Q&A
Q.
Could anything else have been tried in today's case?
A.
We actually tried IVUS guided antegrade entry as well as the retrograde entry and all failed. Hence nothing else was left to be tried.
Q.
Did IVUS help in this particular case?
A.
IVUS did not help in this case and antegrade cap could not be identified.
Q.
Or it caused confusion?
A.
In fact, IVUS caused more confusion than any help.
Q.
What will you advise the patient?
A.
I don’t think we should retry for CTO recanalization attempt. He will be a good case for Robotic LIMA to LAD; that is what we have now recommended.
Q.
Are you planning to increase imaging for CTO?
A.
Actually our experience of imaging guided CTO recanalization is very limited. I certainly will not use imaging to guide CTO recanalization. Yes Imaging numbers are going up in our Cath lab due to increased use in Bifurcation, LM, long and ISR lesions; in accordance with the recent guidelines. Guidelines also donot support Imaging guidance in CTO recanalization as it’s a very complex process.
Q.
Which wire do you prefer for septal surfing?
A.
Fielder XT A is a good initial wire for septal surfing, followed by Gaia-2 as wire escalation.
Q.
Your favorite support catheter? Why?
A.
Of the various support catheters (Finecross, Corsair, Turnpike, Tornus), our preferred work horse support catheter is Finecross; due to good pushability, rarely guide wire sticking and economical. All support Cathers cost around $400 a piece except Corsair which costs around $650.
Q.
What are three strong features of your Interventional Fellows training?
A.
Here are the three strong features of our interventional fellowship;
Dedicated teaching and learning only at one Sinai main campus, Hands on experience as they quickly get familiar with the interventional devices and, Involvement in clinical research with expectation of completing 1-2 research articles during their training.
Q.
An area you can improve upon?
A.
Extra dedicated time for Intravascular imaging in theory and during cases is needed and will be welcomed.
Q.
Is today's radial presentation with compilation of US statistics a death nail for femoral access?
A.
Yes increasing radial access compared to femoral in USA with all the advantages, comes with the caveat of higher CVA in radial group. Hence no death knell to femoral access yet but radial access in USA will continue to increase upto comfortable 70%.
