2 techniques for guidezilla delivery 1. Push on iflated 🎈 2. Inchworming Which is Safer, easier & better ? akbar haq jedicath աǟզǟʀ.ǟɦʍɛɖ د . احمد سمان Ayman Magd Dr . $@ndeep K@m@t Ankur Phatarpekar David J. Cohen, MD, MSc Ankush Gupta Shahrukh Bakar Osama Bisht SREEVATSA NADIG DM... FSCAI FESC Dr Imran Hanif Hashmi Erik Rafflenbeul Khalid Minhas, MD FACCshow more

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @minhaskh Me team #BTT (Balloon assisted tracking technique) For more on techniques see the briliant @PCRonline #HowTo by @deharo_pierre:

@akbarul @jedicath @Ahmed43101178 @aymanka @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh Hi,Personally hv never used guide extension as its difficult to cover its cost in govt set up in India.what i use instead is I do Amplazting of JR(looping it using cuspal support)& use inchworming of the stent to deliver it distally with constant pressure.saves cost/works well.:-

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh Its not "pushing" on inflated balloon but rather pulling the inflated balloon while pushing the guide extension. This will center the guide extension away from the coronary wall and facilitate delivery.

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh BAT must be useful if there’s a lot of proximal disease & you know you’ll end up with an ostioproximal stent too. Guideliner 2 is soft tipped & can be advanced OTW with less caution.

@jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh Over balloon.Use guideplus 2.Will forget guidezilla

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh There is no one correct answer! Sometimes BAT, Torpedo, inchworm, anchoring or/and unsheathing.. the key is to manage all the options and adapt them to each situation! Grate video!

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH I usually advance guidezilla over the balloon shaft without inflation and then exchange the balloon with the stent

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh If I know I’m doing most of the artery. I will balloon the whole thing. Pull the Guidzilla into the distal and then stent the whole way back. If I’m doing a focal mid or distal lesion I push carefully.

@akbarul @jedicath @Ahmed43101178 @aymanka @cardiodoc1988 @care4urheart2 @djc795 @DrAnkushG @shahrukh_bakar @Obisht @nadig_cardio @DrIHHashmi1 @KardiologieHH @minhaskh One of @hjcox_pvd favourite catheters.

Both are the same technique. It’s a two way force with traction on the balloon and slight advancement of the GCE. If the balloon is inflated much distal to the GCE, the chance of damage to the coronary is higher. Inflating closer will reduce the chance. However it depends on where the vessel is diseased and if there is a stent. Sometimes, while deflating a closely inflated balloon, we can advance the GCE better.