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Michael Megaly

@MichaelMegalyMD • 5,777 subscribers

Interventional Cardiologist #CTO #PCI #limbsalvage. Alum @MHIF_Heart @HenryFordHealth Aspiring to make a difference. Opinions personal, not represent employer

Shorts

Something you do not see every day #cardiotwitter folks. 86 woman. Initial angio -LAD aneurysm, 2 weeks later presents with NSTEMI, pericardial effusion but stable hemodynamics. 2nd angiogram. Thoughts? Will share what we did after #ACCFIT #ACCIC

Something you do not see every day #cardiotwitter folks. 86 woman. Initial angio -LAD aneurysm, 2 weeks later presents with NSTEMI, pericardial effusion but stable hemodynamics. 2nd angiogram. Thoughts? Will share what we did after #ACCFIT #ACCIC

18,073 Aufrufe

Why do I like penumbra! A 50 yo pt with NSTEMI ongoing chest pain. Multiple attempts at ballooning doesn’t work. One pass of penumbra, out with a tiny snake of clot, restoration of low, and relief of chest pain #CardioTwitter

Why do I like penumbra! A 50 yo pt with NSTEMI ongoing chest pain. Multiple attempts at ballooning doesn’t work. One pass of penumbra, out with a tiny snake of clot, restoration of low, and relief of chest pain #CardioTwitter

10,023 Aufrufe

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A back table illustration of the technique published by PCRonline 🫀 to remove a stuck perclose footplate in the vessel! Simple and I believe can get us out of trouble! #CardioX peeps, comments welcome

A back table illustration of the technique published by PCRonline 🫀 to remove a stuck perclose footplate in the vessel! Simple and I believe can get us out of trouble! #CardioX peeps, comments welcome

72,865 Aufrufe • vor 2 Monaten

A backtable illustration of a couple techniques you can use if the #Rotaburr gets stuck, 1-The skipping rope technique. We have known it for a couple years, and it was recently published 2-The final resort of cutting the rota driveshaft and advance a guideliner through it to get more leverage to pull. Of course the first thing you do is to pull hard and maybe try to balloon around it, but those can help with tougher situations. #CardioX community, please share your additional tips and comments

A backtable illustration of a couple techniques you can use if the #Rotaburr gets stuck, 1-The skipping rope technique. We have known it for a couple years, and it was recently published 2-The final resort of cutting the rota driveshaft and advance a guideliner through it to get more leverage to pull. Of course the first thing you do is to pull hard and maybe try to balloon around it, but those can help with tougher situations. #CardioX community, please share your additional tips and comments

21,082 Aufrufe • vor 2 Monaten

A unique use of HDR! High-risk saddle PE (now called stage D), in a patient with baseline cardiac index 1.2. Cleared out all right lung except the lower branch (full of clots), attempts to wire or manipulate the penumbra catheter in the branch failed. So I borrowed the coronary #CTO #PCI technique, engaged the cap with the Select catheter. Some contrast to stain, then "wired" the branch with the catheter over which I used the Penumbra Vascular catheter to clean the branch! I think coronary CTO operators can have a solution for any vascular bed! #CardioX

A unique use of HDR! High-risk saddle PE (now called stage D), in a patient with baseline cardiac index 1.2. Cleared out all right lung except the lower branch (full of clots), attempts to wire or manipulate the penumbra catheter in the branch failed. So I borrowed the coronary #CTO #PCI technique, engaged the cap with the Select catheter. Some contrast to stain, then "wired" the branch with the catheter over which I used the Penumbra Vascular catheter to clean the branch! I think coronary CTO operators can have a solution for any vascular bed! #CardioX

12,426 Aufrufe • vor 4 Monaten

My favorite way for Fluoro-guided pericardiocentesis learnt from @HeartDrHanna 1-90 degree lateral (you can get fairly quick) 2-Identify xiphoid under x-ray with your finger 3- needle of choice filled with 100% contrast (my fav is micropuncture in small pts and spinal in large pts) 4-Cine-identify heart border (white) 5-Go subxiphoid, aimed for left shoulder with intermittent pull and inject tiny amount of contrast (stain your way) 6-Once in, you will pull back fluid and you will inject contrast that will line the heart border (shown below) 7-insert long wire and let wrap around the heart to confirm. 8-now can use echo for further confirmation #ACCFIT #ACCIC #Cardiotwitter #CardioED

My favorite way for Fluoro-guided pericardiocentesis learnt from @HeartDrHanna 1-90 degree lateral (you can get fairly quick) 2-Identify xiphoid under x-ray with your finger 3- needle of choice filled with 100% contrast (my fav is micropuncture in small pts and spinal in large pts) 4-Cine-identify heart border (white) 5-Go subxiphoid, aimed for left shoulder with intermittent pull and inject tiny amount of contrast (stain your way) 6-Once in, you will pull back fluid and you will inject contrast that will line the heart border (shown below) 7-insert long wire and let wrap around the heart to confirm. 8-now can use echo for further confirmation #ACCFIT #ACCIC #Cardiotwitter #CardioED

24,251 Aufrufe • vor 1 Jahr

The importance of support. A Long 150 mm RCA #CTO with a mid-segment 12-year-old stent, tough 90-degree angle of attack proximal cap, and distal cap at the bifurcation. First attempt: radial femoral approach-no pushability antegrade or retrograde-aborted. The 2nd attempt used bi-femoral approach, the proximal cap angle of attack solved with supercross, lucky intra-stent navigation, and final tough reverse CART in a big vessel and preserved intrastent position. The radial approach is great, but sometimes, we just need more support to get the job done. The difference in support calculated by physics is huge. #CardioX #ACCFIT

The importance of support. A Long 150 mm RCA #CTO with a mid-segment 12-year-old stent, tough 90-degree angle of attack proximal cap, and distal cap at the bifurcation. First attempt: radial femoral approach-no pushability antegrade or retrograde-aborted. The 2nd attempt used bi-femoral approach, the proximal cap angle of attack solved with supercross, lucky intra-stent navigation, and final tough reverse CART in a big vessel and preserved intrastent position. The radial approach is great, but sometimes, we just need more support to get the job done. The difference in support calculated by physics is huge. #CardioX #ACCFIT

10,892 Aufrufe • vor 1 Jahr

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