Would vessel dissection with a heavily calcified intima flap offer an alternative explanation to as why the lesion became uncrossable? I had a similar experience after using a cutting balloon with high pressure (14-16) where I had to start almost from the beginning with low profile balloons ( did not escalate to rota bc patient had pain and ST elevations, I deemed there was not enough time for this). This case illustrates the degree of respect, skills and readiness to adapt to a changing situation when intervening in elderly patients with diffuse disease, an ever growing population the latest decade.
@manosbrilakis2 жыл бұрын
Excellent point, this is certainly possible.
@tofysoliman74942 жыл бұрын
what about using IVL from the start it is a safer option than balloon rupture and microdissection after IVL ROTA WILL BE USED
@manosbrilakis2 жыл бұрын
Good point - I would not use IVL here because it is such a long lesion and multiple IVL catheters would likely be required.
@Saioffa2 жыл бұрын
Great case, it requires some nerves to do CSI in a dissected vessel. Also why CSI, is it because of the wire (viper file ) so had to use CSI or slow controllable Atherectomy? Final images showed some large septal got occluded so there was a dissection most likely. I did the patient become unstable with no flow in LAD and CTO of RCA? Would you use an Impella in such cases? Great 👍🏻 case
@manosbrilakis2 жыл бұрын
Thanks for the excellent c omments. We used CSI because we could advance the Viper flex tip wire in the LAD. Patient remained hemodynamically stable - Impella could definitely help in case of hemodynamic instability.
@girishdeepak77082 жыл бұрын
Did post stenting IVUS run demonstrate adequate stent expansion in the aneurysm areas?
@manosbrilakis2 жыл бұрын
Good point, yes it did.
@Docsammy2 жыл бұрын
In retrospect a wiggle wire would have been a better parallel wire option.