Good case ... Do you perform any post dilatation for the covered stent ?? In any case if not this case .... 2.what would have been your option if there had been a thrombus in aneurysm ..would you plan pci or just thrombolyse and defer pci ?
We did not perform postdilation of covered stent except for the overlap segment with the proximal DES, as IVUS showed good expansion; however postdilation in recommended, especially for the GraftMaster stent, which is hard to expand. If thrombus was present within the aneurysm, but antegrade flow was still present and wiring could be done without disrupting the thrombus and embolizing would probably treat with covered stent. Otherwise, can consider heparin or GP IIb/IIIa infusion with repeat angio and PCI after 48 hours.
great skills placing ostial stent with AL. when you place the ostial DES overlapping the papyrus, do you postdilate tbe overlapping zone of both stents separately?
Amazing case I know u did post stenting IVUS there is some shelfing at the distal stent edge (outlet of the aneurysm), what did the IVUS tell about it?
I like your concept of failing all the way to success!! Thanks.
Another very much impressive case! Yes, key for success in this case is a choice of Fielder FC and persistence. Great case!
Brilliant managing! Amazing case. Thank you very much!
Good job, hard work
Excellent educational case.
Great case👍👍👍
Very nice! Thanks!
If a major side branch emerged from the aneurysm site, what would your approach be like in this case
Perfect
Good case ... Do you perform any post dilatation for the covered stent ?? In any case if not this case ....
2.what would have been your option if there had been a thrombus in aneurysm ..would you plan pci or just thrombolyse and defer pci ?
We did not perform postdilation of covered stent except for the overlap segment with the proximal DES, as IVUS showed good expansion; however postdilation in recommended, especially for the GraftMaster stent, which is hard to expand.
If thrombus was present within the aneurysm, but antegrade flow was still present and wiring could be done without disrupting the thrombus and embolizing would probably treat with covered stent. Otherwise, can consider heparin or GP IIb/IIIa infusion with repeat angio and PCI after 48 hours.
great skills placing ostial stent with AL. when you place the ostial DES overlapping the papyrus, do you postdilate tbe overlapping zone of both stents separately?
Excellent point - yes, by advancing the stent balloon in after stent deployment.
Persistence
Amazing case
I know u did post stenting IVUS
there is some shelfing at the distal stent edge (outlet of the aneurysm), what did the IVUS tell about it?
Could not advance the IVUS all the way past the covered stent, so unfortunately do not know!
@@manosbrilakis thanks.. But realy very educative case (as usual)