotamonster @Hragy @DocSavageTJU @agtruesdell @nyalborgesmd Fem access, 45cm sheath upfront. 8F AL1, 7F guideliner-BAT past prox tortuousity. Finecross, swap for rota floppy, 1.5 burr. IVUS. Shockwave aero if it goes. If not then cutting balloon/NC

[Michael Megaly @MichaelMegalyMD]

A backtable illustration of a couple techniques you can use if the #Rotaburr gets stuck,

1-The skipping rope technique.
We have known it for a couple years, and it was recently published

https://t.co/fqTn6NXkaT

2-The final resort of cutting the rota driveshaft and advance a guideliner through it to get more leverage to pull.

Of course the first thing you do is to pull hard and maybe try to balloon around it, but those can help with tougher situations.

#CardioX community, please share your additional tips and comments

[Neel Parikh, MD @NeelParikhMD]

@ShariqShamimMD @Hragy @mirvatalasnag @TCTConference @TCTMD @djc795 @tavrkapadia @GilbertTangMD @MarwanSaadMD @kimskeldingmd @nickaram Rota 1.5 burr, NC balloon/wolverine afterwards. IVUS. If unsatisfied with modification would then shockwave 1:1 or mildly oversized. Worries me to go direct to OPN here without some debulking or way of creating calcium fractures. LM to LAD crossover megatron stent.

[Neel Parikh, MD @NeelParikhMD]

@realarainmd ~90% IVI use in STEMI for me. About a third of these I’ll only do IVUS post PCI, usually in unstable/shocky patients. Otherwise always pre and post stent, but after initial balloon to restore flow. Usually defer IVI in small vessel culprits.

[Neel Parikh, MD @NeelParikhMD]

@DrIHHashmi1 Id treat the RCA first. May not be dominant but is clearly supplying collaterals to LAD and appears large enough to stent. Proximal LAD cap doesn’t seem favorable but would plan AWE up front as it is a short segment with HDR. Would be prepared for retrograde if needed.

[Neel Parikh, MD @NeelParikhMD]

@warriorsger Imagine missing 2 shots and having full ability to blame the rim and people believe it

[Neel Parikh, MD @NeelParikhMD]

@PurumittalDr @raico980724 @Ecgloverr @Hragy @DrAnkushG @realarainmd @mmamas1973 @mirvatalasnag @aspergian1 @nadig_cardio @JoySanyal74 @PCRonline @cardiodoc1988 @cardiopandey @evandrofilhobr @minhaskh I’d perform an up front KBI followed by IVUS.

If significant plaque at the ostium of both branches, I would opt for culotte.

Not my preferred 2 stent strategy but I think this would be the ideal scenario for it given the angle, large caliber and similarly sized vessels

[Neel Parikh, MD @NeelParikhMD]

@aspergian1 I can feel the angst on this one

[Neel Parikh, MD @NeelParikhMD]

@baramink This is SCAD. Decent flow. Would not stent. High risk of tracking intramural hematoma down the LCX or propagating it further distally in to the LAD.

[Neel Parikh, MD @NeelParikhMD]

@jl35wilsonMD @curmudgeoncard @TWilsonMD @realarainmd @aspergian1 My plan would likely be Impella supported mid LAD and LM bifurcation with DK crush. Would leave the LCX for the future based on how he does. Would anybody consider viability here before planning their revasc strategy?

[Rajiv Gulati @rajivxgulati]

For ICs in 2025: May your stents be deliverable, clips be positionable, perileaks be trivial and complications be minimal. Happy New Year!

[Neel Parikh, MD @NeelParikhMD]

@SyedYNaqvi1 Would absolutely go IVUS guided provisional LM into LAD. Minimal angiographic disease at Ostial Lcx. Favorable angle in regards to carina shift and the size mismatch between LM and LAD is not prohibitive. He can get CABG for disease progression/ISR later in life if needed.

[Neel Parikh, MD @NeelParikhMD]

@ElonMNews Yes. A.

[Carlo Tumscitz @skat_ct]

A Little trick to save the radial access for an arterial line after #PCI, thanks to @GianlucaCampo78 for the idea!

[Neel Parikh, MD @NeelParikhMD]

RCA CTO. Typical angina on multiple AA meds. Prior attempt unsuccessful @ OSH. AL1/45cm sheath. fielder/corsair. Balloon uncrossable. Guideliner/laser atherectomy. Escalated from 1.5 to 3.0mm balloon. IVUS. 3.0 x38 synergy. 3.5 NC to finish

[Rim Halaby @rimhalabymd]

Have a patient dying from acute #aorticregurgitation ? TABERNACL might help. Connecting a valvuloplasty balloon to a IABP console can function as a counter-pulsation valve. Contact authors for help or report your experience https://t.co/zwRgu68sy6
@CircIntv @TheBethesdaLabs

[Neel Parikh, MD @NeelParikhMD]

@TheCinesthetic Heath ledger as the joker in the dark night and Christoph waltz as Hans lands in inglorious basterds an easy 1-2

[Neel Parikh, MD @NeelParikhMD]

@historyinmemes Did they use this in the movie inception?

[Neel Parikh, MD @NeelParikhMD]

@mandeep_mayo I would approach this with an aorto-LM stent alone with IVUS and a “bumper wire” to ensure ostial coverage. Would also treat any severe lesions in the LAD (difficult to tell in this one view). Medical therapy alone for the LCx. Would be more conservative give his age.