Michael Megaly
@MichaelMegalyMD
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Interventional Cardiologist #CTO #PCI #CLI.Alumnus @MHIF_Heart @HenryFordHealth Aspiring to make a difference
Joined December 2017
Complete revasc but in the legs!.3 vessel below knee CTO-completed with foot flow to heal the wounds. #CardioX
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A wise man once said, its all about the curve you put on the wire. Diagonal wiring attempt 2 minutes didn’t work. Reshape into a new curve, didn’t have time to think 😀
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Is it #HDR or not?.Prox LAD #CTO, Gaia Next III just into cap (I thought), first injection, advance Gaia but a bit much into the body (could not resist) then stopped. Second injection lighted the distal vessel. Gladius into the LAD. @realarainmd .#CardioX
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A lot of work has been done on the impact of #CTO #PCI on LVEF, which I believe is largely due to reversing ischemia and hybernation in true ischemic CM patients. This is most pronounced in LAD CTO PCI patients. Our new paper @AmJCardio studies the impact of Non-LAD CTO PCI on
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It might be subtle differences but sizing might be a bit better using IVUS. I wonder what OCT enthusiasts think.
Which imaging modality optimizes PCI, IVUS or OCT?.We compared mechanical outcomes of coronary stenting using IVUS vs. OCT across 6 RCTs and 2,696 patients. Shoutout to my superstar friend @lshanmukh05 for leading this. @IJCardio .🔗Full paper: 1/4
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Coronary aneurysms lack evidence in how we treat them, pooling the current literature shows surgery used more with LAD with similar mortality to CABG, while PCI has high mortality and used more in RCA. #cardioX.
🚨Our latest study explores outcomes of surgical vs percutaneous revascularization ⚖️ for coronary aneurysms🫀. A rare but critical entity—insights that may guide future management 📚. .#Cardiology #InterventionalCardiology #MedTwitter
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Limb preservation is one of the most rewarding acts in the cath lab!.Older patient presented with worsening bilateral foot wounds, rest pain, and inability to walk for a month. Bilateral SFA long CTOs, and not a good surgical candidate. Left SFA CTO treated with reverse CART.
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RT @DrBIqbal: Introducing the CRISP technique…. Coils are frequently used for therapeutic graft closure to reduce competitive flow followi….
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The importance of support. A Long 150 mm RCA #CTO with a mid-segment 12-year-old stent, tough 90-degree angle of attack proximal cap, and distal cap at the bifurcation. First attempt: radial femoral approach-no pushability antegrade or retrograde-aborted. The 2nd attempt used
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More data to what we already know.
Really important work by @SripalBangalore @JAG24851 @GreggWStone @esbrilakis on the effect of CTOs and revasc on outcomes from the ischemia trial. Link here: Editorial by @ziadalinyc @rallamee here:
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Finally!.Fluid restriction in heart failure is basically BULLSHIT.
One of the most important trials at @ACCinTouch #ACC25 ! Compared fluid restriction to liberal approach in #HeartFailure. Why?. This affects individuals w/HF EVERY DAY! .✨No benefit of Fluid Restriction.✨No HARM for liberal fluid intake.✨Improved QOL in liberal fluid intake
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5- Finally, the best data that stuck with me and probably will affect my practice. Outcomes presented by Taishi Hirai, led by @grantham_aaron. Bringing pt back after STAR at 5-7 weeks had numerically higher success rates compared with 12-14 weeks. My default was 8 weeks, and I
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4-Using DCBs in #CTO #PCI is getting close to reality in the US pending some financial constraints. I always believed it is going to be a great addition in our toolbox and seems like it is picking up in Europe as well based on #EuroCTO data. Excellent talk by @GLGasparini with
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3- The excellent review of knuckling by @RinfretStephane .Understanding how knuckles work and simplifying it with terms as rolling and travelling knuckles, and the explaining the meaning of knuckle behavior change. Complemented by the knuckeology talk @cardiofrizz and how
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When HDR is combined by the mysterious, intriguing technique of #TDADR, data shows success rates through the roof. I had a lot of interest in 3D wiring through angio-guidance, but using live IVUS changes the game. It looks so confusing, but my takeaway is focus on (shaft, tip,
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This year I am late in #my_4_slides on my most important takeaways from #CTO2025. Lots of great stuff and I will start with the intriguing #CTO #PCI techniques I will try in 2025. 1-HDR presentation by @realarainmd .He explains it perfectly, his cases on X are enjoyable. In a
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Friends meet literally from all over the globe at #CTO2025. @evandrofilhobr @jbspadoni @luciotpadilla @jedicath . #CardioX
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