Thank you very much ❤ that will be great if you share the follow up, specially the improvement of EF and also inform us whether you candidate the patient for TAVR. Thank you.
Great question: the culprit in this case appeared to be the left main. Also PCI of the RCA might could require retrograde crossing which would not be feasible. This might be a consideration in the future depending on the patient's clinical course.
Great case as usual Dr. Brilakis. I am wondering was myocardial viability evaluated by any means before the procedure and for what extent did the EF improved after PCI?
Was there any consideration of balloon/IVL the left Iliac before PCI w Impella and then stenting on the way out? You wound up going left femoral anyway. I struggle sometimes with deciding when to do peripheral intervention instead of axillary. Great result!
Excellent point - femoral access and treating the iliac lesions was discussed with the vascular surgery team who thought that axillary would likely be safer, but IVL of the iliac might have worked as well.
It is not - if critical aortic stenosis is present aortic valvuloplasty may be needed - in most cases the Impella can be inserted without aortic valvuloplasty.
Great point - this was discussed with the valve team: mean gradient was only 8 mmHg hence the main source of the problems was considered to be the left main lesion. They are willing to consider TAVR in the future depending on clniical course.
Thank you, Matheus Silva
A great case. Congratulations!
Just impressive as always. Thanks for sharing
Thank you very much ❤ that will be great if you share the follow up, specially the improvement of EF and also inform us whether you candidate the patient for TAVR. Thank you.
Thanks for the excellent case sharing.
Why not CTO-RCA first? Thanks for the case.
Great question: the culprit in this case appeared to be the left main. Also PCI of the RCA might could require retrograde crossing which would not be feasible. This might be a consideration in the future depending on the patient's clinical course.
So impressing case
Very impressing
Great case as usual Dr. Brilakis.
I am wondering was myocardial viability evaluated by any means before the procedure and for what extent did the EF improved after PCI?
Was there any consideration of balloon/IVL the left Iliac before PCI w Impella and then stenting on the way out? You wound up going left femoral anyway. I struggle sometimes with deciding when to do peripheral intervention instead of axillary. Great result!
Excellent point - femoral access and treating the iliac lesions was discussed with the vascular surgery team who thought that axillary would likely be safer, but IVL of the iliac might have worked as well.
Thanks for sharing such case! How long did the balloon hemostasis take?
10 min
Is Aortic stenosis not a contraindications for Impella?
It is not - if critical aortic stenosis is present aortic valvuloplasty may be needed - in most cases the Impella can be inserted without aortic valvuloplasty.
Would tavr first be a better option? We have seen some cases where tavr has improved ef instantly due to better output and Lv geometry.
Great point - this was discussed with the valve team: mean gradient was only 8 mmHg hence the main source of the problems was considered to be the left main lesion. They are willing to consider TAVR in the future depending on clniical course.
Sir have you ever tried Temporal artery?
Not sure what you mean by temporal artery - for access? No, I have not.
@@manosbrilakis for patients with poor l or absent peripheral arteries for diagnostic or interventional purposes.