Q&A
Q.
Please expand on the guide wire strategy if the initial wires would not cross the LAD with multiple dissection planes?
A.
It was a very challenging case in terms of angulation and multiple channels (dissection or recanalized thrombus) in the proximal LAD. Fielder crossed the lesion, after failed Runthrough. Myself and many of our audience voted for the hydrophilic Whisper as the initial wire of choice. If not crossed, then Gaia-3 would have been the next wire escalation.
Q.
What would you do if the dissection plane expands and there is imminent vessel closure?
A.
In that case we would have gone with more tapered and stiffer wires like Gaia-3, Pilot-50 or Confianza-9.
Q.
Would a support catheter work against you in this situation? It needs to be both coaxial and provide support?
A.
Support Cather did its job of providing the adequate support and crossing the lesion. Guide co-axility was the issue and maneuvered accordingly.
Q.
Which OCT system appears most promising in terms of contrast limitations?
A.
All still in works but I suggest to to use the guide extension catheter with OCT, which require only 2-3cc of dye instead of usual 10-12cc.
Q.
Have you used Dextran administration with OCT?
A.
We did use Dextran with OCT in 2 cases, but didn’t find it of much use.
Q.
Regarding Magenta, which features do you like more?
A.
Magenta is a 9.5Fr device and can provide upto 5.5L of flow. It’s eas of use and stability when in place, will make it a preferable next generation MCS.
Q.
How does it compare with Impella?
A.
Both smaller sheath size (9.5 vs 14Fr) and higher flow rates (5.5 vs 4L/min), will favor Magenta over current Impelle CP device.
Q.
After Magenta, which is the next most promising LV support device?
A.
Impella ESP also being 9.5 Fr but has the maximum flow rate of 4.5L/min, will be best contender to Magenta device.
Q.
Do you pre-close Magenta?
A.
All MCS devices are pre-closed with proglide sutures; 2 for 14Fr and 1 for 9.5Fr sheaths.
Q.
What is your prediction about Colchicine and CAD?
A.
My prediction as well as personal experience has been disappointing for the use and efficacy of colchicine in CAD; ACS or CCD. Hence I don’t see its long term future in the management of CAD.
