#Sharing is learning When the “Straightforward” Becomes Unpredictable A simple LAD wiring turned unusually complex within 5 minutes—now stuck with no clear way forward. CABG is not the option on the table. What would be your next move? Cases like these remind us: even the simplest plans can test... our skills and judgmentshow more

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Balloon in prox segment only choice initially Interesting to see what u did

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Next move is to hit the pause button. Reassess. Personally I wouldn’t have done this case w a 6F system. It doesn’t look simple to me based on limited angio. A dual injection would’ve been ideal here in my opinion. I would inflate a balloon proximally, inject, and likely pause.

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Please share all of the initial images, including RCA. Cannot make any recommendations with just one angiogram.

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Next move is wait and do echo , its a contained perforation but u have some trickle of flow down the diagonal.. If CABG is prohibitive risk , then fix RCA and try to see whether u can climb upto LAD through septal collaterals ..

I concur with the esteemed interventionists. The course of the LAD differs from the path inadvertently taken by the Whisper MS. Although the LAD CTO segment is relatively short, it is markedly tortuous.

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds LAD perforation. Balloon tamponade.

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Maybe a hidden LAD aneurism instead of a perf. Injection from colaterals (RCA) could help..

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds It didn’t look like a simple LAD wiring to begin with boss!

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds LAD aneurysm perforation due to poking with Gaia II. - Don’t lose calm - Echocardiogram and patient stabilization if needed - Wire to diagonal and maintained inflation with ballon prox to perf - Try to reach distal LAD through true lumen - If all fail, covered stent to diagonal

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Limited images but it appears to me that this is not a "straightforward" OCT. Moreover, there isn´t "straightforwards" OCT. Maybe a 6 Fr cath to begin with is not the best choice, changing it before passing the wire it will help, "hurry up slowly"

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Who thought this was straightforward 😅? It seems a CTO with ambiguous prox cap just at an aneurysm. I would stop, think, dual injections and ivus to start with.

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Straight forward ? DoNotUnderEstimate

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds Had the same experience last wk with CTO did balloon temponade , pericardiocentasis with autotransfusion ..protamine given perforation sealed..

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds @Laserrman @realarainmd

@DrRajeshG1 @iamritu @ACCinTouch @ESC_Journals @MDedgeCardio @SinaiCards @CtoEuro @CoronaryConnect @DAICeditor @CardioNerds