Cerrahpasa cardiology

Official account of Cerrahpasa Medical Faculty Cardiology Department / account manager Eser DURMAZ, MD, Assoc. Prof, FESC

[Cerrahpasa cardiology @CerrahpasaC]

Educational case 2

Intravascular imaging is not mandatory for type 1 and 2 SCAD. However, it is quite helpful for type 3 SCAD

48 years old female
Mid LAD lesion
Disease free LCX and RCA suggesting nonatherosclerotic cause of MI

OCT solved the case

[Cerrahpasa cardiology @CerrahpasaC]

85 years old female

NYHA III dispnea

Left atrial mass originating from LAA suggesting thrombus.

What would be your treatment plan?

Surgery ? Anticoagulants? Thrombolytics?

[Cerrahpasa cardiology @CerrahpasaC]

Educational case 1

🕵️‍♂️ MINOCA? Mystery solved.

🔺Typical chest pain + ↑Troponin
🔍Angio: mild stenosis, no thrombus
🧲CMR: anterior basal edema + subendocardial LGE
🧿OCT: healed plaque @ prox LAD

[Cerrahpasa cardiology @CerrahpasaC]

Luminal filling defect suggesting dissection or thrombus.

Never forget Woven coronary artery in stable patients.

OCT is the best imaging modality for the confirmation.

[Cerrahpasa cardiology @CerrahpasaC]

This is how reperfusion arrhythmia (VF) looks like😰

Anterior STEMI , first MI

Notice the blood flow of the aorta

Luckily now he is all right after multiple ⚡️⚡️⚡️

[Cerrahpasa cardiology @CerrahpasaC]

After PVI, perimitral flutter slowed with the anterior line but did not stop. Following the PL line, sinus rhythm was restored. The LAA is isolated! Should we close it?

@YalinKivanc

[Cerrahpasa cardiology @CerrahpasaC]

@doc_ecmo That is also our motto in cath lab:))

[Cerrahpasa cardiology @CerrahpasaC]

Proximal balloon uncrossable lesion

Severe tortuosity and two heavy calcification probably calcified nodule

New Rotawire Drive done its job well

Final stent expansion 80% and MSA 8.40 mm2

Good enough???

[Cerrahpasa cardiology @CerrahpasaC]

@AleksanderStep6 Manuel thrombectomy.

[Cerrahpasa cardiology @CerrahpasaC]

Anterior STEMI >>>high thrombus burden>>>thrombus aspiration worked well>>>stenting

What I have learned : right tool in right patient results in excellent outcome

[Cerrahpasa cardiology @CerrahpasaC]

@MichaelMegalyMD That graft is patent despite the severe stenosis of ramus. Restore blood flow of ramus, it would last forever

[Cerrahpasa cardiology @CerrahpasaC]

@riyaz_doc @Obisht @akbarul @care4urheart2 @KardiologieHH @mmamas1973 @mirvatalasnag @TWilsonMD @abadkhan2002 @SareenSaab Predilated the lesion before OCT or directly performed OCT ?

[Cerrahpasa cardiology @CerrahpasaC]

@MichaelMegalyMD What is the point of treating the bifurcation without treating the proximal tight lesion which extends up to LMCA?

[Cerrahpasa cardiology @CerrahpasaC]

@mirvatalasnag @mmamas1973 @sbrugaletta @agtruesdell @thiele_holger @alaide_chief @DrSaritaRao2 @saraceciliamtz @Hragy @Allison_Dupont @KardiologieHH @HadyLichaaMD @ANazmiCalik @AntoniousAttall @SimoneBiscaglia @twj1974 @MogneeA @DrAlsubei @DocSavageTJU @fischman_david @poojaotherwise @adityadoc1 @Babar_Basir @AlkashkariWail The patient is stable, lactate levels are 2 mmol. In case of active vasculitis revascularization should be postponed due to high risk of failure. And it does not matter whether percutaneous or surgical. You can search the literature

[Cerrahpasa cardiology @CerrahpasaC]

@mirvatalasnag @mmamas1973 @sbrugaletta @agtruesdell @thiele_holger @alaide_chief @DrSaritaRao2 @saraceciliamtz @Hragy @Allison_Dupont @KardiologieHH @HadyLichaaMD @ANazmiCalik @AntoniousAttall @SimoneBiscaglia @twj1974 @MogneeA @DrAlsubei @DocSavageTJU @fischman_david @poojaotherwise @adityadoc1 @Babar_Basir @AlkashkariWail Is this a vasculitis?
Takayasu arteritis? If so there is no indication for revasc before the anti-inflammatory treatment. Firat consult with rheumatologist

[Cerrahpasa cardiology @CerrahpasaC]

@RSohnMD Very educational images but in calcified nodule, calcification is not a local finding and should be present at different areas as present in your case

[Cerrahpasa cardiology @CerrahpasaC]

@doc_ecmo Definitely not a homogeneous inflation but the patient is 45 years old and acceptable predilatation

[Cerrahpasa cardiology @CerrahpasaC]

45 Y/M

NSTEMI

Calcified proximal lesions but angiografically no calcification at the middle segments

3.0 NC balloon predilatation

3.5 DES and following

Severe stent underexpansion despite the 3.75 and 4.0 NC postdilatation

Should we use intravascular imaging more liberally?