Thank you Dr Manos. I did it a couple of days ago in a patient with Inf.STEMI ,post cardiac arrest in VF with tough proximal RCA thrombus and it helped me in restoration of flow within seconds.
@shangz02163 жыл бұрын
Thanks for your educative presentation.
@mohamedadam93914 жыл бұрын
Thank you sir we need more videos elaborating tips and tricks of wire tip shaping in different lesions subsets
@BarrieLouis5 жыл бұрын
very interesting case!
@salahuddinsalahuddin32104 жыл бұрын
Thanks
@tuanhoanh11985 жыл бұрын
NITRATE is not effective in resolving no reflow phenomenon but Nicardipine is useful while both have the effect to dilate the vessel. What is the difference, Professor?
@manosbrilakis5 жыл бұрын
Nitrate dilates more the bigger vessels whereas nicardipine dilates more the microvasculature.
@tuanhoanh11985 жыл бұрын
@@manosbrilakis thank you very much for your reply
@farukakturk53885 жыл бұрын
Sir while knuckling how can we ve süre that we are not going subintimally?
@manosbrilakis5 жыл бұрын
Good question: to minimize the risk for subintimal guidewire entry a workhorse guidewire should be used, the knuckle should be formed before reaching the occlusion, and forceful wire advancement should be avoided.
@farukakturk53885 жыл бұрын
@@manosbrilakis thank you very much for your reply.
@ahmedsabbar90495 жыл бұрын
Thank u very much for sharring this intetesting case, I wonder whither the second stent is deployed at a distance from the first one.
@manosbrilakis5 жыл бұрын
Yes it was - there were 2 separate lesions.
@ahmedbasheer81564 жыл бұрын
thanks for this meticulous presentation but I am compatible with dr.ahmed sabbath that there is residual stenosis between two stents may become focus for future denote stenosis
@JCT752 жыл бұрын
@@ahmedbasheer8156 I am sure the residual stenosis is hemodynamically insignificant.
@doc-rdx5 жыл бұрын
such occlusions have RVMI associated with this. sir, would you still use i/c ntg in this ?
@manosbrilakis5 жыл бұрын
Good point. If you have signs/symptoms of right ventricular MI I would not use nitroglycerin. This patient did not have such symptoms.
@tuanhoanh11985 жыл бұрын
Thank you so much for your sharing. I have several questions. 1. when the thrombus is large but the vessel lumen can still be estimated, should we perform direct stenting with moderate pressure on inflation, leaving that with acceptable TIMI 3 flow and come back to check +/- correct the stent in the second procedure in 5-7 days later? how about the risk of stent thrombosis in that handling? 2. when the thrombus can not be broken, operator can not restore the flow even after manual aspiration, what should we do? should we treat with eptifibatide and carry out coronary angiogram 2-3 days later? especially in case of cardiogenic shock?
@manosbrilakis5 жыл бұрын
1. I would do thrombectomy first in this case and then stent without FU cath. 2. Consider laser - consider CABG if the surgeon would take the patient. If this fails IIb/III and FU angiogram appear reasonable.
@tuanhoanh11985 жыл бұрын
@@manosbrilakis i really appreciate your sharing
@vt36355 жыл бұрын
I would avoid knucle cause of thrombus dislodgment
@durgaprasad-nv2cd5 жыл бұрын
Thank you very much sir, please help me when can we expect release of manual of PCI