🔹What will be ur approach for this #PCI? 📌Transferred from OSH with this angio. Presented with HF now optimized. 📌82M, significant LMB stenosis, RCA #CTO, LVEF 10-15%, PAD. Turned down for #CABG #CardioTwitter #Cardiology #ACCFIT European Bifurcation Club BCM Cardiology AKUCardiology

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Impella supported pci LMT-LAD. med Rx all else. Try to keep it simple as much as possible. Only clear benefit is likely angina relief. Maybe less HF episodes triggered by ischemia. No mortality benefit in an 82yo as much as you can predict - already past average life expectancy.

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Learning so much from your cases, thank you!

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Thank you. I learn so much for #cardiotwitter friends everyday!

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Impella assisted PCI from LM to LAD with Rota/IVL, Spot stenting of LCX and DEB to ramus

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Great thoughts. Thanks. We do not have DEB yet at our institution.

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @Almanfi_Cardio @evandrofilhobr Upfront MCS. Fix the circ proper first. Dk crush large ramus into Lm-lad. Latter will require atherectomy +\- IVL. In an 82 yo would treat RC medically for now. Quad therapy as hard as you can for HFrEF. All IVI guided of course.

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Stabilise,MCS ,Rota LM,prepare Cx and RI may be DCB -provisional LM LAD

@BifurcationClub @BCMHeart @AkuCardiology @mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Med rx if no angina

@mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr Agree with the surgeons. Will any revascularization change the prognosis. If Angina then needs a convo with the patient

@mmamas1973 @adityadoc1 @Pooh_Velagapudi @JingLiu_MD @minhaskh @BakhshiHooman @HadyLichaaMD @AntoniousAttall @Almanfi_Cardio @evandrofilhobr He has both angina + HF. Had multiple long discussions with the patient & family now plan for high risk PCI (shared decision making). What % risk of major complications would u quote during discussion with the patient?