Q&A
Q.
You have changed your wire escalation strategy? What are your three preferred wires now in the escalation process?
A.
Our CTO wire escalation used to be; Fielder, MiracleBro 6 and Confianza 9-12 (popularly called FMC for teaching purpose) and now is Fielder, Gaia 3 and Confianza 12 (popularly called FGC).
Q.
What contributed to the successful CTO today?
A.
Persistence and technical skills, escalation strategy of Confianza guided by contra lateral injections.
Q.
Which do you prefer - Guidezilla or Guideliner?
A.
We have observed that Guidezilla performs better then Guideliner in terms of trackability across the angulated vessel segment. Hence Guidezilla has now become our favorite.
Q.
Are there newer support catheters that one can consider?
A.
Recently Medtronics has also introduced their support catheter called Telescope; we have used about 10 but did not find it superior to Guidezilla.
Q.
What will be your anti platelet strategy for this patient?
A.
Pt was on clopidogrel and was continued as PRU was 188. Yes Ticagrelor could be another choice.
Q.
What is your take home message from TWILIGHT?
A.
Clearly adding aspirin on the background of Ticagrelor has no additional antiplatelet effect and can be safely eliminated after 1-3 months of PCI.
Q.
Is this the beginning of the end of the remarkable journey of Aspirin for PCI?
A.
Seems that way now after numerous trials recently showing aspirin being a big culprit for bleeding without affecting ischemic events.
Q.
As you look at aspirin, were there non platelet events that contribute to its increased bleeding?
A.
Yes GI bleeding is one of them and aspirin is a big culprit. I think GI bleeding by aspirin being an acid, is caused by its direct corrosive effect on gastric mucosa.
Q.
Will you begin to translate the results of these new trials into practice?
A.
Yes we have already created a new recommendation in the cath reporting, making 81mg aspirin daily for 1 month, or 3 months in addition to lifelong.
Q.
What do you now feel is ideal dose and duration of aspirin for ACS and for stable patient, post DES?
A.
I strongly believe it is One month for Aspirin in ACS as well as stable CAD, as we learnt from Global Leaders trial.
