Jaime Pugeda

Interventional Cardiologist at Pulse Heart Institute. CTO/Complex PCI. Husband, Dad, Triathlete.

[Jaime Pugeda @jgpugedamd]

@KovacicMihajlo Agree with everyone on initial management. If decided on stent route, prepare everything for distal embolization management. Suggest no aggressive post dilation fo stent if adequate stent expansion on IVUS.

[Jaime Pugeda @jgpugedamd]

@GEICC3 @thiele_holger @agtruesdell @SCAI @adityadoc1 @GreggWStone @DavidLBrownMD @DrAmirKaki @perc_surgeon @mmamas1973 @KPujdak Presuming patient wants revasculzrization, would optimize first, document CT surgery response. If declined for CABG , would do LAD with iabp support. Potentially stage the rest.

[Jaime Pugeda @jgpugedamd]

@vamshi_gade_md @mmamas1973 @drandrewsharp @nolanjimradial @djc795 @RodrigoBagur @SVRaoMD @MohanedEgred @ajaykirtane @cardioPCImom @jmahmed @ncurzen @Pooh_Velagapudi @mirvatalasnag @jedicath @Drroxmehran @GreggWStone @drrashid05 @mbmcentegart @rwyeh @perc_surgeon @omendiz @sbrugaletta @fischman_david @DocSavageTJU @Hragy @ShaziaTHussain1 I think the same about “nailing the ostia”. However if truly 90 degree angle and no left main, i do stent the ostia and intentionally protrude into left main by 1-2mm of i can. Lots of IVUS.

[Jaime Pugeda @jgpugedamd]

@Obisht IVUS guided( for size) cutting balloon.

[Jaime Pugeda @jgpugedamd]

@BagaiJayant @MohanedEgred @Obisht @evandrofilhobr @HadyLichaaMD @aspergian1 @perc_surgeon @KambisMashayek1 Had 2 similar cases. Above all recommendations failed. I ballooned the distal LM to modify somehow ostial circ plaque and, by luck, it worked. Of course there is the risk of shutting down the vessel.

[Jaime Pugeda @jgpugedamd]

@mandeep_mayo We have been succesful with ELCA of the thrombus in a similar case. But we did not stent the proxinal vessel as the size was 7-8mm by IVUS.

[Jaime Pugeda @jgpugedamd]

@lorenzo2509 Excellent result. I always thought the 2.15 burrs require 9F!

[Jaime Pugeda @jgpugedamd]

@Ravi_Hira_MD Ravi, we could not have done it without the Post Malone playlist!

[Jaime Pugeda @jgpugedamd]

@jcspratt @Ravi_Hira_MD @A_N_Mahmoud_MD @MichaelMegalyMD @momermd @MarwanSaadMD @mmamas1973 @RhianEDavies1 @shishem @sbrugaletta @DLBHATTMD @ESC_Journals @rwyeh Agree. My most difficult dissection cases where I couldnt pass a stent, I was only able to deliver them because I counterintuitively used roto.