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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

Rodrigo V. Wainstein, MD, PhD

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18,815 views • 2 years ago •via X (Twitter)

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8 Comments

Rodrigo V. Wainstein, MD, PhD2 years ago

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

Jeffrey Wilson, MD2 years ago

@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.

Alex Truesdell2 years ago

@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):

MIЯVΛƬ #IC2 years ago

@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

Jack Hall2 years ago

@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.

Lorenzo Azzalini2 years ago

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

Pramod V Menon2 years ago

@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…

Hany Ragy2 years ago

@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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