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Dr Imran Hanif Hashmi
Registrace 23. 11. 2013
Interventional cardiology tips and tricks
Bailout retrograde wiring.
TVD. CABG refused by pt.
started from RCA. After predil. guide and wire came out. while re-engagement. there was an ostial dissection of rca extent retrograde into the aorta. multiple attempts to access the true lumen failed with various wires. PT had chest pain. so decided to fix the lcx first. then retrograde wiring from lad to cross into RCA and then into the aorta. retrograde wire snared and the guide was engaged into the true lumen after that it was routine PCI.
PT remained stable and now after several months, she is asymptomatic.
started from RCA. After predil. guide and wire came out. while re-engagement. there was an ostial dissection of rca extent retrograde into the aorta. multiple attempts to access the true lumen failed with various wires. PT had chest pain. so decided to fix the lcx first. then retrograde wiring from lad to cross into RCA and then into the aorta. retrograde wire snared and the guide was engaged into the true lumen after that it was routine PCI.
PT remained stable and now after several months, she is asymptomatic.
zhlédnutí: 260
Video
Embolization of systemic bronchial arteries for massive hemoptysis.
zhlédnutí 129Před 2 měsíci
Embolization of systemic bronchial arteries for massive hemoptysis.
Retrograde carlino for difficult distal cap.
zhlédnutí 184Před 2 měsíci
Retrograde carlino for difficult distal cap.
Nano Crush, step by step.
zhlédnutí 4,9KPřed rokem
70-year-old female, morbid obesity. previously placed stent in lad patent. LCX, OM bifurcation. nano crush used. timi III flow achieved.
Deficult scenario during p pci. culprit LCX. non Culprit LMS and LAD.
zhlédnutí 627Před rokem
male pt presented with inf STEMI. LVF. ischemic MR. shifted for primary pci. culprit LCX total occlusion and non Culprit LMS and lad with critical stenosis. primary pci to lcx done there was slow reflow so decided to not to do lms, lad during index procedure. shifted to icu on norepinephrine and lasix infusion. improved in a couple of hours. Next day, echo mild MR. During index admission, we de...
Anamolous RCA. inf STEMI. primary pci of Anamolous RCA.
zhlédnutí 3,7KPřed rokem
Young male presented with inf STEMI. unable to locate RCA from rt radial access. switched to femoral access. Anamolous RCA arising from left aortic sinus. AL1,MP,AR2 failed to engage. AL2 used. nonselectuve inj showed total occlusion of rca. unable to engage selectively. free wiring used to cross in rca. GEC 6f wasn't crossed the 2nd bend of AL2. so 5.5f GEC used to engage the rca. then it was ...
critical Aorto ostial LMS stenosis. Buddy NC balloon tech for post dil.
zhlédnutí 2,9KPřed rokem
elderly male pt. ACS, ongoing chest pain. critical Aorto ostial LMS stenosis. left dominant system. additional tight lesion at mid lad. buddy NC balloon tech used for focal post dilation of Aorto ostial LMS.
intervension in heavily calcified small calibre vessels.
zhlédnutí 605Před rokem
75-year-old male. CCS III. heavily calcified diffusely diseased small calibre vessels. ivus wasn't crossed. rotablation 1.25mm burr. culotte stenting for LAD/D1. JSBKT for LMS,LAD, LCX. 1.5mm balloon used for JSBKT. the goal was to keep lcx open. ivus pull back at end. timi III flow.
critical LMS stenosis with 2 CTO.
zhlédnutí 1,4KPřed rokem
male pt with bladder tumour. TVD. CCS III angina. cabg turned down by surgeon due to co morbidity. urologist wasn't happy to operate with this CAD. failed pci to lad at OSH. they did pci to rca. now complex intervention. carlino for lad. failed l. AWE failed. STRAW. rewired successful. lcx cto functional. lms lad lcx minicrush. pot, kiss, re pot.
contrast modulation tech for CTO.
zhlédnutí 1,3KPřed rokem
74y old female, AF. presented with NSTE ACS. left dominant system. LCX distal diffuse disease. mid-LAD CTO. ipsilateral septal to septal collaterals. Gaia 3rd to puncture the cap. MC engaged 1cc contrast injection. pilot 200 crossed easily.
STEMI in pregnancy
zhlédnutí 646Před rokem
30y old female, 3 months pregnant presented with h/o ant STEMI. ivus guided pci to LAD. on ivus atherosclerotic plaque rapture. no evidence of SCAD.
Reverse wire technique.
zhlédnutí 2,2KPřed rokem
complex TVD. 65y olx male. cabd refused by pt. complex lms lad lcx pci. tortuous vessels. reverse wire technique to wire the tortuous OM. DKC for lms lad and lcx. tortuous mid rca was also fixed. plan for staged pci to distal rca bifurcation.
Retrograde cto ostial LAD.Post CABG.
zhlédnutí 2,1KPřed rokem
70 y old male. occluded graft to om. Lima is there but non functional. only svg to diagonal was patent and giving flow to lad. symptomatic despite of GDMT. MPI ve for severe reverse able ischemia in lad territory. recurrent admissions with HF. CTO lad attempted with AWE and RCART. final Timi III flow.
complex RCA intervention in post CABG patient.
zhlédnutí 1,7KPřed rokem
complex RCA intervention in post CABG patient.
Multivessel disease in setting of STEMI.
zhlédnutí 3,4KPřed rokem
Multivessel disease in setting of STEMI.
Hybrid approach for aortic balloon valvotomy
zhlédnutí 920Před 2 lety
Hybrid approach for aortic balloon valvotomy
Kyphoscoliosis, a real challenge for PMBC.
zhlédnutí 647Před 3 lety
Kyphoscoliosis, a real challenge for PMBC.
Not a cto
Great results. Strong work
The plaqure rupture is clearly distal. A short stent would havd been enough. Unnecessary long stent which and in a poorly prepared segment. With underexpanded stent now and covered stent, you have set up the patient for instent restenosis and probably cabg later. A strong man will manage the complication. A smart man will plan to not get into such situation.
Great case and wonderful result. The problem with AL2 is that it hooks non-selectively and ultimately volume of contrast is more. In this case, EBU 3/3.5 can also be tried.
Great case, nice save
Distal LCx (immediately after OM offspring) is not satisfying as the Stent seems to be not fully expanded there
The main branch stent is undersized looking at distal part of the circumflex. On ivus this will be a 4.0 vessel. Hard to treat when comes back with ISR.
Not sure that it’s undersized in general. But as the main sclerosis is at that very distal Cx area there should have been more pre- and postdilation
In case of very difficult angulation you can do Nona Crush, but problems sometimes you miss the true ostium...
Congrats！
Aggressive post dilatation should be avoided in Primary PCI
Lad?
Was there dissection in aortic cusps? I can see some contrast stain hanging up there
Definitely there was
what treat..? only baloon or insert new stent in old stent?
Bohat bari taqleef se nikal aai aap ki waja se Jazzaq ALLAH
Thanks dr Aap ne 4 months ago mera UAE procedure kia ALLAH Aap pe mehrban rahe hamesha
Did you use covered stent for it or just did the prolonged balloon inflation
My lad size 1.6 mm. Which best .bypass or.stent. sir?
Assalamualaikum Sir g ye LAD se RCA nahe gaya wire 🤔
Why so mismanaged? The whole case...
Спасибо за кейс.
Could have done lcx to om2 provisional with wire in om1
It was not good idea to touch the LAD after that Complication. Thank u for Video
In the US the family would kill you too. What is the purpose of showing this blunder? Don’t oversize your balloon? Maybe don’t stage fixing the LAD the same hospitalization? That would be intuitive to most of us.
Mashaa Allah , very nice case sir
Overzealous post dilation while attempting good cosmetic result will give you such sort of complications....bottom line please don't overdo it😊
Very nice case
Respect
Masha Allah Excellent Share Sir.❤
Super
Excellent
Sir Great case to Learn , thanks for sharing
Nice job sir Informative video.
Asalam.o.Alaikum. Sir. H r u. Sir 7 September 2023 my Angiography done. LHC a showed. Final diagnos. Non-obstructive CAD. LM-Normal. LAd-Normal. LCx-patent stent, Left PDA 80% dieseas. RCa-Mid to Distal plaquing noted. MPS report showed. Medium size moderate intensity, predominantly reversible perfusion defect involving basal to mid inferior and inferolateral segment. Sir please your expert opinion and advice please. Thanks. Regards. Ejaz Ahmed.
That is fascinating!!
Unless a severe contraindication, this patient should get a coronary bypass graft
Good work. p RCA stent seems under expended.
awesome results MashAllah
The guiding katheter AR 1.0 or Judkins right?
AL 1
Good result
Do you routinely use IVUS or not?
Good end result 👏
Thank you very much. Would you please tell us about the wires and microcatheter you used?
Caravel MC. Pilot 50, gaia 2nd, CP 12. Then pilot 200
@@drimranhanifhashmi5442 thank you 🙏❤️
Excellent job
Nice job
Why don't tell us what you did?
Can you tell us what you did?
Nice job! What is the difference in mini and nano crush here? MACE, TLR?
No head to head trial between mini, nano, and DKC.
Please mention ur wires and any microcatheter support, if needed
Workhorse wire, sion blue in this case. MC wasn't utilised. Export aspiration cath used.
AL 0.75 ?
AL 2
👍
Masha Allah Excellent Share Sir. May Allah Almighty bless you with his Rehmat.
Same to you