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I recently performed a #SurgicalStentectomy together with Faisal Bakaeen MD. These operations are challenging and full of technical nuances. The decision to remove a coronary stent is never simple and requires careful consideration of anatomy, stent location, distal targets, and the safest strategy for complete revascularization. A fascinating operation—and... show more

Gianluca Torregrossa

5,687 subscribers

10,630 просмотров • 10 дней назад •via X (Twitter)

#SurgicalStentectomy

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Комментарии: 6

Фото профиля Prasannasimha🇮🇳

Prasannasimha🇮🇳10 дней назад

@FaisalBakaeen A full metal jacket is a disservice2 the patient. While we may do stent endarterectomy etc the damaged endothelium has been emdarterectomised& Patencies can never match a primary LIMA to LAD. If patient could tolerate a stent endartectomy he/she could have undergone primary CABG

Фото профиля Shahzad Raja

Shahzad Raja9 дней назад

@FaisalBakaeen Metal jackets have a price. Great case, technically demanding, decision making even more so. A reminder of when NOT to stent, and why complex coronary surgery matters.

Фото профиля Sam Pollock

Sam Pollock9 дней назад

@FaisalBakaeen I did once in RCA, cardiologist was told no nickel. The patient was having severe allergic symptoms. RCA was almost like a carotid and received a vein patch. They did well

Фото профиля K Yogesh

K Yogesh9 дней назад

@FaisalBakaeen 👌

Фото профиля Michel Pompeu Sá

Michel Pompeu Sá9 дней назад

@FaisalBakaeen Wow😱😱😱 Impressive👍👍👍

Фото профиля Nader Joghetaei, MD

Nader Joghetaei, MD9 дней назад

@FaisalBakaeen Why was the stent removed?

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How to modify stent strings in less than a minute so they are not inadvertently tugged on. I borrowed this technique from Dr. Lingeman and haven’t had a patient accidentally remove their stent since. No need for trying to tape the strings out of the way… just cut to length IU Endourology

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Austen Slade, MD, MBA

46,690 просмотров • 3 лет назад

🟩TIMI TIMI (Thrombolysis in Myocardial Infarction) flow is an angiographic grading system used to describe the degree of epicardial coronary blood flow after reperfusion therapy (thrombolysis or PCI) in acute myocardial infarction. It was developed by the TIMI study group to provide a standardized, reproducible way to assess coronary perfusion on angiography. TIMI flow grades 🟥TIMI 0: No perfusion There is no antegrade flow beyond the point of coronary occlusion. 🟪TIMI 1: Penetration without perfusion Contrast passes beyond the obstruction but fails to opacify the entire distal coronary bed and appears to stagnate. 🟦TIMI 2: Partial perfusion Contrast crosses the obstruction and opacifies the distal bed, but flow and/or clearance is slower than in normal or non-affected coronary segments. 🟩TIMI 3: Complete perfusion Normal antegrade flow with rapid filling and clearance of contrast in the distal coronary bed, comparable to an uninvolved vessel. Key point TIMI flow reflects epicardial coronary artery patency, not microvascular perfusion. Achieving TIMI 3 flow is strongly associated with better clinical outcomes after myocardial infarction. CardiovascularCorner

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CardiovascularCorner

11,031 просмотров • 8 месяцев назад

4 A.M. STEMI call. 45-year-old male with acute anterior STEMI activated through the STEMI pathway. Coronary angiography showed complete thrombotic occlusion of the LAD. Initial ballooning restored flow, and a drug-eluting stent was deployed successfully… or so we thought. Seconds later came one of the true nightmares in interventional cardiology: The stent was physically delivered. Deployment was confirmed. But fluoroscopy showed… no stent in the lesion. The LAD still looked unstented. Immediate full fluoroscopic search of the patient’s body was performed. No lost stent was seen anywhere. The table? Negative. The sheath? Negative. The guiding system inside the body? Negative. Unfortunately, stent boost was unavailable at that moment, and IVUS was not accessible. Multiple vigorous flushes of the guiding catheter failed to reveal the missing stent. At that point, the concern escalated dramatically — embolized stent? Lost in the system? Somewhere unseen? Decision was made to retrieve the entire system and physically inspect everything outside the patient. Still nothing. Finally, as a last attempt, the guiding catheter was carefully cut in small external segments. And there it was. The entire undeployed stent was trapped inside the OUTSIDE portion of the guiding catheter — beyond the fluoroscopy field — firmly stuck despite repeated flushing attempts. The relief in the cath lab at that moment was indescribable. A new stent was then successfully deployed with excellent final angiographic result. Lessons from the night: • Never trust assumptions in the cath lab • Lost stents can hide in unexpected places • Systematic troubleshooting saves lives — and saves operators from panic • Sometimes the solution is not high-tech… but persistence and careful thinking Interventional cardiology continues to humble us. #Cardiology #InterventionalCardiology #STEMI #PCI #CathLab #CoronaryIntervention #LAD #CardioTwitter #MedTwitter #STEMIPathway

4 A.M. STEMI call. 45-year-old male with acute anterior STEMI activated through the STEMI pathway. Coronary angiography showed complete thrombotic occlusion of the LAD. Initial ballooning restored flow, and a drug-eluting stent was deployed successfully… or so we thought. Seconds later came one of the true nightmares in interventional cardiology: The stent was physically delivered. Deployment was confirmed. But fluoroscopy showed… no stent in the lesion. The LAD still looked unstented. Immediate full fluoroscopic search of the patient’s body was performed. No lost stent was seen anywhere. The table? Negative. The sheath? Negative. The guiding system inside the body? Negative. Unfortunately, stent boost was unavailable at that moment, and IVUS was not accessible. Multiple vigorous flushes of the guiding catheter failed to reveal the missing stent. At that point, the concern escalated dramatically — embolized stent? Lost in the system? Somewhere unseen? Decision was made to retrieve the entire system and physically inspect everything outside the patient. Still nothing. Finally, as a last attempt, the guiding catheter was carefully cut in small external segments. And there it was. The entire undeployed stent was trapped inside the OUTSIDE portion of the guiding catheter — beyond the fluoroscopy field — firmly stuck despite repeated flushing attempts. The relief in the cath lab at that moment was indescribable. A new stent was then successfully deployed with excellent final angiographic result. Lessons from the night: • Never trust assumptions in the cath lab • Lost stents can hide in unexpected places • Systematic troubleshooting saves lives — and saves operators from panic • Sometimes the solution is not high-tech… but persistence and careful thinking Interventional cardiology continues to humble us. #Cardiology #InterventionalCardiology #STEMI #PCI #CathLab #CoronaryIntervention #LAD #CardioTwitter #MedTwitter #STEMIPathway

د. ناصر القحطاني Nasser Alqahtani

20,342 просмотров • 4 месяцев назад

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CardiovascularCorner

18,450 просмотров • 1 год назад

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Dr. Filippo Cademartiri

19,876 просмотров • 5 месяцев назад

Today was one of those cases that remind me why the cath lab is never routine. 40yo with DM, HTN & ESRD on HD came with diffuse ST depression. Angio → critical ostial LM. Just as I took first pics and i disengaged the LM to breath in and think of strategy or call the surgeon , the patient arrested. CPR started 💥 No time to waste — I went straight for LM PCI during CPR. Stent deployed → flow restored → patient survived! 🙏 Moments like this remind us: ⚙️ importance of Team coordination ⚡️ Quick decision-making ❤️ And courage under pressure — can truly save a life. I’m planning to bring him back in after stabilization for IVUS and optimize LM stent .

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