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Iatrogenic aortic dissection post ivus guided LM IVL + DKC. Hemodynamics stable and no CP post procedure. How to prevent this complication? Alex Truesdell Mamas A. Mamas MIЯVΛƬ #IC ༄ 。° Evandro Martins F. MD Hany Ragy Amir Kaki, MD Lorenzo Azzalini DKarmpaliotis Jack Hall David J. Cohen, MD,... show more
8 条评论

Agree that non coaxial GC position may be a potential cause to this complication. But in this case the aortic dissection was probably caused by agressive pre dil of a ostial LM calcified nodule that was pushed against the aortic wall as you can see in the video below

@agtruesdell @mmamas1973 @mirvatalasnag @evandrofilhobr @Hragy @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @aspergian1 @djc795 @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 Be obsessive about guide position/coaxiality. I often use a GEC that is advanced over a 🎈 shaft after deflation into the LM DES especially if coaxial guide engagement is difficult. But would do nothing here except stop injecting and get serial CTAs. Result looks amazing.

@mmamas1973 @mirvatalasnag @evandrofilhobr @Hragy @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @aspergian1 @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 👍”Never Walk Into a [Cath Lab] You [and Your Patient] Can’t Walk Out Of” (“Ronin” Movie paraphrased):

@agtruesdell @mmamas1973 @evandrofilhobr @Hragy @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @aspergian1 @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 #TipForFIT Complications happen: -Key is to recognize & treat them -Ask for help..2 pair of hands can be useful when patients crash & it makes you a better operator not worse

@agtruesdell @mmamas1973 @mirvatalasnag @evandrofilhobr @Hragy @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 Thank you for sharing. Great result on the lesion. The only thing I can add is the simple law of physics: for every action there is sn equal but opposite reaction. For FITs, when withdrawing large bulky devices (large NC balloons, ShockWave, etc) you have to pull harder.

@agtruesdell @mmamas1973 @mirvatalasnag @evandrofilhobr @Hragy @DrAmirKaki @DKarmpaliotis @aspergian1 @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 Come

@agtruesdell @mmamas1973 @mirvatalasnag @evandrofilhobr @Hragy @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @aspergian1 @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 Stent the LM into aorta….should tack it up…Shit happens man…I realized after 20 years….we do our best to keep shit FROM happening…but sometimes we can’t help it….if you do enough cath/pci…it’s inevitable….dont kill yourself over it…

@agtruesdell @mmamas1973 @mirvatalasnag @evandrofilhobr @DrAmirKaki @LAzzaliniMD @DKarmpaliotis @aspergian1 @djc795 @jl35wilsonMD @Babar_Basir @KateKearney4 @SrihariNaiduMD @sbrugaletta @KPujdak @TheNarulaSeries @DrJayMohan @KambisMashayek1 How do you follow up this case?
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