As usual....brilliant lecture.... Please shed some light on thrombus trapping by direct stenting and what about avoiding pre and post dilatation in case of thrombus containing lesion...???
Thank you! I will give you the same reply as below: The idea of direct stenting does not apply to heavy thrombus. As I describe, you do not want to stent in the midst of very heavy thrombus, as you have a high risk of macro and micro embolization from cheese crater effect (rather than trapping the thrombus, you squeezed it through the stent cells; remember the stent has open cells). Also, significant risk of stent thrombosis, esp if you aggravate distal flow. The cerebral stent retriever concept is different: it is s a slow self-expanding stent (no balloon) that is pulled out. In milder thrombus burden (thrombus
Thank you from Australia. Amazing talk as usual. My only thought is that if using a strong suction like Penumbra attached to your Tuohy, a threaded/screw end type valve for a stronger seal. I would worry a spring loaded valve might entrain air and also reduce the suction effect.
Thank you. You are correct. There is a concern about vacuum suctioning when connecting Penumbra suction to Tuohy/Guideliner, which creates air and air embolism. That is why, after this maneuver, it is important to remove the Guideliner from the body while on negative suction, then back bleed the Tuohy vigorously (passively initially, to get potential air out).
Thank you Dr. Hanna for the great taeching. Just one question: Why should we exactly use a dual lumen catheter for i.c. II.b/IIIa or i.c. lysis rather a standard microcatheter. Thanks for your answer.
You may use a standard microcatheter, but you would have to pull out the wire to inject the drugs. A dual lumen catheter allows you to maintain distal wire access and also has the advantage of being monorail system. It is a Monorail system that allows you to maintain distal wire access, while you inject the drugs via the OTW port
Dr Hanna thank you for your excellent lectures.When you give intracoronary eptifibatide, what dose do you use and how do you mix the intracoronary bolus, Thank you
Thank you! And great question. We use the same bolus dose that would be used intravenously, which is what was used in all trials of IC GPI. I administer each bolus via a 10 ml syringe, sometimes 2 syringes mixed with blood. For eptifibatide, we use the standard 2 boluses of 180 mcg/kg/bolus, given 10 min apart (or 1 dose if GFR
Very helpful and nice talk dear Dr. Hanna. What do you think about directly stenting the lesion with thrombus and avoid ballooning it to prevent distal embolization?
Thank you! The idea of direct stenting does not apply to heavy thrombus. As I describe, you do not want to stent in the midst of very heavy thrombus, as you have a high risk of macro and micro embolization from cheese crater effect (rather than trapping the thrombus, you squeeze it through the stent cells; remember the stent has open cells). Also, significant risk of stent thrombosis, esp if you aggravate distal flow. The cerebral stent retriever concept is different: it is s a slow self-expanding stent (no balloon) that is pulled out. In milder thrombus burden (thrombus
@@eliashanna8248thank you for the detailed answer. I am glad to have your book and be able to hear your voice and communicate with you on youtube. Greetings from Germany. ❤
Dear Dr Hanna, thank you so much for the great lecture.. im a great fan of your lectures and have always learnt alot from your lectures.. I have a question: You mentioned the idea of avoiding stenting and marinating the patient with glycoprotein 2b/3a inhibitors for ~24hours in case the heavy thrombus persists.. what if the heavy thrombus burden persists even after repeat angio? The cerebral stent retreiver isnt availabe in our cath labs in the UK, so what would be your strategy in case of persistent heavy thrombus burden on the repeat angio? Many thanks
Thank you! IT is likely that one of the 4 essential techniques will work, especially the local tpa. IF none worked and marinating the pt did not work either, consider laser if you have it. Another technique that is somewhat similar and more widely available than stent retriever is to deploy a Filter or Spider wire distal to the clot. Then pull the Filter wire and try to trap the clot and pull it in the guide. There is, however, a concern about clot dislodgement and aortic/cerebral embolization doing this; stent retriever is safer in that regard, as it integrates into the thrombus.
This is a phenomenal talk as usual Dr. Hanna. I miss working with you so much
Ahmed, the best interventional fellow ever :). We all miss you!!
Top talk Dr. Hanna. We are waiting for a lecture about laser. Thank you
Thans Dr Hanna for this excellent talk. requesting you for a talk(s) on CTO PCI, which is a complex area.
Thanks for your presentation may you add The ECG of inferior STEMI heavy thrombus for purposes of early recognition
Thank you Dr. Hanna. How about manual aspiration thrombectomy through guideliner or other type of aspiration catheter, instead of Penumbra System?
Have you heart about the IIb/IIIa inhibitor injection via perforated ballon (one foe predilatation) using the deflator syringe?)
As usual....brilliant lecture.... Please shed some light on thrombus trapping by direct stenting and what about avoiding pre and post dilatation in case of thrombus containing lesion...???
Thank you! I will give you the same reply as below:
The idea of direct stenting does not apply to heavy thrombus. As I describe, you do not want to stent in the midst of very heavy thrombus, as you have a high risk of macro and micro embolization from cheese crater effect (rather than trapping the thrombus, you squeezed it through the stent cells; remember the stent has open cells). Also, significant risk of stent thrombosis, esp if you aggravate distal flow. The cerebral stent retriever concept is different: it is s a slow self-expanding stent (no balloon) that is pulled out.
In milder thrombus burden (thrombus
Thank you for the valuable inputs......
Thank you from Australia. Amazing talk as usual. My only thought is that if using a strong suction like Penumbra attached to your Tuohy, a threaded/screw end type valve for a stronger seal. I would worry a spring loaded valve might entrain air and also reduce the suction effect.
Thank you. You are correct. There is a concern about vacuum suctioning when connecting Penumbra suction to Tuohy/Guideliner, which creates air and air embolism. That is why, after this maneuver, it is important to remove the Guideliner from the body while on negative suction, then back bleed the Tuohy vigorously (passively initially, to get potential air out).
Thank you Dr. Hanna for the great taeching. Just one question: Why should we exactly use a dual lumen catheter for i.c. II.b/IIIa or i.c. lysis rather a standard microcatheter. Thanks for your answer.
You may use a standard microcatheter, but you would have to pull out the wire to inject the drugs. A dual lumen catheter allows you to maintain distal wire access and also has the advantage of being monorail system. It is a Monorail system that allows you to maintain distal wire access, while you inject the drugs via the OTW port
Dr Hanna thank you for your excellent lectures.When you give intracoronary eptifibatide, what dose do you use and how do you mix the intracoronary bolus, Thank you
Thank you! And great question. We use the same bolus dose that would be used intravenously, which is what was used in all trials of IC GPI. I administer each bolus via a 10 ml syringe, sometimes 2 syringes mixed with blood. For eptifibatide, we use the standard 2 boluses of 180 mcg/kg/bolus, given 10 min apart (or 1 dose if GFR
Very helpful and nice talk dear Dr. Hanna. What do you think about directly stenting the lesion with thrombus and avoid ballooning it to prevent distal embolization?
Thank you! The idea of direct stenting does not apply to heavy thrombus. As I describe, you do not want to stent in the midst of very heavy thrombus, as you have a high risk of macro and micro embolization from cheese crater effect (rather than trapping the thrombus, you squeeze it through the stent cells; remember the stent has open cells). Also, significant risk of stent thrombosis, esp if you aggravate distal flow. The cerebral stent retriever concept is different: it is s a slow self-expanding stent (no balloon) that is pulled out.
In milder thrombus burden (thrombus
@@eliashanna8248thank you for the detailed answer. I am glad to have your book and be able to hear your voice and communicate with you on youtube. Greetings from Germany. ❤
Dear Dr Hanna, thank you so much for the great lecture.. im a great fan of your lectures and have always learnt alot from your lectures..
I have a question:
You mentioned the idea of avoiding stenting and marinating the patient with glycoprotein 2b/3a inhibitors for ~24hours in case the heavy thrombus persists.. what if the heavy thrombus burden persists even after repeat angio? The cerebral stent retreiver isnt availabe in our cath labs in the UK, so what would be your strategy in case of persistent heavy thrombus burden on the repeat angio?
Many thanks
Thank you! IT is likely that one of the 4 essential techniques will work, especially the local tpa. IF none worked and marinating the pt did not work either, consider laser if you have it.
Another technique that is somewhat similar and more widely available than stent retriever is to deploy a Filter or Spider wire distal to the clot. Then pull the Filter wire and try to trap the clot and pull it in the guide. There is, however, a concern about clot dislodgement and aortic/cerebral embolization doing this; stent retriever is safer in that regard, as it integrates into the thrombus.