Q&A
Q.
The add-on, replacement case is one of the hardest case arranged during ccclive cases?
A.
This replacement of the live case at the last minute underscore the depth and efficiency of Sinai’s operations. We are really proud of it!
Q.
Begin to explain, how a case is replaced at short notice for the webcast?
A.
Again this replacement of a LM case with almost similar another LM bifurcation case underscore the depth of our clinical enterprise.
Q.
In such situations, is there still patient consent for the webcast?
A.
Yes irrespective of the status, all pts for live transmission require to sign a separate media consent in front of a witness, after full explanation of the educational mission of the live relay and where it is being broadcasted.
Q.
What was the biggest challenge for this case, and what was your strategy all along to cross the challenging LCX?
A.
As we saw, biggest challenge of the case was 90% very angulated lesion in ostial LCx and needed an angulated catheter to cross the lesion. That is what was done in the case by using Supercross 120 with just Runthrough wire.
Q.
Has Supercross mostly replaced the Venture catheter?
A.
As you know Venture catheters are no longer being manufactured and only Supercross angulated catchers are available; 45, 90, 120 and 180 degrees
Q.
Is it available only as an over the wire device?
A.
That is correct that Supercross is available as only over the wire and no monorail yet.
Q.
Were you not concerned about Rotablator of such severe angulation?
A.
Actually these angulated lesions of LCx or Diagonals, are at very high risk of perforation after RA which is essential for plaque modification. Hence extra care with slow Rota burr advancement and use of smallest burr like 1.25mm will do the job safely.
Q.
How do you overcome the wire bias?
A.
Wire bias is less with the Rota-floppy wire and should be used routinely. Also wire bias sometimes works in our favor for better luminal gain.
Q.
Has there been less enthusiasm for IVL at your institution?
A.
IVL use is very enthusiastic at our institution as well as nationally and globally. IVL is now being used in 8-10% of 1Million PCIs done in USA.
Q.
What single maneuver made this superb case possible?
A.
Use of Supercross catheter, although was late in the process, made the procedure successful; and hence the main turning point of the case.
