Dr Imran Hanif Hashmi

@DrIHHashmi1 • 2,957 subscribers

interventional cardiologist

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Dr Imran Hanif Hashmi

Shorts

A 60‑year‑old female presented with NSTE‑ACS. Angiography showed a mid‑LAD lesion that looked simple and lacked high‑risk features. After predilating with a 2.5 mm balloon at 10 atm, a massive perforation occurred. What do you think led to this?

How would you handle this LAD,D1,D2 trifurcation.

A 51-year-old male presented with SOB. Dilated RA, RV severe PHTN. What do you think about it.

Difficult scenario to deal with. Young male with severe chest pain. ST elevation in III, avr, V1 and ST depression in all other leads. Would like to hear from colleagues, how to handle this.

Everything was fine till post-dilation and then...... Adrenaline surge..

A 70-year-old man with inferior STEMI. What's your take on the likely culprit vessel, and how would you manage this case?

How to handle this LAD, D1&amp; D2. One important thing to mention there is a small coronary cameral fistula from the distal lad to LV visible at the end of the cine. This can create confusion as wire perforation after intervention.

What should I do? A 50-year-old diabetic female presented to the gastroenterology OPD with abdominal pain, Refer to our ER, having inf STEMI. LVEF 30%. Shifted to the cath lab for PPCI.

Ant STEMI, LVF. Previous history of PTCA at some other place no record available. Poor compliance. Severe LV dysfunction. What would you do?

84y/f underwent CAG via 6F femoral route. Hemostasis was secured with manual compression. In CCU, she developed hypotension and massive Ant. Abdominal wall hematoma. Her groin was clean. Shifted back, did SFA stick, and took the femoral shot. What do you think what had happened

Ant STEMI at midnight. What would you do in such a scenario? 1 Provisional or 2 Upfront 2 stent strategy. Just curious to know if is there any impact of late working hours on the bifurcation strategy.

Upfront RA or not? Young male, Renal Transplant candidate. On MHD for last 10 y.

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SCAD or not. 34y male. Newly diagnosed DM. Chest pain. Osteo proximal lad critical stenosis. What do you think, is it SCAD or not?

What do you think about this. Failed procedure, Partially successful or Successful procedure.

What do you think about this LAD?

RCA functional CTO. All good till we pulled out the wire, Then it was obvious. What to do next.

Stent ablation of a freshly deployed Stent is a high-risk bailout procedure for a severely underexpanded freshly deployed Stent due to underestimating CN. A case of IVI and rota regret. Disclaimer. Lesion preparation wasn't adequate.

Inf STEMI. Mid PDA tight lesion. Pre dil. Check injection while stent positioning and then......

#HDRanalysis. RCA CTO at proximal stent edge very close to ostium. Guide support was challenging. Tough proximal cap. Gaia 3rd, CP 12 failed. #HDR tried but failed. Cap punctured with Gaia 2nd. #HDR again. Pilot 200 crossed MC failed. 1.0, 2.5,3,3🎈 Acceptable final results.

Young male, ACS late presentation. LCX total thrombotic occlusion. LAD was mid/distal subtotal occlusion. RCA CTO with multiple bridge collaterals. How much to do?

80y old male. NSTE ACS. LVEF 30% How much should be done in one setting?

What do you think about this LAD? A young male presented with Ant STEMI. ST V1 to V4. Shifted for PPCI. Found this. How would you treat this pt.

60y old male. ACS. What approach would you take for this ostial LAD?

Young male. Large ASD. The posterior superior margin is quite deficient. RV dysfunction. PASP 90mmhg. Left to right shunt. 34 mm device. LUPV deployment failed. RUPV deployment. Device occlusion test for 30min. No hemodynamics deterioration. Device released.

What do you think about deployment depth? Good enough or too deep. Mild PVL.

Can someone help me with vessel identification? Anamolous LM from Rt aortic sinus. However, I was unable to identify LAD and LCX. Which one is LAD?

70-year-old hypothyroid obese female. Ongoing chest pain. How much would be enough for this pt?

An elderly male pt presented with NSTE ACS. LVEF 30%. CABG declined by CS as pt was declared high surgical risk by a pulmonologist due to severe lung disease. What do you think how much should be done in one setting?

Post CABG. Multiple hospitalisations after CABG. EF dropped from 50 to 30/35%. Patent grafts but.....

Young female with effort angina. What do you think about this LCX? Woven coronary artery. Recanalized thrombus. Recanalized CTO.

How fast have you ever paced for PBPV? 22y male. Valvular PS. Severe RVH. Balloon slipped multiple times at 150, 200, 250, and 300 pacing Finally pacing at 360b did the job. Immediate post-procedure PPg dropped from 135mmHg to 60mmHg.

Contrast modulation is also helpful for microchannel tracking RCA &amp; LAD CTO. RCA has a microchannel but wasn't able to cross with multiple wires. Did Contrast modulation then it was crossed easily with PJ wire without tip bend. LAD was crossed with Gaia 3rd. Timi III flow.

How to handle this LAD, D1& D2. One important thing to mention there is a small coronary cameral fistula from the distal lad to LV visible at the end of the cine. This can create confusion as wire perforation after intervention.

Contrast modulation is also helpful for microchannel tracking RCA & LAD CTO. RCA has a microchannel but wasn't able to cross with multiple wires. Did Contrast modulation then it was crossed easily with PJ wire without tip bend. LAD was crossed with Gaia 3rd. Timi III flow.