Musa A. Sharkawi Profile picture
Sep 15, 2020 14 tweets 10 min read Read on X
Here are some important interventional cardiology algorithms I've compiled over the past couple of years. The good IC/CTO operator always knows what the next step is. Major credit to @esbrilakis for many of these algorithms. Must think systematically about every PCI. 1/
Very nice algorithm on tough to wire vessels. Important techniques to know: Use of SuperCross (only use 120/they tend to straighten out), Hairpin wiring technique, deflection balloon, and probably most importantly, appropriate wire shape. 2/
A suggested algorithm on use of hemodynamic support in PCI. 3/
Algorithm on treating bifurcation lesions. 4/
Suggested algorithms on treating balloon undilatable (de novo vs ISR) and balloon uncrossable lesions. Those are important to commit to memory. 5/
Complications. In general steps 1 and 2 are to keep calm and to call for help.

How to deal with coronary perforation: Note: Should know how to use coils and fat embo in the cath lab (attached videos). 6/
Causes and management of No Reflow. It is critical to think of the most likely cause and proceed accordingly. 7/
Lastly, it is critical to know how large the stents you implanted can go up to safely. 8/
Types of coronary perforations
CTO algorithms including how to tackle ambiguous proximal caps, impenetrable caps and the different dissection/re-entry strategies.
This is a very helpful algorithm by @TanveerRab et al. on how to treat patients with OHCA vis a vis coronary angiography. #CommonSense
How to treat ISR per @kevinjamescroce's algorithm. Must treat stent under-expansion which is the predominant mechanism in most.

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More from @MusaSharkawiMD

Jan 31, 2021
Step-by-step tweetorial on percutaneous post-infarct VSD closure. Late presenting inferior MI.
Cardiac CT can be very helpful in planning the approach and in noting nearby structures. Here, the defect is quite basal - semilunar valves can disrupted.
1- GA and TEE guidance. Note proximity of the defect to the tricuspid valve.
Read 17 tweets

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