Yes for the the controversial topic of observed higher 5-year mortality after PCI in the Excel trial, the recent meta-analysis of 5 RCTs with 1-5 years of f/u has shown similar mortality after PCI and CABG. Hence it is appropriate to say that Interventionalists were correct in the EXCEL debate.

Yes it is a very important message that both PCI and CABG have similar mortality in low-intermediate Syntax risk pts (Syntax score <33). This observation will be very important for the PCI update guideline writing committee.

I expect these LM PCI outcome observations will favorably influence the guidelines writing committee to make PCI as a viable alternative to CABG for the treatment of less complex LM CAD.

Yes as shown in the reports as well as our own experience at Sinai, 65-70% of type 2 MI have significant CAD and treating it appropriately may improve their prognosis. Cath is recommended in thsese semi-elective setting rather then urgent setting after the primary event cools down. Cath is not recommended in cases of myocardial injury as it is more of a myocardial process rather then CAD. More important part of the management of type 2 MI should include appropriate MT similar to type 1 MI. I hope these aggressive strategic measures will improve type 2 MI favorably. We have set a predefined protocol on those lines to treat Type 2 MI at MSH with a dedicated interventionalist and a NP to manage these pts in non-cardiolgy units.

Yes presentation of Type 2 MI may be very atypical in both men and women but will have some underlying illness and predisposing factor causing supply/demand mismatch along with rise and fall of Troponin.

We like Gaia wire because of their 1:1 torqueability, hydrophilic coating, differential penetration power (Gaia 2; 0.011” tip and 3.5gm penetration power , Gaia 3; 0.012” tip and 4.5gm penetration power) and ability to remain in the lumen. another key to use these wires is not to over torque and wait few seconds after each movement as ropecoil design tip will find the way into true lumen or pierce the tough CTO cap.

We actually have only first generation of Gaia 2 and Gaia 3 series. The Gaia 3 has 4.5gm top and 0.012” tip and is ideal for CTO recanalization.

Approximately 70% of CTOs are done using Rt femoral (working guide) and Lt radial (for retrograde collaterals) in our cath lab. Bilateral femorals are used in 26-28% of cases and bilateral radials in <5% of CTO cases.

For planned rare retrograde approach, most (>95%) are done using both femorals and rarely combination of Rt femoral and Lt radial.

Persistence and recognizing early that Gaia 3 has gone subintimal and then quickly escalate to Confianza 9 guidewire.