Doing solo-operator ROTAPRO .(rotational atherectomy). STARTING POSITION (after testing & adjusting burr speed):. Dynaglide ON, wire inside clip inside “brake defeat slot” (make sure to insert clip while pressing black button). #RadialFirst

Simultaneous SCAD + TAKOTSUBO. SCAD-subo or tako-SCAD —. which came first ?? 👀. 60F w/ NSTEMI. Echo ➡️ takotsubo.Angio ➡️ prob SCAD of ramus. note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout). @rajivxgulati

During difficult delivery in crazy RCA (👇🏼), stent got stuck but stent balloon catheter pushed few mms farther downstream. ➡️ Most of stent deployed (albeit undersized👇🏼) BUT proximal end un-deployed (👇🏼). Not apparent b/c NO imaging ….until recurrent STEMI 3 wks later 👀

ANSWER:. Undersized AND partially undeployed. See next 👇🏼 for details. @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag.

RT @RSohnMD: 1/ Step-by-step. “CORONARY FUNCTION TESTING” for #ANOCA #INOCA . PREPARATION:. 1. Hold all vasodilators for 48 hours (exceptio….

What an UNDERSIZED STENT looks like by #OCT 👀 . 👇🏼👇🏼👇🏼

Intra-plaque hemorrhage (IPH). — involving 12 mm of LAD ostium. — another great example showing #OCT’s ability to clarify ACS mechanism

Always consider #ANOCA . 50M w/ debilitating episodes of “atypical” CP at rest. Non-exertional. ➡️ normal vasodilator nuclear stress. Before & after acetylcholine 👇🏼 👀. #coronaryvasospasm

The LADD OSTIAL Lesion 👀. ➡️ perfect target for #DCB?. 60 yo man w/ NSTEMI . IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs. 👇🏼👇🏼👇🏼. Cutting balloon + 3.5 mm DCB (75 s)

Ok, I’ll end the suspense —. ⬇️. ic NTG solves the riddle 👀. Amazing case of severe coronary #vasospasm true #Printzmetal

60 yo woman w/ acute severe CP. EKG & cath below 👇🏼👇🏼👇🏼. How would you approach this?. #CardioTwitter #STEMI

DES ➡️ MSA 8.6 mm2

Sometimes cutting balloon is enough for CALCIUM NODULE (non-eruptive MLA 1.4 mm2). OCT pre- & post CB 👀.➡️ good expansion MLA 7.8 mm2. See next for DES result 👇🏼👇🏼

5/ Association of MB w/ spasm & CMD. #CardioTwitter #vasospasm #CMD #microvascular #MyocardialBridge #ANOCA #MINOCA @mirvatalasnag

4/ Reference:.

3/ IMPORTANTLY 👇🏼👇🏼👇🏼 . ** Most MBs cause diastolic restriction and/or neg remodeling (ref👇🏼). CASE:. 50 yo athlete ➡️ angina 2 yrs. MB w/ “fixed” narrowing (cath👇🏼). CCTA & IVUS (see👇🏼) confirm no plaque / dissection. Dobut RFR = 0.72 (nl > 0.76). 🔪 unroofing ➡️ CP-free

2/ MYOCARDIAL BRIDGES (MBs). MINOCA mechanisms:. - Proximal atherosclerosis ➡️ plaque erosion or rupture.- Coronary vasospasm.- Downstream SCAD (example👇🏼)

1/ MYOCARDIAL BRIDGES (MBs). ANOCA mechanisms:. - Slow early diast relaxation.- Diast vessel restriction +/- neg remodeling.- Branch steal (Venturi effect).- Proximal atherosclerosis.- Associated vasospasm, CMD (common!). (see next for MINOCA)

Answer ➡️ 3. Macrophages.

What is this👇🏼 OCT finding ?? 👀. (not the diffuse fibrous plaque, i.e. next to 🔵 line ➡️ the bright stuff casting a dense shadow behind it). 1. Thin-cap fibroatheroma (TCFA).2. Red clot.3. Macrophages.4. Calcium.5. Artifact. (answer next)

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