Case and Plan:
70-year-old male presented with severe CCS Class II angina and positive stress echo for anterior and on inferoseptal ischemia. A Cardiac Cath on May 20, 2021 revealed 2 V CAD: 95% mid RCA, 80% distal RCA, 30%-50% distal LM, 80% proximal LAD/D1 bifurcation (1,1,1), normal systolic LV function and SYNTAX Score of 22. Patient underwent successful intervention of mid and distal RCA using rotational atherectomy and Promus Elite DES. Patient is now planned for imaging guided (LM) staged PCI of proximal LAD/D1 bifurcation using rotational atherectomy and dedicated 2-stent Mini-Crush technique.
Q&A
Q
Congratulations on your 12th anniversary. What has been the biggest gain for year #1.
A.
Thanks being in this 12 year journey together.
I am happy to proudly announce that our mission which we started 12 years ago, Global Interventional teaching; has been greatly fully fulfilled. Started with 550-900 monthly audience in few countries in 2009, now has grown to 22000+ per month in 139 countries. Simply to say ' Mission Accomplished'. Hence biggest gain since year #1, has been continued increasing recognition and establishment of ccclivecases as a very important unbiased step-by-step technical educational tool for our Intervenional community especially fellows-in-training
Q
Which case for this year has been the most educational?
A.
Of all 12 cases of this academic year, in my opinion best case was of December 2020 moderated by Dr Antonio Colombo; subtotal prox LAD followed by a large disease free diagonal and then very angulated mid LAD with 80% lesion. Despite lot of discussion and suggestion of various approaches, Dr Kini suggested that we should stent the prox LAD lesion with wire in the diagonal and then bring the venture angulated catheter to wire the mid LAD. Exactly that is how we did that case successfully. There were multiple teaching points and educational technical tricks discussed and done in that particular case.
Q
As you look over the years that ccclivecases has progressed, what would be some of the most satisfying gains?
A.
Satisfying gains have been to present and do the cases with utmost safety, AUC appropriateness and without industry bias. Fully down-able PPT slides of didactic lectures have been appreciated by many viewers.
Q
Which single device made the largest contribution to managing CAD?
A.
I will say that the Rotational Atherectomy (RA) has allowed us to do the most complex cases in a successful and succinct manner. Hence will get my vote of a top single essential device contributing to our interventional succeess.
Q
Which single device ended by most disappointing?
A.
Most disappointing single device has been Orbital Atherectomy (OA), despite all the appropriate technical tips, many cases we did had significant dissection, spasm or slow flow. Although there were no major complication in these OA cases. Hence RA supersede OA in our daily practice tackling the complex calcified lesions.
Q
hich clinical trial(s) has been the most impactful?
A.
Recent trials in last 5-6 years comparing 2-stents vs 1-stent for bifurcation lesion, have shown that correctly done 2 stents are better then one. We were practicing this 2-stent approach for bifurcation lesions for last 20 years despite negative trails in the past. Now very pleased to know that even RCT results support 2-stent approach.
Q
You have partner email address for with ACC, Medscape and HMP communication - were those partnerships helpful?
A.
We started our ccclivecases journey with HMP communication (Sept 2009) which gave us the initial startup base and then the Heart.Org, partnership increased the monthly audience from 1-2K to 5K+. Next milestone occurred after ACC took over by crossing monthly audience to 10K+ in many episodes. When we broke off with ACC in 2014, we felt that our ccclivecases will have significant downfall. But on the contrary, we continued to grow independently without any society or organization sponsorship. Currently each episode has minimum 20K+ viewers. Getting to the YouTube has added 40%+ of the audience. This is the clear reflection and testament of the trust of our audience globally, who believes the format and contents of the ccclivecases.
Q
What are you planning to do differently for the next few years for ccclivecases?
A.
We will continue to expand the theme message of unbiased teaching of Interventional cases and present the latest data in the didactic discussion. We will continue to experiment of inviting guest faculty on the zoom for added panel discussion.
Q
Any plans for more global expansion?
A.
As you well know, we tried having simultaneous transmission in other languages like Spanish, Chinese but we're not successful. One time we also contemplated adding 4-5 other centers outside USA, but could not advance the plan further. One day our vision is to provide round the clock through out the week, livecases channel incorporating many global centers. Till then, we will continue the current format which has been quite successful.
Q
Are we moving away from print and digital interventional cardiology education to Apps guided training?
A.
I agree that educational Apps will start playing a key role in our daily educational training. But I still believe that print and digital media are here to stay for continued interactive educational teaching.
