Usama Sadiq

Interventional and Structural Cardiologist

[Anas T. Noman @AnasNomanMD]

Hydraulic Exchange Technique:

super useful in complex PCI/CTO work.

Quick way to get a microcatheter off a short wire without a 300cm wire, trapper, or trapping balloon.

Connect an indeflator to the microcatheter, pressurize to 20 atm (it drops constantly, so keep bumping it back up), and just open the Touhy and microcatheter will come out right away. The hydraulic force pushes the catheter back on its own while keeping the wire in position.
I don’t do it over a hydrophilic wire as it can jump forward and cause a tip perforation. I use a workhorse wire.

Video below

Credit to @JAG24851 for teaching me such valuable skills!

@TCT_ME_ @6ayyeboon @AlkashkariWail @mirvatalasnag @amrmohsen213 @BinAbdulHak_A @MarwanSaadMD @aelsab @MusaSharkawi @djc795 @MohammedQintar @mhammadah @AlhijjiM @JDDCFratti @acamajmd @crfheart @djc795 @mmamas1973 @crfheart @BakhshiHooman @Almanfi_Cardio @Dr_ibrahimHarbi @scottiejj12 @MohammedAlo

[Ankush Gupta @DrAnkushG]

POT is the last step we do in LMBA before coming out, after that nothing. In #IKISSLM trial, we are seeing a lot of LSD at proximal stent edge-both on imaging and stent boost. #CardioTwitter
This was also documented in OCTOBER trial as USD (unintended stent deformation).
@SanyaChhikara @DrRajeshVijay @DrRajeshG1 @drnbajaj76 @mmamas1973 @Dr_AshokSeth @drnbajaj76 @ccijournal @realarainmd @sajannarayanan @adityadoc1 @Pooh_Velagapudi @SrihariNaiduMD @poojaotherwise @ABeneduceMD @BoopathyCardio @ErwMulia @christiankfuku @FeliceGragnano @JoySanyal74 @latchumanadhas @MarciMonteg @JACCJournals @GopalKkoduru @nadig_cardio @DrDeepakKrishn1 @UppalLipi @Sujathavip @yaqoub_lina @gbiondizoccai @cardio1richa @Tesslagra @NishithChandra @SanjogKalra @abadkhan2002 @serioustaurean @ACCinTouch @care4urheart2 @AnkurGuptaMD @AnkurKalraMD @AdityaMandawat @ShariqShamimMD @SachinGoelMD @Hragy @drpkhazra @djc795 @aayshacader

[Michael Megaly @MichaelMegalyMD]

I would say that the KISS trial @JACCJournals not only proved that you do not need to do routine SB intervention (commonly kissing), rather I would say the most significant change is proving the concept of POT-side-POT (done in 57% of SB interventions and seems to be more favorable than kissing).

I have been recently doing POT-side-POT instead of kissing when I need SBI and that study proved it can be better!

Congrats to the authors and @sbrugaletta for an insightful editorial!

https://t.co/H3m2dHoufQ
#cardioX

[mandeep singh @mandeep_mayo]

Some strategies to adopt for a undilatable lesion. It is not uncommon to combine 2 lesion modification techniques (Rotatripsy). Use IV imaging to decide your strategy. My preference is Rota (for non bifurcation) and IVL for bifurcation lesion. You can use scoring/cuttingOPN 🎈

[Bilal Iqbal @DrBIqbal]

Here is my algorithm:

1) Vasodilator therapy (if hemodynamic allow and pull)

2) Pull Rotawire. This works very effectively, 90% of times. It is frequently overlooked. The 0.014 tip works as a great way to bring back the stuck burr. Make sure wire is free with brake off for maximal efficiency. Pulling the driveshaft is less effective, as it is made of 3 coiled wires which gives some elasticity to the driveshaft.

3) If burr is free beyond lesion, can use short dynaglide runs and then pull. Prinicple is that dynamic friction is lower. Don’t overdo this and also with skipping rope technique, there is risk of driveshaft breakage and burr loss due to torsional forces with a fix s immobile burr!

4) Cut driveshaft and remove teflon sheath

5) Deliver GE over driveshaft to the burr and pull.

6) Intimal/subintimal wire and ballooning to dislodge burr and pull.

7) Re-deliver GE over driveshaft and pull.

8) Obtain second access and adding a ping-pong guide. Remember a ping-pong guide is not required in most cases. Once Teflon sheath is removed, a 6F guide can accommodate: Driveshaft + coronary wire, Driveshaft + Caravel microcatheter, Driveshaft + Corsair/Turnpike LP microcatheters, Driveshaft + 2.5-4mm balloons

9) Combine subintimal ballooning and GE over driveshaft and pull. Only these maneuvers requires ping-pong guides.

10) Call surgeons.

[Michael Megaly @MichaelMegalyMD]

A back table illustration of the technique published by @PCRonline to remove a stuck perclose footplate in the vessel!
Simple and I believe can get us out of trouble!

https://t.co/UOG0sfoOT4

#CardioX peeps, comments welcome

[Joaquim Spadoni Barboza @jbspadoni]

I had the privilege to help to launch the much waited new low profile sheath for impella. These are the main changes:

1. No need to peel away, not tapered and leave in!!
2. 1.5 fr smaller than prior generation
3. Hydrophilic dilator, no need to pre dilate (was already not doing but even easier now)
4. Coiled making it kink resistant
5. Side port is short and with bigger caliber. That might open the possibility for external bypass using the leave in sheath!
6. Easier single access
7. New improved reposition/locking mechanism (similar to the 5.5)

For me the best is getting rid of the reposition sheath! That will make our Cardiogenic shock care in the ICU much better!!

@UICcardfellows @Babar_Basir @evandrofilhobr

[Davide Capodanno @DFCapodanno]

Introducing the percutaneous aorto-coronary bypass graft. The VECTOR procedure revascularizes the left main coronary artery using retrograde and antegrade steps: a retrograde wire exits the left main (distal graft), an electrosurgical wire exits the aortic root (proximal graft), a guidewire rail is created, and a stent graft is delivered from the aorta to the left main. What could possibly go wrong?
https://t.co/iNUNbHdGiT

[Ashley Miller @icmteaching]

🧵 Starling’s Law: Misunderstood, Misapplied, and Still Misleading
1
🚨 “Starling’s Law explains how the heart increases cardiac output.”

You’ve probably heard this a thousand times.
But it’s wrong.
Or at least - very incomplete.
Let’s fix it.
Because this matters - for heart failure, fluids, vasopressors, inotropes, afterload, and how we think about the whole system.

[jedicath աǟզǟʀ.ǟɦʍɛɖ @jedicath]

preop cath for MV surgery. A long wrap around diagonal ends in a contrast filled structure? has anyone seen similar? I don’t have an answer, CT by @m_alfawara
@nadig_cardio @mandeep_mayo @DocSavageTJU @djc795 @ColletCarlos @ziadalinyc @DrRajeshG1 @rafavidalperez

[Jay Mohan, D.O., FACC, FSCAI, FASE, RPVI @DrJayMohan]

I have so many questions….

Angio-Seal for Right Ventricle Perforation During Pericardiocentesis for Cardiac Tamponade: A Case Report - Journal of the Society for Cardiovascular Angiography & Interventions https://t.co/oWgSAnu3Oz

[Usama Sadiq @USadiq01]

@tedcruz @grok is Ted Cruz a puppet of AIPAC?

[Usama Sadiq @USadiq01]

@ZohranKMamdani @BillAckman how sad for you LOL. Congratulations @ZohranKMamdani

[Said Ashraf MD, FACC, FSCAI @SaidAshrafMD]

Early morning wake up - guess the culprit with @jedicath ! How would you manage this? Will share what I did..
#cardiotwitter

[Edgar Argulian @argulian]

A patient with known cardiomyopathy in ICU, had viral prodrome. BP 81/45 mmHg. Sinus rhythm with narrow QRS. Properly aligned CW interrogation across the mitral valve is shown, what are the findings and hemodynamic implications?

[Marwan Saad @MarwanSaadMD]

MANTA is an effective large-bore VCD in TAVR. Downside: lack of convenient bailout. Conventional bailout (contralateral CFA or radial) may not be fast (major bleeding) or easy (vessel dissection/total closure) enough. What to do? 🧵 1/
@TCT_ME_ #TCTMiddleEast @crfheart @MyJSCAI

[Salman Arain @realarainmd]

How I Talk About Left Main PCIs - And You Should Too!* 🧵

(*A suggestion of course!)

This is one of the cases from my talk on MCS for high risk PCI. Case first, then the analysis.

86 year old man, unstable angina, EF 40%, turned down for CABG at OSH, transferred with IABP. The

[SREEVATSA NADIG DM FSCAI FESC @nadig_cardio]

No IC wants this- but, every one who works in cath lab need to know how to handle this menace !
Mid LAD perforated following pre dilation with 2.5 🎈 at 10 🏧 .
Hwo would u handle this #cardiotwitter #CardioX

[Dr. Ángel G. Nájera Albarrán @angna_86]

What is happening here? 🇲🇽 #Cardiology #EKG #MedTwitter #CardioTwitter #PCI #complexpci @mornei2011 @BotCardiology @EkgHacks @smithECGBlog @IC_SIAC @EM_RESUS @PCRonline @SOCiME_ @ecgandrhythmRoe @marioalrb84_a @akbarul @HiramSalas13 @ShariqShamimMD @cardioelihu @secardiologia

[Usama Sadiq @USadiq01]

Excited to join the amazing team at Deborah Heart next year for my interventional cardiology fellowship.
Alhamdulillah.