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6 in the A
United States
Приєднався 31 січ 2021
6-in-the-A is a channel about interventional cardiology and coronary artery disease.
We talk about typical cath lab cases from a typical interventional cardiologist at a typical community hospital. Nothing fancy, just cases you could very well see on your next call.
Cath lab RTs, RNs, midlevels, interventional cardiology fellows, and practicing interventional cardiologists in the community may find the content useful.
Some videos are geared more towards patients.
There may even be a few nuggets to keep my more academically-inclined colleagues entertained!
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Channel Link: www.youtube.com/@6intheA
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All contents are for entertainment purposes only. No medical advice is intended or provided. Clinical vignettes do not reflect actual patient scenarios. Any resemblance is purely coincidental. Opinions are my own, and I reserve the right to change my opinion at any time, without notice, and for any reason.
We talk about typical cath lab cases from a typical interventional cardiologist at a typical community hospital. Nothing fancy, just cases you could very well see on your next call.
Cath lab RTs, RNs, midlevels, interventional cardiology fellows, and practicing interventional cardiologists in the community may find the content useful.
Some videos are geared more towards patients.
There may even be a few nuggets to keep my more academically-inclined colleagues entertained!
===
Channel Link: www.youtube.com/@6intheA
===
All contents are for entertainment purposes only. No medical advice is intended or provided. Clinical vignettes do not reflect actual patient scenarios. Any resemblance is purely coincidental. Opinions are my own, and I reserve the right to change my opinion at any time, without notice, and for any reason.
STEMI Disaster: Stent malfunction, LAD Dissection, and Stent Loss
A routine STEMI turned bad quickly when the stent balloon ruptured and the partially expanded stent was dragged out of the LAD. There was a large LAD dissection and eventually LAD shutdown. We discuss the case and how we used the "STAR technique" (sub-intimal tracking and re-entry) from CTO PCI as a bail-out.
Chao-Wei Hwang, M.D., Ph.D.
Johns Hopkins University School of Medicine
Cardiac Cath Lab, Frederick Health Hospital
Chao-Wei Hwang, M.D., Ph.D.
Johns Hopkins University School of Medicine
Cardiac Cath Lab, Frederick Health Hospital
Переглядів: 2 291
Відео
PCI for STEMI + refractory VF with LUCAS CPR
Переглядів 1,5 тис.День тому
A young man presented with STEMI after shoveling snow. He arrested in the hallway on the way to the Cath Lab, and had refractory VF. We performed multi-vessel PCI of the LAD and RCA with the patient in nearly continuous VF supported by the LUCAS mechanical CPR device. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Acute Stent Recoil
Переглядів 2,2 тис.28 днів тому
We discuss a case of acute stent recoil during ostial RCA PCI, and go over strategies to prevent and deal with stent recoil, including the "pulse post-dilation" technique and double-stenting. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Stenting through Protruding Ostial Stent
Переглядів 2,9 тис.Місяць тому
We discuss a case of restenosis of an ostial RCA stent that protrudes well out into the aorta. I go over the "Double-Wire Technique" to cannulate the mouth of the protruding stent as well as tips for stenting through the side of a protruding stent. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
LIMA goes where?! Several cases of unusual CABG anatomy
Переглядів 1,7 тис.2 місяці тому
I go over several cases of quite unusual CABG anatomies. Link to LIMA-cardiac vein case: ua-cam.com/video/FBXQw3be2p8/v-deo.html Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Cardiogenic Shock from LVOT obstruction post-MI
Переглядів 2,5 тис.2 місяці тому
We discuss a case of post-MI cardiogenic shock from dynamic left ventricular outflow tract obstruction (LVOTO). We discuss how to manage cardiogenic shock with dynamic LVOTO, and also review other common reasons for post-MI shock. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Dual Antiplatelet Therapy after PCI in 2024
Переглядів 2,6 тис.3 місяці тому
My discussion of DAPT after PCI in 2024 at the annual Johns Hopkins Suburban Hospital Interventional Skills Day. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Nested Bifurcation Stenting of Left Main Trifurcation
Переглядів 3,5 тис.3 місяці тому
We discuss a case of Left Main Trifurcation PCI that required the use of the "nested bifurcation PCI" technique. This is useful when only 6 French guide catheters are available. We review how nested bifurcation PCI is done and also briefly go over the literature for left main trifurcation stenting. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederi...
STEMI: Could not engage anomalous RCA!
Переглядів 4,5 тис.4 місяці тому
We discuss a case of anomalous RCA STEMI in which it was impossible to engage the RCA with a guide catheter. We review guide catheters to use with anomalous coronary arteries, discuss wiring with diagnostic catheters, and go over techniques to exchange catheters over coronary wires. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Tortuous RCA: Re-direction with Sasuke
Переглядів 3 тис.5 місяців тому
We discuss wiring techniques for tortuous coronary arteries, and talk about the use of the Sasuke dual lumen catheter in tortuous vessels as a tool for wire re-direction and potentially for wire re-entry from a dissection plane into true lumen. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Discordant FFR/iFR/RFR
Переглядів 1,9 тис.5 місяців тому
We discuss the available evidence for what to do when the FFR result is discordant with the iFR or RFR result. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
DK Crush: Step by step
Переглядів 9 тис.7 місяців тому
We go over how to perform the DK Crush stenting technique (double kissing crush) step by step for non-provisional bifurcation PCI in a LAD/Diagonal bifurcation case. Other bifurcation videos you might be interested in: TAP stenting (LAD/Diagonal bifurcation): ua-cam.com/video/YC2WlbKAR4g/v-deo.html TAP stenting (LCX/OM bifurcation): ua-cam.com/video/TZUb6IRRwvA/v-deo.html Culotte stenting: ua-c...
PCI of Septal Perforator in Isolated Septal STEMI
Переглядів 3,4 тис.7 місяців тому
We discuss septal branch PCI in an unusual case of an isolated septal STEMI without LAD involvement. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
How to size kissing balloons and POT balloons
Переглядів 4,9 тис.8 місяців тому
We discuss Finet's Law (2/3 rule), Murray's Law, and Mitsudo's Proposal for how to size kissing balloons and POT balloons in bifurcation PCI. We also give specific example for how to use these rules in PCI cases. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
Wellens T waves & de Winter T waves
Переглядів 4,6 тис.9 місяців тому
We review two ominous T wave abnormalities that are important to recognize early: the de Winter T waves (STEMI-equivalent indicating acute LAD occlusion) and the better known Wellens T waves (suggesting severe LAD stenosis). We discussed diagnostic criteria and management. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital
LBBB + MI: Sgarbossa and Modified Sgarbossa Criteria
Переглядів 5 тис.Рік тому
LBBB MI: Sgarbossa and Modified Sgarbossa Criteria
Stent Stripped Off Balloon During STEMI
Переглядів 6 тис.Рік тому
Stent Stripped Off Balloon During STEMI
PCI in the elderly: Should Great Grandma go to the cath lab?
Переглядів 2,7 тис.Рік тому
PCI in the elderly: Should Great Grandma go to the cath lab?
Rough STEMI then balloon could not deflate!
Переглядів 5 тис.Рік тому
Rough STEMI then balloon could not deflate!
Erratum: In "Step 9" / Slide 20 / 14:40 mark, re-wiring the side branch again should be through 2 stent layers, not 3.
One of our astute viewers thought that the IVUS image actually showed that the IVUS catheter was in false lumen, and that the true lumen was to the right of the dissection flap. I thought we were true lumen throughout, but I must admit that sometimes I still have trouble telling things apart. Color doppler might have helped. In this case, we principally wanted to make sure that we ended in true lumen. This was clear in the full IVUS run (which I don't show). Fortunately for us, there are no branches to worry about in the LIMA, so it's less critical if part of the stent was in false lumen as long as the ends are in true lumen.... What I am sure of is this: The more I do this, the more I realize how much I still have yet to learn.