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Evandro Martins F. MD

@evandrofilhobr • 20,581 subscribers

🇧🇷 Interventional Cardiologist | #RadialFirst #CTO #ImageFirst | Complex PCI & Structural Heart | Sharing cases, science & passion

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Junior rota-operator was starting this case under my supervision, after burr was advanced I noticed this...and immediately warrant him to stop. Correction was done and case went smoothly.

Junior rota-operator was starting this case under my supervision, after burr was advanced I noticed this...and immediately warrant him to stop. Correction was done and case went smoothly.

24,414 views

#CTO101 72M, large burden ischemia @ anterior wall & CCS II-III angina despite OMT LAD CTO - blunt (some ambiguity) & calcium chunk How would you tackle this?

#CTO101 72M, large burden ischemia @ anterior wall & CCS II-III angina despite OMT LAD CTO - blunt (some ambiguity) & calcium chunk How would you tackle this?

10,826 views

Nice TAVR result in a very small anatomy but vascular access complication.

Nice TAVR result in a very small anatomy but vascular access complication.

13,220 views

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RCA CTO w/ ambiguous proximal cap. Knuckle wire advanced subintimally and probably inadvertently tracked an RV marginal branch, exploding... Luckily, perforation was into the RV cavity. No pericardial effusion, no tamponade. No need this time but always have echo + pericardiocentesis kit ready.

RCA CTO w/ ambiguous proximal cap. Knuckle wire advanced subintimally and probably inadvertently tracked an RV marginal branch, exploding... Luckily, perforation was into the RV cavity. No pericardial effusion, no tamponade. No need this time but always have echo + pericardiocentesis kit ready.

Evandro Martins F. MD

14,501 views • 1 month ago

Patient at home using a 24h Holter monitor. Trace reading after his death.

Patient at home using a 24h Holter monitor. Trace reading after his death.

Evandro Martins F. MD

67,427 views • 1 year ago

Shocking news. Looks like Damar Hamlin suffered a commotio cordis. Hope he recovers asap.

Shocking news. Looks like Damar Hamlin suffered a commotio cordis. Hope he recovers asap.

Evandro Martins F. MD

89,541 views • 3 years ago

85F. Double occlusions RCA & LAD. CMR with heavy burden ischemia. Target was RCA, 1ry retro due px cap ambiguity using AV epicardial channel. Device uncrossable lesion after wire IP crossing. Grenadoplasty. IVUS & CB for plaque modification.

85F. Double occlusions RCA & LAD. CMR with heavy burden ischemia. Target was RCA, 1ry retro due px cap ambiguity using AV epicardial channel. Device uncrossable lesion after wire IP crossing. Grenadoplasty. IVUS & CB for plaque modification.

Evandro Martins F. MD

15,689 views • 6 months ago

47🤠, symptomatic with an abnormal stress test (treadmill test - CP & ST depression at peak exercise). following angiogram... What are your next steps for evaluating this patient?

47🤠, symptomatic with an abnormal stress test (treadmill test - CP & ST depression at peak exercise). following angiogram... What are your next steps for evaluating this patient?

Evandro Martins F. MD

47,916 views • 3 years ago

Tip for the #calciumcrackers using Shockwave Medical I’ve been prepping the SW balloon the same way I do w/ Stingray balloon. Very fast and effective. - 20cc empty luer lock syringe for vaccuum generation - 3cc luer lock syringe with pure dye - simple stopcock (blue one is my favorite) Don’t do negative pressure with indeflator before the first insuflation.

Tip for the #calciumcrackers using Shockwave Medical I’ve been prepping the SW balloon the same way I do w/ Stingray balloon. Very fast and effective. - 20cc empty luer lock syringe for vaccuum generation - 3cc luer lock syringe with pure dye - simple stopcock (blue one is my favorite) Don’t do negative pressure with indeflator before the first insuflation.

Evandro Martins F. MD

40,658 views • 2 years ago

My worst nightmare in the last 10 years practicing interventional cardiology. Annular rupture during TAVR with BEV. Emergent surgery was triggered but the patient couldn’t get out of extracorporeal circulation after valve replacement.

My worst nightmare in the last 10 years practicing interventional cardiology. Annular rupture during TAVR with BEV. Emergent surgery was triggered but the patient couldn’t get out of extracorporeal circulation after valve replacement.

Evandro Martins F. MD

37,766 views • 2 years ago

$Satuday mood. 93 👨🏼‍🦳 very active, 3 hospitalizations for recurrent angina refractory to optimal medical tx. Normal EF. How would you approach?$

Satuday mood. 93 👨🏼‍🦳 very active, 3 hospitalizations for recurrent angina refractory to optimal medical tx. Normal EF. How would you approach?

Evandro Martins F. MD

29,077 views • 2 years ago

One of the great cases we’ve done in our 2 days CTO Club 2025 meeting. Crazy ostial LAD CTO w/ severe parietal calcium and aneurysmal morphology. Antegrade approach using Power Puncture of px cap w/ H14 followed by AW w/ H14 after failing AW Gladius > GN3. Also tried HDR. 4.0 IVL & 2 Megatrons 4.5 & 5.0.

One of the great cases we’ve done in our 2 days CTO Club 2025 meeting. Crazy ostial LAD CTO w/ severe parietal calcium and aneurysmal morphology. Antegrade approach using Power Puncture of px cap w/ H14 followed by AW w/ H14 after failing AW Gladius > GN3. Also tried HDR. 4.0 IVL & 2 Megatrons 4.5 & 5.0.

Evandro Martins F. MD

15,787 views • 1 year ago

Sometimes we must take calculated risks to achieve good outcome — as long as every step is carefully planned. 🔹 Proximal LAD CTO opened retrogradely through patent LIMA. 🔹 Distal LAD collaterals used for RCA CTO retrograde recanalization. When there’s no easy way, build one!

Sometimes we must take calculated risks to achieve good outcome — as long as every step is carefully planned. 🔹 Proximal LAD CTO opened retrogradely through patent LIMA. 🔹 Distal LAD collaterals used for RCA CTO retrograde recanalization. When there’s no easy way, build one!

Evandro Martins F. MD

10,934 views • 9 months ago

$Have you ever had? How to solve it? How to prevent it? This is a case of stuck “jailed” guide-wire due to the formation of knot on itself during attempt of wire removal in a provisional bifurcation PCI. During trials of wire removal the wire coil unraveled and detached followed by fracture of the core in a more proximal segment. PS: Wire fragment was left alone due advanced patient age and risk of stent deformation during attempt to snare it.$

Have you ever had? How to solve it? How to prevent it? This is a case of stuck “jailed” guide-wire due to the formation of knot on itself during attempt of wire removal in a provisional bifurcation PCI. During trials of wire removal the wire coil unraveled and detached followed by fracture of the core in a more proximal segment. PS: Wire fragment was left alone due advanced patient age and risk of stent deformation during attempt to snare it.

Evandro Martins F. MD

15,160 views • 1 year ago

There’s no free lunch…😅 ROTAMONSTER

There’s no free lunch…😅 ROTAMONSTER

Evandro Martins F. MD

13,560 views • 1 year ago

Probably my most challenging case this year… RCA ISR CTO - AW Corsair Pro 135 w/ Gladius / GN 3 / CP12 / Astato 20. Poor progression (15mm progression in 1 hour attempt). Very very fibrotic. GZ 7F. 1.25 / 2.0 balloons (rupture). Retro through S1. Mamba Flex & Sion Black to PL. Puncture to stent with GN3. No progression. Abandoned S1. Apical epicardial channel. Mamba Flex & Sion Black. Changed to Finecross. J wire technique to for channel crossing. Gladius & Pilot 200 & GN3 & CP12 & Aststo 20 for RWE couldn’t go inside stent. Knuckled gladius outside stents. CP12/Astato for RW. GZ assisted RCART and failed. Fresh H14 crossed to aorta. Snared H14 but locked inside the guide catheter, hard time to free the wire locked onto snare. H14 unlocked. Finecross stucked but finally after new attempt could traverse to aorta. R350 snared in brachiocephalic trunk. 4 DES. 1 DES stripped. 3.5 & 4.0 NCs. IVUS

Probably my most challenging case this year… RCA ISR CTO - AW Corsair Pro 135 w/ Gladius / GN 3 / CP12 / Astato 20. Poor progression (15mm progression in 1 hour attempt). Very very fibrotic. GZ 7F. 1.25 / 2.0 balloons (rupture). Retro through S1. Mamba Flex & Sion Black to PL. Puncture to stent with GN3. No progression. Abandoned S1. Apical epicardial channel. Mamba Flex & Sion Black. Changed to Finecross. J wire technique to for channel crossing. Gladius & Pilot 200 & GN3 & CP12 & Aststo 20 for RWE couldn’t go inside stent. Knuckled gladius outside stents. CP12/Astato for RW. GZ assisted RCART and failed. Fresh H14 crossed to aorta. Snared H14 but locked inside the guide catheter, hard time to free the wire locked onto snare. H14 unlocked. Finecross stucked but finally after new attempt could traverse to aorta. R350 snared in brachiocephalic trunk. 4 DES. 1 DES stripped. 3.5 & 4.0 NCs. IVUS

Evandro Martins F. MD

18,693 views • 2 years ago

RCA aorto-ostial - ISR CTO with older overhanging under-expanded stent. Impossible to engage with any guide. Retro through septals w/ Mamba Flex 150. Samurai RC. Retro crossing with Hornet 14 (2x). MC uncrossable. Tip in H14 into JR in aortic arch. Trapping. Externalization. Undilatable ostial lesion. 3.5 & 4.0 balloon rupture 30 ATM. Wolverine 4.0 - 22 ATM. 4.5 balloon 32 ATM. MLA from 2.2 -> 6.1 mm2. No SW available, unfortunately.

RCA aorto-ostial - ISR CTO with older overhanging under-expanded stent. Impossible to engage with any guide. Retro through septals w/ Mamba Flex 150. Samurai RC. Retro crossing with Hornet 14 (2x). MC uncrossable. Tip in H14 into JR in aortic arch. Trapping. Externalization. Undilatable ostial lesion. 3.5 & 4.0 balloon rupture 30 ATM. Wolverine 4.0 - 22 ATM. 4.5 balloon 32 ATM. MLA from 2.2 -> 6.1 mm2. No SW available, unfortunately.

Evandro Martins F. MD

21,991 views • 3 years ago

Do you #imagefirst your STEMI's cases? Trivial case. 57M - LAD STEMI while playing soccer Thrombectomy - TIMI 3 flow - IVUS - Stent - then following IVUS. We must strive & seek long-term results even in acute settings P.S.: this isn't good...

Do you #imagefirst your STEMI's cases? Trivial case. 57M - LAD STEMI while playing soccer Thrombectomy - TIMI 3 flow - IVUS - Stent - then following IVUS. We must strive & seek long-term results even in acute settings P.S.: this isn't good...

Evandro Martins F. MD

22,711 views • 3 years ago

My suggestion for changing the “rotaburr entrapment algorithm” is to use knuckle wire technique (KWT) to create space and allow release of the burr. I suggest using KWT before “cut-shaft” strategies. Emmanouil Brilakis ROTAMONSTER

My suggestion for changing the “rotaburr entrapment algorithm” is to use knuckle wire technique (KWT) to create space and allow release of the burr. I suggest using KWT before “cut-shaft” strategies. Emmanouil Brilakis ROTAMONSTER

Evandro Martins F. MD

12,263 views • 1 year ago

84🧑‍🌾, CCS IV angina despite all the OMT you can imagine. CABG turndown. 3VD (2 CTOs RCA-LCx & calcified LAD). MRI all viable territories, EF 40s. High-Risk PCI to the left system w/ IABP support. Giving some hope to the ones most in need. Superseletive OM injection, ping-pong guides & #IVUSguidedADR

84🧑‍🌾, CCS IV angina despite all the OMT you can imagine. CABG turndown. 3VD (2 CTOs RCA-LCx & calcified LAD). MRI all viable territories, EF 40s. High-Risk PCI to the left system w/ IABP support. Giving some hope to the ones most in need. Superseletive OM injection, ping-pong guides & #IVUSguidedADR

Evandro Martins F. MD

19,455 views • 3 years ago

LAD CTO - JCTO 3 (concomitant RCA CTO), only epicardial ipsilateral collaterals. AW failed and bad dx target for SR ADR. Retro from OM collateral - perf - fat embolization. Retro from Diag collateral. Attempt of AW with wire marker. MC advanced through the channel. RCART with Gaia Next 3 & 2.0 balloon. Good outcome, uneventful recovery.

LAD CTO - JCTO 3 (concomitant RCA CTO), only epicardial ipsilateral collaterals. AW failed and bad dx target for SR ADR. Retro from OM collateral - perf - fat embolization. Retro from Diag collateral. Attempt of AW with wire marker. MC advanced through the channel. RCART with Gaia Next 3 & 2.0 balloon. Good outcome, uneventful recovery.

Evandro Martins F. MD

13,380 views • 2 years ago

PCI of severe calcified aorto-ostial RCA CTO. "5 min wrap-up of a 4h endeavor" Mental power and resilience was the key for success.

PCI of severe calcified aorto-ostial RCA CTO. "5 min wrap-up of a 4h endeavor" Mental power and resilience was the key for success.

Evandro Martins F. MD

10,514 views • 2 years ago

Complex retrograde channel tracking for LAD CTO recanalization. The balance between confidence & fear to succeed. Kambis Mashayekhi Dr. Bill Lombardi

Complex retrograde channel tracking for LAD CTO recanalization. The balance between confidence & fear to succeed. Kambis Mashayekhi Dr. Bill Lombardi

Evandro Martins F. MD

10,571 views • 3 years ago

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