Case Presentation #1

Size: px
Start display at page:

Download "Case Presentation #1"

Transcription

1 Case Presentation #1 SCAI Fellows Course December 7, 2013 Barry F Uretsky, MD University of Arkansas for Medical Sciences Central Arkansas Veterans Health System Little Rock, AR

2 Case Presentation #1 65 yo M s/p CABG PDA and OM 2007 with both grafts known to be occluded, EtOHism, HTN, DM, LV dysfct (EF 20%). Spent 5 of last 6 months in hospital with resp infection progressing to ARDS. Discharged from hosp 5 weeks PT current admission. Presented with heart failure after 5 wk hx of CCS III angina.

3 Catheterization Findings 95% ostial left main 100% RCA 100% OM 100% SVG to PDA and OM SYNTAX score= 41 STS score= 9.6%

4

5 Aortography performed in preparation of possible PCI with Impella

6 Treatment Plan Reviewed by Heart Team. Surgeons refused to operate primarily because of co morbidities and relative malnutrition.

7 Treatment Plan Reviewed by Heart Team. Reviewed by Heart Team. Surgeons refused to operate primarily because of co morbidities and relative malnutrition. Plan was to perform stenting of left main under LV assist (Impella) support.

8 Impella Insertion Preclose technique utilized for percutaneous closure. Device would not pass easily through iliac artery despite previous angiogram showing patent vessel.

9

10 Impella Insertion Preclose technique utilized for percutaneous closure. Device would not pass easily through iliac artery despite previous angiogram showing patent vessel. Short 14Fr sheath exchanged for 30 cm 14 Fr sheath and Impella passed followed by aortogram from right femoral access to assure no vascular trauma.

11 LM BA under Impella Support

12 3.0x12 mm BA 4.0x12 mm BA 4.0x12 mm EES LM Stenting IVUS: MLA 12.6 mm 2 MLD 4.1 mm

13 Final Result

14 Follow Up 4 mos post PCI: Feeling great! No chest pain, increasing daily activities.

15 Lessons from Case Study CAD patients often have PVD. Prior to Impella insertion, angiography should be used to assure reasonable chance of placement. Be prepared to intervene if there are peripheral complications. Maximize safety net even with easy LM lesions.

16 Case Presentation # 2 SCAI Fellows Course December 7, 2013 Barry F Uretsky, MD University of Arkansas for Medical Sciences Central Arkansas Veterans Health System Little Rock, AR

17 Case Presentation #2 43 yo military veteran with 3 wk hx of exertional CP with minimal exertion. Hx of somatoform pain disorder, requiring cane, for ambulation and use of wheel chair at times. Nuclear stress test : large anteroseptal reversible defect

18 Catheterization Findings 95% bifurcation left main 80% RCA SYNTAX Score= 14 STS Score= 0.2%

19

20 Treatment Plan Reviewed by Heart Team. Surgeons agreed to operate. Pt had LIMA to LAD, SVG to OM, and RIMA to RCA.

21 Follow up Pt was asymptomatic for first 6 mos after CABG but then developed angina for past one month. Meds: ASA 81 mg Metoprolol 50 mg bid ISMN 30 mg qd Simvastatin 40 mg qd Methadone 10 mg tid prn pain

22 Catheterization Findings 95% bifurcation left main 80% RCA LIMA to D1: patent SVG to OM: patent RIMA to PDA: occluded

23

24

25

26

27 Treatment Plan? a) PCI of LM b) PCI of RCA c) PCI of RCA and LM d) Increase Med Rx e) Other

28 Rx Plan: FFR guided PCI

29

30 FFR = 0.84

31 FFR 0.86

32 FFR 0.72

33 Final Result

34 Final Result FFR post PCI= 0.98

35 Lessons from Case Study Patent grafts do not ensure complete revascularization. FFR valuable to determine culprit lesion post CABG.

36

37

38 Case Presentation # 3 SCAI Fellows Course December 7, 2013 Barry F Uretsky, MD University of Arkansas for Medical Sciences Central Arkansas Veterans Health System Little Rock, AR

39 Case Presentation #2 58 yo man without med hx. Recreational cocaine user, last time 3 d PTA. 30 min of severe chest pain. ECG in ambulance showed ST elevation in ant leads. Transmitted to ED. Cath Lab activated. PE: BP 120/100; HR 120/min RR:30/min. Wheezing, in pulm edema. Time sequence: 6:00 ECG in ambulance 6:07 Cath team activated 6:12 Arrival in ED ED Care including intubation 6:57 Arrival in Cath Lab 7:08 Access 7:16 First balloon inflation

40 First Fluoroscopy (7:14)

41 What to Do? Right coronary angiography Immediate balloon angioplasty IABP Impella CABG Other

42 Immediate balloon angioplasty (7:16)

43 After Stenting (LM to Circumflex)

44 Final Result (after FKS and IVUS)

45 RCA

46 ECG in Cath Lab Immediately before PCI 48 min after PCI

47 Follow Up Echo later the same day estimated ejection fraction at 10% Patient maintained BP; in fact, became hypertensive requiring diuretic (then became hypotensive) Heart rate gradually decreased to normal range. Patient extubated 24 hours later

48 Lessons from Case Study 30 50% of patients with ACS from LM die during hospitalization but..

49 Lessons from Case Study 30 50% of patients with ACS from LM die during hospitalization but.. 50% or so can be salvaged.

50 Lessons from Case Study 30 50% of patients with ACS from LM die during hospitalization but.. 50% or so can be salvaged. Time is crucial. Plan strategy to utilize the small window most effectively.

2/26/2013. NCDR.13 Case Scenario Presentation Cath PCI Registry. Disclosures. Objectives. Dashboard Implications of Some Major Metrics

2/26/2013. NCDR.13 Case Scenario Presentation Cath PCI Registry. Disclosures. Objectives. Dashboard Implications of Some Major Metrics NCDR.13 Case Scenario Presentation Cath PCI Registry Dashboard Implications of Some Major Metrics Disclosures Tony Hermann has nothing to disclose Mark Hutcheson has nothing to disclose Cornelia Anderson

More information

STEMI ST Elevation Myocardial Infarction

STEMI ST Elevation Myocardial Infarction STEMI ST Elevation Myocardial Infarction Breakout Session One Moderators: Quinn Capers IV, MD and Scott M. Lilly, MD, PhD Cases Presented by: Umair S. Ahmad, MD 1 Outline 1. Multivessel Revascularization

More information

CCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD. Teo et al, Canadian Journal of Cardiology 2014;30:

CCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD. Teo et al, Canadian Journal of Cardiology 2014;30: CCS/CAIC/CSCS Position Statement on Revascularization Multi-vessel CAD Teo et al, Canadian Journal of Cardiology 2014;30: 1482-1491 Parallel Paper: Canadian Cardiovascular Society Guidelines for the Diagnosis

More information

Antonio Colombo. Centro Cuore Columbus and S. Raffaele Scientific Institute, Milan, Italy. Miracor Symposium. Speaker: 15. Parigi: May 16-19, 2017

Antonio Colombo. Centro Cuore Columbus and S. Raffaele Scientific Institute, Milan, Italy. Miracor Symposium. Speaker: 15. Parigi: May 16-19, 2017 Parigi: May 16-19, 2017 Miracor Symposium Speaker: 15 Antonio Colombo Centro Cuore Columbus and S. Raffaele Scientific Institute, Milan, Italy Nothing to disclose PiCSO Impulse System Elective high risk

More information

J. Schwitter, MD, FESC Section of Cardiology

J. Schwitter, MD, FESC Section of Cardiology J. Schwitter, MD, FESC Section of Cardiology CMR Center of the CHUV University Hospital Lausanne - CHUV Switzerland Centre de RM Cardiaque J. Schwitter, MD, FESC Section of Cardiology CMR Center of the

More information

I Was Too Late With Device Placement

I Was Too Late With Device Placement SCAI SHOCK 2018 A Team-Based Course On Cardiogenic Shock General Session # 2 Saturday, October 13, 2018 8:39 8:51 AM Boston Park Plaza - Boston, MA I Was Too Late With Device Placement M Chadi Alraies,

More information

Stress Echocardiography: Illustrative Cases Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,

More information

New Concepts in Acute Coronary Syndromes Beyond 2000 (XX) Interactive Case Presentations

New Concepts in Acute Coronary Syndromes Beyond 2000 (XX) Interactive Case Presentations New Concepts in Acute Coronary Syndromes Beyond 2000 (XX) Interactive Case Presentations Dr. Richard Bon Surrey Memorial Hospital, Surrey, BC Canadian Cardiovascular Congress 2014 October 26, 2014 Conflicts

More information

ΑΝΤΙΓΝΩΜΙΕΣ ΣΤΗΝ ΕΠΕΜΒΑΤΙΚΗ ΚΑΡΔΙΟΛΟΓΙΑ:Νόσος στελέχους Αγγειοπλαστική

ΑΝΤΙΓΝΩΜΙΕΣ ΣΤΗΝ ΕΠΕΜΒΑΤΙΚΗ ΚΑΡΔΙΟΛΟΓΙΑ:Νόσος στελέχους Αγγειοπλαστική ΑΝΤΙΓΝΩΜΙΕΣ ΣΤΗΝ ΕΠΕΜΒΑΤΙΚΗ ΚΑΡΔΙΟΛΟΓΙΑ:Νόσος στελέχους Αγγειοπλαστική X. ΓΡΑΪΔΗΣ Επεμβατικός καρδιολόγος, FSCAI Kλινική Euromedica-Κυανούς Σταυρός, Θεσσαλονίκη The Fear factor The two words LEFT MAIN

More information

8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes

8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference Dubai: October Acute Coronary Syndromes 8th Emirates Cardiac Society Congress in collaboration with ACC Middle East Conference 2017 OSPEDALE Dubai: 19-21 October 2017 Acute Coronary Syndromes Antonio Colombo Centro Cuore Columbus and S. Raffaele

More information

Cardiologic history. Anamnesis. Female BD Risk factors HTN, DM, Dyslipidaemia. Cardiologic Long history. Last admission Heart failure

Cardiologic history. Anamnesis. Female BD Risk factors HTN, DM, Dyslipidaemia. Cardiologic Long history. Last admission Heart failure Anamnesis Cardiologic history Female BD 29.7.1939 Risk factors HTN, DM, Dyslipidaemia Cardiologic Long history Last admission Heart failure 2004 NSTEMI CX stenosis DES on CX 2012 Acute Pulmonary Oedema

More information

Lessons learned From The National PCI Registry

Lessons learned From The National PCI Registry Lessons learned From The National PCI Registry w a v e On Behalf of The Publication Committee of the National PCI Registry Objectives & Anticipated Achievements To determine the epidemiology of patients

More information

Coronary stenting: the appropriate use of FFR

Coronary stenting: the appropriate use of FFR Coronary stenting: the appropriate use of FFR Morton J. Kern, MD Professor of Medicine Chief of Cardiology LBVA Associate Chief Cardiology University California Irvine Orange, California To treat or not

More information

Complicated PTCA of Left Main Total Occlusion in NSTEMI

Complicated PTCA of Left Main Total Occlusion in NSTEMI Complicated PTCA of Left Main Total Occlusion in NSTEMI Dr AM Thirugnanam MD, FSCAI, PhD Sr. Interventional Cardiologist Ipcard Cardiac Care Center, Hyderabad, India Disclosure Statement of Financial Interest

More information

Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome

Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Surgical vs. Percutaneous Revascularization in Patients with Diabetes and Acute Coronary Syndrome Chris C. Cook, MD Associate Professor of Surgery Director, CT Residency Program, WVU ACOI 10/17/18 No Disclosures

More information

Interventions in the Elderly

Interventions in the Elderly Interventions in the Elderly Satya Reddy Atmakuri MD FIFTH ANNUAL SYMPOSIUM I Have No Financial Interest to Disclose People greater than 65 years of age will increase from 12% of population in 2000 to

More information

CASE from South Korea

CASE from South Korea CASE from South Korea Bon-Kwon Koo, MD, PhD, Seoul, Korea Outpatient clinic of a non-interventional cardiologist F/56 Chief complaint: Angina with recent aggravation, CCS II~III Brief history: # Stroke

More information

David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio

David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine The Ohio State University Division of Cardiovascular Medicine Columbus, Ohio 1 STABLE ISCHEMIC HEART DISEASE: A NON-INVASIVE CARDIOLOGIST S PERSECTIVE 2018 Cardiovascular Course for Trainees and Early Career Physicians APRIL 20, 2018 David A. Orsinelli, MD, FACC, FASE Professor,

More information

Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users

Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users Use of Nuclear Cardiology in Myocardial Viability Assessment and Introduction to PET and PET/CT for Advanced Users February 1 5, 2011 University of Santo Tomas Hospital Angelo King A-V Auditorium Manila,

More information

Bifurcation stenting with BVS

Bifurcation stenting with BVS Bifurcation stenting with BVS Breaking the limits or just breaking the struts? Maciej Lesiak Department of Cardiology University Hospital in Poznan, Poland Disclosure Speaker s name: Maciej Lesiak I have

More information

National Intervention Council

National Intervention Council National Intervention Council Cardiological Society of India Registry Performa for Coronary, Non- Coronary & Peripheral Interventions Period January 1st 2016 to December 31 st 2016 Dr. (Prof.) N.N. Khanna

More information

That unprotected LM: To STENT or NOT to STENT. Vasilios Papademetriou, MD Professor of Medicine Georgetown University

That unprotected LM: To STENT or NOT to STENT. Vasilios Papademetriou, MD Professor of Medicine Georgetown University That unprotected LM: To STENT or NOT to STENT Vasilios Papademetriou, MD Professor of Medicine Georgetown University Vasilios Papademetriou, MD I have no relevant financial relationships Patients are complicated

More information

Difficult Data Definitions and Scenario s

Difficult Data Definitions and Scenario s Difficult Data Definitions and Scenario s Presenter Disclosure Information Cornelia Anderson BSN, RN To following relationships exist related to this presentation: No Disclosures Objectives Discuss key

More information

Excimer Laser for Coronary Intervention: Case Study RADIAL APPROACH: CORONARY LASER ATHERECTOMY FOR CTO OF THE LAD FOLLOWED BY PTCA NO STENTING

Excimer Laser for Coronary Intervention: Case Study RADIAL APPROACH: CORONARY LASER ATHERECTOMY FOR CTO OF THE LAD FOLLOWED BY PTCA NO STENTING Excimer Laser for Coronary Intervention: Case Study RADIAL APPROACH: CORONARY LASER ATHERECTOMY FOR CTO OF THE LAD FOLLOWED BY PTCA NO STENTING 1 2013 Spectranetics. All Rights Reserved. Approved for External

More information

Coronary interventions

Coronary interventions Controversial issues in the management of ischemic heart failure Coronary interventions Maciej Lesiak Department of Cardiology, University Hospital in Poznan none DECLARATION OF CONFLICT OF INTEREST CHF

More information

Post-Procedure Care and Same-Day PCI. Arnold Seto, MD, MPA

Post-Procedure Care and Same-Day PCI. Arnold Seto, MD, MPA Post-Procedure Care and Same-Day PCI Arnold Seto, MD, MPA Post-Procedure Care Success of radial program depends upon effective access site management Training of staff critical to increase comfort with

More information

Percutaneous Coronary Intervention: Update

Percutaneous Coronary Intervention: Update Percutaneous Coronary Intervention: Update Alphonse M. Ambrosia, DO, FACC Interventional Cardiologist CardioVascular Associates of Mesa Mesa, Arizona Disclosures Speakers Bureau Boston Scientific Medtronics

More information

NCDR CathPCI Registry v4.4 Diagnostic Catheterization and Percutaneous Coronary Intervention Registry

NCDR CathPCI Registry v4.4 Diagnostic Catheterization and Percutaneous Coronary Intervention Registry A. DEMOGRAPHICS Last Name 2000 : First Name 2010 : Middle Name 2020 : SSN 2030 : - - - SSN N/A 2031 Patient ID 2040 : (auto) Other ID 2045 : Birth Date 2050 : *** @ Sex 2060 : *** @ O Male O Female Race:

More information

Fractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center

Fractional Flow Reserve: Basics, FAME 1, FAME 2. William F. Fearon, MD Associate Professor Stanford University Medical Center Fractional Flow Reserve: Basics, FAME 1, FAME 2 William F. Fearon, MD Associate Professor Stanford University Medical Center Conflict of Interest Advisory Board for HeartFlow Research grant from St. Jude

More information

Flexibility of the COMBO Dual Therapy Stent

Flexibility of the COMBO Dual Therapy Stent TM CaseSpotlight Flexibility of the COMBO Dual Therapy Stent Doctor Peter den Heijer is an of the Catheterization Laboratory at the Department of Cardiology of the Amphia Ziekenhuis, Breda, The Netherlands.

More information

Cardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology

Cardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations

More information

Percutaneous Coronary Interventions Without On-site Cardiac Surgery

Percutaneous Coronary Interventions Without On-site Cardiac Surgery Percutaneous Coronary Interventions Without On-site Cardiac Surgery Hassan Al Zammar, MD,FESC Consultant & Interventional Cardiologist Head of Cardiology Department European Gaza Hospital Palestine European

More information

LM stenting - Cypher

LM stenting - Cypher LM stenting - Cypher Left main stenting with BMS Since 1995 Issues in BMS era AMC Restenosis and TLR (%) 3 27 TLR P=.282 Restenosis P=.71 28 2 1 15 12 Ostium 5 4 Shaft Bifurcation Left main stenting with

More information

Chronic Total Occlusion: A case for coronary artery bypass grafting

Chronic Total Occlusion: A case for coronary artery bypass grafting Chronic Total Occlusion: A case for coronary artery bypass grafting Prof. Alfredo R Galassi MD, FESC, FACC, FSCAI Director of Cardiac Catheterization and Interventional Cardiology Unit Department of Medical

More information

FFR vs icecg in Coronary Bifurcations FIESTA ClinicalTrials.gov Identifier: NCT

FFR vs icecg in Coronary Bifurcations FIESTA ClinicalTrials.gov Identifier: NCT FFR vs icecg in Coronary Bifurcations FIESTA ClinicalTrials.gov Identifier: NCT01724957 Dobrin Vassilev MD, PhD Assoc. Prof. in Cardiology Head Cardiology Clinic, Alexandrovska University Hospital Medical

More information

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy

Le# main treatment with Stentys stent. Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Le# main treatment with Stentys stent Carlo Briguori, MD, PhD Clinica Mediterranea Naples, Italy Disclosure Statement of Financial Interest I, Carlo Briguori DO NOT have a financial interest/ arrangement

More information

Stable Angina: Indication for revascularization and best medical therapy

Stable Angina: Indication for revascularization and best medical therapy Stable Angina: Indication for revascularization and best medical therapy Cardiology Basics and Updated Guideline 2018 Chang-Hwan Yoon, MD/PhD Cardiovascular Center, Department of Internal Medicine Bundang

More information

Quinn Capers, IV, MD

Quinn Capers, IV, MD Heart Attacks Mended Hearts Presentation, January, 2017 Quinn Capers, IV, MD Associate Professor of Medicine (Cardiovascular Medicine) Director, Transradial Coronary Interventions Division of Cardiovascular

More information

Percutaneous coronary intervention of RIMA. The real challenge!

Percutaneous coronary intervention of RIMA. The real challenge! Percutaneous coronary intervention of RIMA The real challenge! Speaker's name: I do not have any potential conflict of interest Clinical Case 76-year old woman Previous History Actual Disease Diabetes

More information

Clopidogrel and ASA after CABG for NSTEMI

Clopidogrel and ASA after CABG for NSTEMI Clopidogrel and ASA after CABG for NSTEMI May 17, 2007 Justin Lee Pharmacy Resident University Health Network Objectives At the end of this session, you should be able to: Explain the rationale for antiplatelet

More information

Managing the Low Output Low Gradient Aortic Stenosis Patient

Managing the Low Output Low Gradient Aortic Stenosis Patient Managing the Low Output Low Gradient Aortic Stenosis Patient R A Nishimura MD Judd and Mary Leighton Professor of CV Mayo Clinic No disclosures Valvular Stenosis Severity of Aortic Stenosis Mean gradient

More information

Benefit of Performing PCI Based on FFR

Benefit of Performing PCI Based on FFR Benefit of Performing PCI Based on FFR William F. Fearon, MD Associate Professor Director, Interventional Cardiology Stanford University Medical Center Benefit of FFR-Guided PCI FFR-Guided PCI vs. Angiography-Guided

More information

Fractional Flow Reserve. A physiological approach to guide complex interventions

Fractional Flow Reserve. A physiological approach to guide complex interventions Fractional Flow Reserve A physiological approach to guide complex interventions What is FFR? Fractional Flow Reserve (FFR) is a lesion specific, physiological index determining the hemodynamic severity

More information

Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)?

Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Cronicon OPEN ACCESS CARDIOLOGY Case Report Left Main Stenosis. Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft Surgery (CABG)? Valentin Hristov* Department of Cardiology, Specialized

More information

Unprotected LM intervention

Unprotected LM intervention Unprotected LM intervention Guideline for COMBAT Seung-Jung Park, MD, PhD Professor of Internal Medicine, Seoul, Korea Current Recommendation for unprotected LMCA Stenosis Class IIb C in ESC guideline

More information

Coronary Artery Disease: Revascularization (Teacher s Guide)

Coronary Artery Disease: Revascularization (Teacher s Guide) Stephanie Chan, M.D. Updated 3/15/13 2008-2013, SCVMC (40 minutes) I. Objectives Coronary Artery Disease: Revascularization (Teacher s Guide) To review the evidence on whether percutaneous coronary intervention

More information

Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!

Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,

More information

What oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor

What oral antiplatelet therapy would you choose? a) ASA alone b) ASA + Clopidogrel c) ASA + Prasugrel d) ASA + Ticagrelor 76 year old female Prior Hypertension, Hyperlipidemia, Smoking On Hydrochlorothiazide, Atorvastatin New onset chest discomfort; 2 episodes in past 24 hours Heart rate 122/min; BP 170/92 mm Hg, Killip Class

More information

Assessing Myocardium at Risk: Applying SYNTAX

Assessing Myocardium at Risk: Applying SYNTAX Assessing Myocardium at Risk: Applying SYNTAX Farouc Jaffer MD PhD FSCAI FACC FAHA Associate Professor of Medicine, Harvard Medical School Director, CAD Program and Chronic Total Occlusion PCI Program

More information

Percutaneous Mechanical Circulatory Support Devices

Percutaneous Mechanical Circulatory Support Devices Percutaneous Mechanical Circulatory Support Devices Daniel Vazquez RN, RCIS Miami Cardiac & Vascular Institute FINANCIAL DISCLOSURES none CASE STUDY CASE STUDY 52 year old gentlemen Complaining of dyspnea

More information

Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after

Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after Multiple PCI of SVG-LAD and SVG-OM graft vessel in a Bangladeshi patient starting 7 years after CABG with and without distal Protection Device Shahabuddin Talukder MBBS, FCPS, D.card Consultant Cardiologist

More information

Between Coronary Angiography and Fractional Flow Reserve

Between Coronary Angiography and Fractional Flow Reserve Visual-Functional Mismatch Between Coronary Angiography and Fractional Flow Reserve Seung-Jung Park, MD., PhD. University of Ulsan, College of Medicine Asan Medical Center, Seoul, Korea Visual - Functional

More information

Catheter selection for transradial angiography and intervention

Catheter selection for transradial angiography and intervention Catheter selection for transradial angiography and intervention Sandeep Nathan, MD, MSc, FACC, FSCAI Assistant Professor of Medicine Director, Interventional Cardiology Fellowship Program Director, Interventional

More information

Current Management of Coronary Artery Disease with Special Emphasis on the Elderly and Diabetic

Current Management of Coronary Artery Disease with Special Emphasis on the Elderly and Diabetic Current Management of Coronary Artery Disease with Special Emphasis on the Elderly and Diabetic Dr Albert Ko FRACP, FCSANZ Interventional Cardiologist Ascot Angiography Auckland, New Zealand Diagnosis

More information

Case Presentations TAVR: The Good Bad and The Ugly

Case Presentations TAVR: The Good Bad and The Ugly Case Presentations TAVR: The Good Bad and The Ugly Vincent J. Pompili, MD, FACC, FSCAI Professor of Internal Medicine Director of Interventional Cardiovascular Medicine and Cardiac Catheterization Laboratories

More information

What do the guidelines say?

What do the guidelines say? Percutaneous coronary intervention in 3-vessel disease and main stem What do the guidelines say? Nothing to disclose Dariusz Dudek Institute of Cardiology, Jagiellonian University Krakow, Poland The European

More information

Robotic & Hybrid Coronary Revascularization

Robotic & Hybrid Coronary Revascularization Robotic & Hybrid Coronary Revascularization Michael Chu, MD, FRCSC Associate Professor of Surgery Western University, London Health Sciences Centre, London, ON, Canada Saudi Heart Association 2017 Riyadh,

More information

APPENDIX F: CASE REPORT FORM

APPENDIX F: CASE REPORT FORM APPENDIX F: CASE REPORT FORM Instruction: Complete this form to notify all ACS admissions at your centre to National Cardiovascular Disease Registry. Where check boxes are provided, check ( ) one or more

More information

ROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE

ROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE ROLE OF CORONARY PRESSURE & FFR IN MULTIVESSEL DISEASE Angioplasty Summit TCT ASIA Seoul, Korea, april 24th, 2008 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands A rather common

More information

Paris, August 28 th Gian Paolo Ussia on behalf of the CoreValve Italian Registry Investigators

Paris, August 28 th Gian Paolo Ussia on behalf of the CoreValve Italian Registry Investigators Paris, August 28 th 2011 Is TAVI the definitive treatment in high risk patients? Impact Of Coronary Artery Disease In Elderly Patients Undergoing TAVI: Insight The Italian CoreValve Registry Gian Paolo

More information

2/26/2013. Appropriateness Use Criteria (Drilldown) Disclosures. Tony Hermann has nothing to disclose. Mark Hutcheson has nothing to disclose

2/26/2013. Appropriateness Use Criteria (Drilldown) Disclosures. Tony Hermann has nothing to disclose. Mark Hutcheson has nothing to disclose Appropriateness Use Criteria (Drilldown) Disclosures Tony Hermann has nothing to disclose Mark Hutcheson has nothing to disclose Connie Anderson has nothing to disclose Issam Moussa has nothing to disclose

More information

Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium. Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute

Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium. Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute Cardiac Viability Testing A Clinical Perspective Annual Cardiac Imaging Symposium Lisa M Mielniczuk MD FRCPC University of Ottawa Heart Institute 62 year old male Anterior STEMI late presentation, occluded

More information

Patient with low-flow low-gradient aortic stenosis and ischemic cardiomyopathy TAVR and possibly percutaneous revascularization

Patient with low-flow low-gradient aortic stenosis and ischemic cardiomyopathy TAVR and possibly percutaneous revascularization Patient with low-flow low-gradient aortic stenosis and ischemic cardiomyopathy TAVR and possibly percutaneous revascularization + K Spargias, MD, PhD THV Director Hygeia Hospital Disclosures - Proctor

More information

Case Review: Borderline LM with IVUS and FFR. Ravi Ramana, DO Heart Care Centers of Illinois SCAI Annual Conference 2010

Case Review: Borderline LM with IVUS and FFR. Ravi Ramana, DO Heart Care Centers of Illinois SCAI Annual Conference 2010 Case Review: Borderline LM with IVUS and FFR Ravi Ramana, DO Heart Care Centers of Illinois SCAI Annual Conference 2010 Disclosures No relevant disclosures. Borderline Left Main Disease Significant LMS

More information

Ventricular Arrhythmias

Ventricular Arrhythmias Presenting your most challenging cases Venice Arrhythmias Ventricular Arrhythmias Gioia Turitto, MD Presenter Disclosure Information A questionable indication for CRT-D in a patient with VT after successful

More information

Frans Van de Werf, MD, PhD Leuven, Belgium

Frans Van de Werf, MD, PhD Leuven, Belgium STEMI Cases and the ESC STEMI Guidelines Frans Van de Werf, MD, PhD Leuven, Belgium The Easy Case 2/21/2011 History and Risk Factors 50-year old male patient Past medical history: Teratoma right testis

More information

ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions

ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Julinda Mehilli, MD Deutsches Herzzentrum Technische Universität Munich Germany ISAR-LEFT MAIN: A Randomized Clinical Trial on Drug-Eluting Stents for Unprotected Left Main Lesions Background Left main

More information

Left Main Intervention: Will it become standard of care?

Left Main Intervention: Will it become standard of care? Left Main Intervention: Will it become standard of care? David Cox, MD FSCAI, FACC Director, Interventional Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown,

More information

New Jersey Cardiac Catheterization Data Registry, Version 2.0 (Please report data only for patients 16 years or older.)

New Jersey Cardiac Catheterization Data Registry, Version 2.0 (Please report data only for patients 16 years or older.) A. ADMINISTRATIVE New Jersey Cardiac Catheterization Data Registry, Version 2.0 (Please report data only for patients 16 years or older.) 1. Facility Code: 2. Facility Name: 3. Procedure Type (Choose only

More information

NCVD-PCI Registry. Percutaneous Coronary Intervention (PCI) Registry, MALAYSIA c/o National Heart Association of Malaysia

NCVD-PCI Registry. Percutaneous Coronary Intervention (PCI) Registry, MALAYSIA c/o National Heart Association of Malaysia NCVD-PCI Registry National Cardiovascular Disease Database (NCVD) National Cardiovascular Disease Database (NCVD) Percutaneous Coronary Intervention (PCI) Registry, MALAYSIA c/o National Heart Association

More information

Percutaneous Intervention of Unprotected Left Main Disease

Percutaneous Intervention of Unprotected Left Main Disease Percutaneous Intervention of Unprotected Left Main Disease Technical feasibility and Clinical outcomes Seung-Jung Park, MD, PhD, FACC Professor of Internal Medicine Asan Medical Center, Seoul, Korea Unprotected

More information

Preoperative Cardiac Risk Assessment: Approach & Guidelines

Preoperative Cardiac Risk Assessment: Approach & Guidelines Preoperative Cardiac Risk Assessment: Approach & Guidelines By, Liam Morris, MD., FACC (02/03/18) CPG : Clinical Practice Guidelines GDMT : Guidelines Directed Medical Therapy GWC : Guideline Writing Committee

More information

Form 4: Coronary Evaluation

Form 4: Coronary Evaluation Form : Coronary Evaluation Print this Form t Started Date of Coronary Evaluation Coronary Evaluation Indication for Coronary Evaluation Check only one. Angio NOT DONE: n invasive test performed Followup

More information

Cardiogenic Shock in Acute MI

Cardiogenic Shock in Acute MI Cardiogenic Shock in Acute MI Mark Sheldon, MD UNMH Interventional Cardiology Objectives Overview Treatment Definition Shock profiles Causes Medical Mechanical Illustrative case Questions? Revascularization

More information

Disclosures. Inpatient Management of Non-ST Elevation Acute Coronary Syndromes. Edward McNulty MD, FACC. None

Disclosures. Inpatient Management of Non-ST Elevation Acute Coronary Syndromes. Edward McNulty MD, FACC. None Inpatient Management of Non-ST Elevation Acute Coronary Syndromes Edward McNulty MD, FACC Assistant Clinical Professor UCSF Director, SF VAMC Cardiac Catheterization Laboratory Disclosures None New Guidelines

More information

Revascularization Strategies in Patients with Severe LV Dysfunction

Revascularization Strategies in Patients with Severe LV Dysfunction Revascularization Strategies in Patients with Severe LV Dysfunction Richard Lee, M.D., M.B.A. Saint Louis University The Center for Comprehensive Cardiovascular Care C4 Severe LV Dysfunction Defined as

More information

Stress Echo Cases Sunday, October 8, :10 3:30 PM 20 min

Stress Echo Cases Sunday, October 8, :10 3:30 PM 20 min 2017 ASE Echo Florida, Orlando, FL Stress Echo Cases Sunday, October 8, 2016 3:10 3:30 PM 20 min 1 M U H A M E D S A R I Ć, M D, P H D D i r e c t o r o f E c h o c a r d i o g r a p h y L a b A s s o

More information

Count Down to COMBAT

Count Down to COMBAT Count Down to COMBAT Randomized COMparison of Bypass Surgery versus AngioplasTy using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease Roxana Mehran, MD Associate Professor of

More information

Rationale for Left Ventricular Support During Percutaneous Coronary Intervention

Rationale for Left Ventricular Support During Percutaneous Coronary Intervention Rationale for Left Ventricular Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Associate Professor, Division of Cardiology Director, Acute Circulatory Support Program

More information

Richard Grocott Mason

Richard Grocott Mason Richard Grocott Mason What to do with a 50 year old man with chest pain? Does the pain sound cardiac? Is this a possible acute coronary syndrome? Does patient have a previous cardiac history? Natural history

More information

Version 4.4. Institutional Outcomes Report 2014Q3. National Outcomes Report Aggregation Date: Jan 12, :59:59 PM

Version 4.4. Institutional Outcomes Report 2014Q3. National Outcomes Report Aggregation Date: Jan 12, :59:59 PM Version 4.4 Institutional Outcomes Report 2014Q3 National Outcomes Report 999997 Aggregation Date: Jan 12, 2015 11:59:59 PM Publish Date: Jan 29, 2015 If User desires to publish or otherwise distribute

More information

Controversies in Coronary Revascularization. Atlanta CCU April 15, 2016

Controversies in Coronary Revascularization. Atlanta CCU April 15, 2016 Controversies in Coronary Revascularization Atlanta CCU April 15, 2016 Habib Samady MD FACC FSCAI Professor of Medicine Director, Interventional Cardiology, Emory University Director, Cardiac Catheterization

More information

Surgery Interesting Cases

Surgery Interesting Cases Stanford Division of Vascular Surgery Interesting Cases 11/15/2010 Vascular Surgery HPI: 57yoM h/o HTN, HLD, tobacco use, anxiety, and family hx of ruptured AAA. Developed sudden onset severe abdominal

More information

Left Main Intervention: Where are we in 2015?

Left Main Intervention: Where are we in 2015? Left Main Intervention: Where are we in 2015? David A. Cox, MD FSCAI Director, Cardiology Research Associate Director, Cardiac Cath Lab Lehigh Valley Health Network Allentown, PA Fall Fellows Course Laa

More information

MULTIVESSEL PCI. IN DRUG-ELUTING STENT RESTENOSIS DUE TO STENT FRACTURE, TREATED WITH REPEAT DES IMPLANTATION

MULTIVESSEL PCI. IN DRUG-ELUTING STENT RESTENOSIS DUE TO STENT FRACTURE, TREATED WITH REPEAT DES IMPLANTATION MULTIVESSEL PCI. IN DRUG-ELUTING STENT RESTENOSIS DUE TO STENT FRACTURE, TREATED WITH REPEAT DES IMPLANTATION C. Graidis, D. Dimitriadis, A. Ntatsios, V. Karasavvides Euromedica Kyanous Stavros, Thessaloniki.

More information

was admitted to the Cardiology Service at the from Y /M /D to Y / M / D under the care of Dr..

was admitted to the Cardiology Service at the from Y /M /D to Y / M / D under the care of Dr.. Patient: was admitted to the Cardiology Service at the from Y /M /D to Y / M / D under the care of Dr.. Discharge Diagnoses include: q CAD-CCS Class: m 0 m 1 m 2 m 3 m 4 q Unstable angina q Non STEMI (non-st

More information

Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease

Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease Impact of Angiographic Complete Revascularization after Drug-Eluting Stent Implantation or Coronary Artery Bypass Surgery for Multivessel Coronary Disease Young-Hak Kim, Duk-Woo Park, Jong-Young Lee, Won-Jang

More information

CABG for ischemic cardiomyopathy, post myocardial infarction and cardiogenic shock

CABG for ischemic cardiomyopathy, post myocardial infarction and cardiogenic shock CABG for ischemic cardiomyopathy, post myocardial infarction and cardiogenic shock Yoshiya Toyoda, MD, PhD William Maul Measey Professor of Surgery Chief, Cardiovascular Surgery Surgical Director, Mechanical

More information

Who is the high risk patient?

Who is the high risk patient? Who is the high risk patient? High risk of periprocedural death or other major complications (hemodynamic compromise, MI, stroke, dialysis) Contributors of Risk Lesion/Procedure Governed by 1. Patient

More information

Lésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille

Lésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille Lésions du tronc commun: Reste t il une place pour la chirugie? Pierre Deharo, CHU TIMONE, Marseille Disclosure Statement of Financial Interest I currently have, or have had over the last two years, an

More information

OCT guidance for distal LM lesions

OCT guidance for distal LM lesions OCT guidance for distal LM lesions FRANCESCO BURZOTTA INSTITUTE OF CARDIOLOGY CATHOLIC UNIVERSITY OF THE SACRED HEART ROME, ITALY LM suitability for OCT At FU in stented LM Parodi G et al. Eurointervention

More information

Form 4: Coronary Evaluation

Form 4: Coronary Evaluation Patient Details Hidden Show Show/Hide Annotations Form : Coronary Evaluation Print this Form t Started Date of Coronary Evaluation Coronary Evaluation Indication for Coronary Evaluation Check only one.

More information

Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention

Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention Clinical Appropriateness Guidelines: Percutaneous Coronary Intervention Appropriate Use Criteria Effective Date: January 2, 2018 Proprietary Date of Origin: 08/27/2015 Last revised: 08/01/2017 Last reviewed:

More information

FRACTIONAL FLOW RESERVE: STANDARD OF CARE

FRACTIONAL FLOW RESERVE: STANDARD OF CARE FRACTIONAL FLOW RESERVE: FROM INVESTIGATIONAL TOOL TO STANDARD OF CARE TCT ASIA Seoul, Korea, april 26 th, 2012 Nico H. J. Pijls, MD, PhD Catharina Hospital, Eindhoven, The Netherlands FRACTIONAL FLOW

More information

Clinical case in perspective. Cases from Poland

Clinical case in perspective. Cases from Poland Clinical case in perspective Cases from Poland Assoc. Prof. Jacek Legutko, MD, PhD President-Elect of the Association for Percutaneous Cardiovascular Interventions of the Polish Cardiac Society Institute

More information

Stable Ischemic Heart Disease. Ivan Anderson, MD RIHVH Cardiology

Stable Ischemic Heart Disease. Ivan Anderson, MD RIHVH Cardiology Stable Ischemic Heart Disease Ivan Anderson, MD RIHVH Cardiology Outline Review of the vascular biology of atherosclerosis Why not just cath everyone with angina? Medical management of ischemic cardiomyopathy

More information

TEE guided TAVR using BASILICA technique in patient with stenotic Freestyle aortic bioprosthesis

TEE guided TAVR using BASILICA technique in patient with stenotic Freestyle aortic bioprosthesis TEE guided TAVR using BASILICA technique in patient with stenotic Freestyle aortic bioprosthesis Zuyue Wang MD Associate professor, Georgetown University School of Medicine MedStar Heart and Vascular Institute

More information

Rationale for Prophylactic Support During Percutaneous Coronary Intervention

Rationale for Prophylactic Support During Percutaneous Coronary Intervention Rationale for Prophylactic Support During Percutaneous Coronary Intervention Navin K. Kapur, MD, FACC, FSCAI Assistant Director, Interventional Cardiology Director, Interventional Research Laboratories

More information

2017 Cardiology Survival Guide

2017 Cardiology Survival Guide 2017 Cardiology Survival Guide Chapter 4: Cardiac Catheterization/Percutaneous Coronary Intervention A cardiac catheterization involves a physician inserting a thin plastic tube (catheter) into an artery

More information

CABG Surgery following STEMI

CABG Surgery following STEMI CABG Surgery following STEMI Susana Harrington, MS,APRN-NP Cardio-Thoracic Surgery Nebraska Methodist Hospital February 15, 2018 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction:

More information