Dear Brilakis, we follow your posts with interest. In our clinic, we use the Sofia aspiration catheter in ectatic cases with high thrombus burden (especially in the right coronary artery) and the results are quite satisfactory.
In a stemi obviously switching to femoral access quickly is right thing. For subclavian tortuosity, i sometimes use a 75cm Terumo destination sheath which allows engagement. 6F guide will fit 6F destination sheath.
Great point - we typically do this if we have TIMI 3 flow - antegrade flow was not very good after thrombectomy in this case and the patient had persistent ST elevation
I think that high pressure balloon inflation should probably be avoided in STEMI due to risk of distal embolization (except in balloon undilatable lesions).
Dear Brilakis, we follow your posts with interest. In our clinic, we use the Sofia aspiration catheter in ectatic cases with high thrombus burden (especially in the right coronary artery) and the results are quite satisfactory.
Thank you, great point.
Thanks for the educative case presentation.
Perfect 👍
In a stemi obviously switching to femoral access quickly is right thing. For subclavian tortuosity, i sometimes use a 75cm Terumo destination sheath which allows engagement. 6F guide will fit 6F destination sheath.
try to use infinity 90 cmsheath
Perfect
Excellent case! Thoughts on Angiojet for this case?
What your opinion, if we use Ikary left with long sheat from femoral access (after coronary angiography). Btw very Excellent case.. Thank you so much
That would likely work, thanks for your comment!
What do you think of pre emptive ic verapamil before stenting so as to prepare microvasculature for possible embolization post stenting?
What about local thrombolysis with low dose tenecteplase
In the presence of dense thrombus, better results are obtained if clotinab is given before the balloon. What do you think about this issue?
Abciximab is not available in the US anymore, but it can help reduce thrombus burden and improve flow.
What about Giving eptifibatide 48 hours and bring back patient?
Great point - we typically do this if we have TIMI 3 flow - antegrade flow was not very good after thrombectomy in this case and the patient had persistent ST elevation
Is post dilatation or high pressure deployment necessary in stemı? Restoreing tımı 3 flow and post dilatation can be an option. What is your strategy?
I think that high pressure balloon inflation should probably be avoided in STEMI due to risk of distal embolization (except in balloon undilatable lesions).