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- Просмотров 4 226 914
Manos Brilakis
Добавлен 29 окт 2011
Sensei Podcast Episode 90: Byeong-Keuk Kim
Insights on how to learn CTO and complex PCI by Dr. Byeong-Keuk Kim from Yonsei University College of Medicine, Seoul, South Korea.
Просмотров: 230
Видео
Case 256: Manual of CTO PCI - CTO PCI referral with CT only
Просмотров 1,1 тыс.12 часов назад
A patient presented with exertional angina and was found to have a mid LAD on coronary CT angiography. The CTO had a blunt proximal cap at the takeoff of a diagonal branch, length of 26 mm, and good quality distal vessel. He was referred directly for PCI of the LAD CTO. Coronary angiography confirmed the CCTA findings. Antegrade wiring was done using a ReCross dual lumen microcatheter and Gaia ...
Sensei Podcast Episode 89: Göran Olivecrona
Просмотров 27721 час назад
Insights on how to learn CTO and complex PCI by Dr. Göran Olivecrona from Skåne University Hospital, Lund, Sweden
Case 255: Manual of CTO PCI - Retrograde through an occluded SVG
Просмотров 1,1 тыс.День назад
A patient with prior CABG presented with angina and was found to have a distal RCA CTO with occlusion of the SVG-PDA. The RCA CTO had a blunt cap, length of approximately 25 mm, and diffusely diseased distal vessel that was filling via epicardial collaterals from the OM and LAD. A primary retrograde strategy was selected because the distal vessel was diffusely diseased. A Gladius Mongo was adva...
Sensei Podcast Episode 88: Khalid Tammam
Просмотров 52514 дней назад
Insights on how to learn CTO and complex PCI by Dr. Khalid Tammam from International Medical Center, Jeddah, Saudi Arabia.
Case 172: Manual of PCI - Double bifurcation
Просмотров 2,3 тыс.14 дней назад
A patient was referred for PCI of a double bifurcation lesion: (a) LAD diagonal bifurcation and (b) bifurcation of the diagonal into a superior and an inferior branch. Coronary physiology with a pressure wire and AngioFFR was performed showing a long lesion in the LAD and a more focal lesion in the diagonal. The superior diagonal branch did not have significant stenosis, hence provisional stent...
Sensei Podcast Episode 87: James Choi
Просмотров 27421 день назад
Insights on how to learn CTO and complex PCI by Dr. James Choi from the Presbyterian hospital in Dallas, Texas.
Case 171: Manual of PCI - The uncrossable lesion
Просмотров 2,7 тыс.21 день назад
A patient with exertional angina was found to have a severely calcified distal RCA lesion that could not be crossed by any balloons and was referred for repeat PCI attempt. The RCA was engaged with an AL1 8 French guide catheter. We were unable to cross the lesion with a guidewire, despite using a microcatheter and multiple wires with different bends at the tip. Eventually we used a Sasuke dual...
Sensei Podcast Episode 86: Raj Chandwaney
Просмотров 299Месяц назад
Insights on how to learn CTO and complex PCI by Dr. Raj Chandwaney from the Oklahoma Heart Institute, Tulsa, Oklahoma.
Case 254: Manual of CTO PCI - CART
Просмотров 1,9 тыс.Месяц назад
A patient with prior CABG surgery was referred for PCI of a native RCA CTO due to recurrent failure of the SVG-PDA. Coronary CT angiography was done prior showing the proximal cap to be at the takeoff of an acute marginal branch, length of 34 mm, and calcification at the proximal cap and within the occlusion segment. A primary retrograde approach was used with a Pilot 200 wire advanced through ...
Sensei Podcast Episode 85: Pierfrancesco Agostoni
Просмотров 496Месяц назад
Insights on how to learn CTO and complex PCI by Dr. Pierfrancesco Agostoni from HartCentrum, ZNA Middelheim, Antwerp, Belgium.
Case 253: Manual of CTO PCI - IVUS guided puncture
Просмотров 2,1 тыс.Месяц назад
A patient was referred for PCI of an LAD CTO. The LAD had an ambiguous proximal cap, length of approximately 25 mm with diffusely diseased distal vessel that was filling via septal collaterals from the RCA. An IVUS was inserted in the diagonal branch clarifying the proximal cap ambiguity. IVUS-guided puncture succeeded in crossing the proximal cap. After advancing a Corsair XS into the occlusio...
Sensei Podcast Episode 84: Sergey Furkalo
Просмотров 364Месяц назад
Insights on how to learn CTO and complex PCI by Dr. Sergey Furkalo from the National Institute of Surgery and Transplantology of AMS of Ukraine, Kiev, Ukraine.
Case 252: Manual of CTO PCI - Rota-Tripsy for a heavily calcified CTO
Просмотров 2 тыс.Месяц назад
A patient presented with exertional dyspnea due to a RCA CTO and a mid LAD lesion. He underwent an unsuccessful attempt for RCA CTO recanalization and was referred for a 2nd attempt. He had a mid RCA CTO with heavy calcification, clear proximal cap, short length of ~10 mm, diffusely diseased distal vessel and a PDA filling via an epicardial collateral through the diagonal branch. Antegrade wiri...
Sensei Podcast Episode 83: Jeffrey Moses
Просмотров 407Месяц назад
Insights on how to learn CTO and complex PCI by Dr. Jeffrey Moses from Columbia University, New York.
Case 170: Manual of PCI - Covered stent did not work
Просмотров 3,5 тыс.Месяц назад
Case 170: Manual of PCI - Covered stent did not work
Sensei Podcast Episode 82: Thomas Hovasse
Просмотров 342Месяц назад
Sensei Podcast Episode 82: Thomas Hovasse
Case 251: Manual of CTO PCI - RCA with tandem CTOs
Просмотров 1,9 тыс.2 месяца назад
Case 251: Manual of CTO PCI - RCA with tandem CTOs
Sensei Podcast Episode 81: Elliot Smith
Просмотров 3162 месяца назад
Sensei Podcast Episode 81: Elliot Smith
Case 169: Manual of PCI - The 3.5 mm stent
Просмотров 3,1 тыс.2 месяца назад
Case 169: Manual of PCI - The 3.5 mm stent
Sensei Podcast Episode 80: Stefan Harb
Просмотров 4702 месяца назад
Sensei Podcast Episode 80: Stefan Harb
Case 168: Manual of PCI - CT and FFRangio guided PCI
Просмотров 1,6 тыс.2 месяца назад
Case 168: Manual of PCI - CT and FFRangio guided PCI
Sensei Podcast Episode 79: Jacopo Oreglia
Просмотров 2872 месяца назад
Sensei Podcast Episode 79: Jacopo Oreglia
Case 167: Manual of PCI - CTO PCI techniques for a wire uncrossable lesion
Просмотров 2,7 тыс.2 месяца назад
Case 167: Manual of PCI - CTO PCI techniques for a wire uncrossable lesion
Sensei Podcast Episode 78: Brian Jefferson + Taral Patel
Просмотров 3152 месяца назад
Sensei Podcast Episode 78: Brian Jefferson Taral Patel
Case 250: Manual of CTO PCI - Retrograde via ipsilateral epicardial collateral: tip in to the rescue
Просмотров 1,9 тыс.2 месяца назад
Case 250: Manual of CTO PCI - Retrograde via ipsilateral epicardial collateral: tip in to the rescue
Case 249: Manual of CTO PCI - Left main CTO PCI
Просмотров 2,5 тыс.3 месяца назад
Case 249: Manual of CTO PCI - Left main CTO PCI
Sensei Podcast Episode 76: Mario Iannaccone
Просмотров 4953 месяца назад
Sensei Podcast Episode 76: Mario Iannaccone
Case 248: Manual of CTO PCI - Micro Rx
Просмотров 2,4 тыс.3 месяца назад
Case 248: Manual of CTO PCI - Micro Rx
Dr. Brilakis, you have many fans in Korea after your KSIC lecture. We hope to see you here soon!
Dr. Kim is on the Brilakis channel! He is a distinguished leader in the KSIC society, known for his servant leadership and warm heart. Thank you for introducing such a wonderful person!😀
Deploying a longer noncovered stent in the covered stent helps to make endothelisation faster? It may also keep edges of covered stent on the vessel wall and well apposed
May deploying a longer stent in graft stent? This may keep the edges of covered stent.
And in predilatation with N.C what is the balloon to vesselam ratio? Is lowering the diameter and increasing the pressure logic?
🎉
Hello, Professor Emmanouil Brilakis. Can I ask one question "out of topic"? We have three complications in this complex case: how to save our nerve cells, when we decide how to solve this problems? It is very important! We have perforation, pericardial effusion, and we can't to deliver the pk papyrus stent to the target zone! Thank You for this case, You have "metallic nerves" !!! Sincerely, for Your Wizarding Work. It is great, and I have no words!👏👏👏
Great job 👏🏻 you are talented with your series of excellent lectures
Could we use DCB in DG and only provisional stenting for LAD in this case ?
Thanks for the excellent case sharing.
Happy Friday Manos Abdul
update to date, innovative and evidence based practice! Using: data from PREVENT, using CT for planning and reducing number of procedures for the patient (discomfort, radiation), and finally utilizing high resolution OCT. Well-Done 👍
Thanks for the excellent case presentation.
thank you
Nice case. Is CART feasible in this case? Thank you
Thanks for these great videos, Some retrograde approach videos have not been uploaded in playlist.
What a pleasing beautiful case
Thank you
Thank you
How come you change to the pilot 200 retrograde rather than sticking with the gladius MG in the PDA?
Excellent case.In case of severe lesion not moderate one, do you still relay on FFR for strategy planning? Thanks
If lesion is very severe angiographically I do not use FFR as it is almost always positive - post PCI FFR can be useful even in such cases though.
Great conversation thanks to both of you. I was in the same meeting in Türkiye 🇹🇷 if I am not wrong the case was presented by Prof. Dr Şevket Görgülü which was about closing Vessel with a distrupped baloon
nice case , I have a couple of questions if I may: First: Would it be safer to avoid ballooning the superior diagonal branch beforehand? second:2.25 is too small a stent to put in LAD, isnt it?
Good points - Agree that not predilating the SB is preferable to minimize the risk of dissection. Also agree re:stent sizing but it is usually better to start with a smaller stent and postdilate to larger diameter than start with a larger stent that may cause distal edge dissection.
I went to ijcto Hyderabad, really hoping to meet you there. 😢
Why did you place 3 mm stent proximally and ask for 3.5 mm stent distally? also,did you post dilate proximal stent to 3.5 mm?
Are you sure lad stent was 2.25 mm.what stent do you use that can go upto 3.5 from 2.25 mm?also,did you post dilate distal part of stent?
Yes, stent can be postdilated to 3.5 mm.
Thanks for the excellent case presentation.
Excellent job Caution is needed when pressure wires are advanced through MB stent to check pinched side branches, especially in some case of high calcium burden at bifurcation (even after stenting) these pressure wires can easily get stuck leading to unpleasant complications. I would always use FFR Angio after stenting as it was perfectly mentioned here
Nice result. But are you concerned for Ostial pinching of superior branch?
Yes but decided to not do additional ballooning as the patient was asymptomatic and the branch had TIMI 3 flow.
@@manosbrilakis will angio ffr can help here.?
It seems like there is some compromise on the ostium of the upper branch of diagonal. Do you think in the future it May cause problem?
Good point - this is definitely possible - it can often be challenging to strike a balance about what is "enough" or not.
Do we have to see from another angle how much we protruding into lad when we implanting first stent?
Great cases as usual Manos. My only point is about the LAD stent, you chose 2.25 mm diameter. POT with 3.5 will lead to over expansion . The ONYX 2.25 goes up 3.25. I would have used a larger diameter and deployed at lower pressures then post dilated accordingly.
I agree with your opinion about stent size and need IVUS or OCT to confirm the proximal stent is good apposition.
This looks like 2.75 stent. Not 2.25
May be Onyx Frontier as Onyx Frontier 2.0--2.5 mm expand up to 3.5 mm
Great point!
Many advocates the use of OCT for bifurcation stenting, especially for making sure the proper SB strut wiring before 2nd kissing balloon..what is your view on that? Thank you
Absolutely! Intravascular imaging is extremely useful in bifurcation PCI.
Left atrial branch is missing now, right?
THANK YOU DR FOR DOING MY PROCEDURE ON APRIL 26th, 2024…..BECAUSE OFYOU AND YOUR ENTIRE TEAM I HAVE LIFE AGAIN…..I AM FROM WISCONSIN AND SO BLESSED T HAVE BEEN SENT YOUR WAY….I AM ALMOST BACK TO NORMAL….THANKS AGAIN
What is grenadoplasty?
Inflation of a small balloon (usually 1.5 - 2.0 mm) at high pressure until it ruptures. The rupture may modify the plaque and facilitate subsequent equipment advancement.
What if atherectomy also failed?
Options include laser, various plaque modification balloons, extraplaque wire crossing.
@@manosbrilakis Sir if we went from around the lumen and after ballooning and we faced a rupture? What will be our options. Graft stents would be hard to deliver.
@@farukakturk5388 Good question: equipment delivery is much easier in the extraplaque (subintimal space). Balloon and stent sizing should be more conservative in the extraplaque space and high-pressure balloon inflations avoided.
@@manosbrilakis Thank you very much. I appreciate for your kind response
" You shall not Cross"--- Mano- "Oh, yes I will!"
Thanks for sharing.
Thank you sir, had your retro wire ended in subintimal space, doing a reverse cart in a single guide would have been difficult. Would you have used ping pong guides? Any solutions for doing a reverse cart in a single guide?
Thanks sir .. very nice and interesting 👏👏
Good case sir
Excellent case
Prof. Brilakis, how exactly was your technique with the PDA? It was not a crush, right? Did you place the stent with a little Protrusion, wired through the struts that protruded and modeled them onto the main vessel? Would there not be a Kissing necessary?
Would like to know cost of the procedure?? Well done case
Thanks
I thought venture catheter has angle and for lcx.
Thanks for the excellent case sharing.
Wow
Thanks sir
Thank you for the great case Professor. Is there a risk of thrombi showering into the native vessel from the coiled SVG graft Professor?
No
Is it mandatory to occlude the SVG?
@@apurvavasavada383 no but if there’s significant competitive flow from the graft the risk of stent thrombosis is higher, theoretically. No data. Just anecdotal experience. On the downside it removes a conduit to fix a CTO in the future. IMO depends on the degree of competitive flow.