Impella CP supported HR-PCI, from a single femoral access, with RotationalAtherectomy into RCA and IVUS-guided PCI on LMCA @AlbertoCereda1 #SanCarloBorromeoHospital (Milan, @ASST_PaoloCarlo) #ImpellaCP #CompanionSheat (singleaccess) #HRPCI #RotaPRO #IVUS

#CTO #HDR #MAT #MHA #singleaccess #EuroCTO #EUROACTOS2025 Live CTO CASE. RCA CTO How to do #HDR . Pilot 200→HDR→sionblack→HDR→sionblack→HDR→sionblack→CB Stent DCB @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LCX #CTO #MHA #Singleaccess #HDR #TDADR #TDHDR #TDAW Pilot200→HDR(EP)→sionblack KWT→Cross branch→#TDHDR with UB3→HDR(EP)→#TDAW with G2→HDR(EP)→sionblack KWT→#TDADR and #TDAW→Crossed TL This is a representative example of utilizing #TDADR rescue in situations where #HDR is ineffective. EP staining poses no clinical concern. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

RCA double #CTO very tough case with severe calcium. #MHA #singleaccess . #HDR #TDADR #TDHDR #TDAW #KWT #Carlino. . all branch are saved. 4hrs wow. Pilot200→HDR(IP)→sionblack→KWT→#HDR (EP)→#KWT→#Carlino→#TDADR→#TDHDR (IP)→sionblack→#Carlino→KWT failed→UB3→Carlino→KWT (branch)→UB3→#powercarlino→KWT→#TDADR→#TDHDR→sionblack→#TDAW with G2→HDR→sionblack→HDR→sionblack→HDR→XT non tip→HDR (EP)→KWT→#TDADR to PD→HDR→sionblack→DTL→#4AV with DLC Final CAG shows ugly stains are disappeared, No cardiac effusion. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF

#CTO #MHA #singleaccess #HDR #rota #CB #DCB Pilot200→HDR→Type1→XT non tip→2nd HDR→Type 2→sionblack→cross→rota1.5→CB2.75→DCB @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LAD #CTO #calcification #singleaccess #MHA Referal case of failed LAD CTO PCI. #TDADR Very sever calcification. with#Boston IVUS#TDADR wi Pilot 200→＃HDR→EP→sionblack　#KWT→#TDADR→Swap sionblack→ Stent @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

➡️ #ComplexPCI ➡️ #RCA_CTO ➡️ #SingleAccess ➡️ #Bridging_Collaterals ➡️ #RadialFirst ➡️ #AW #CTOs common in #IHD. #CTO_PCI is the technical challenges Improvements in technique dedicated devices for #CTO_PCI , combined with advances in procedural strategy, have resulted in success and outcomes. #Antegrade_wiring #AW #CTOs #proximal_cap

#COMPLETE #REVASCULARISATION: - For patients with #MyocardialInfarction and #multivessel #CAD, adopting the #SingleAccess #RadialFirst approach for routine nonculprit-lesion #PCI can aim for #completeRevascularization. This strategy, whether executed during the initial #hospital stay or shortly after discharge, has shown potential benefits over a #culprit-lesion-only #PCI method. It has the potential to reduce the #risk of #death from #cardiovascular causes or #New #MI , along with lowering the risk of #CV -related #mortality, new myocardial infarction, or #ischemia-driven #revascularization #MI #Heartattack #PCR #TCT2025 #EuroPCR #EuroPCR2025

➡️ #RCA_CTO ➡️ #SingleAccess ➡️ #RadialFirst #AntegradeWiring is the prevailing #CTO crossing technique. Most #ProximalCaps have a clear tapered stump & can be wired by intermediate penetration force wires #Cardiology #AIIMS #Raebareli

LAD #CTO #HDR #MHA #singleaccess. . #rota Sionblack was not crossed →#HDR→IP #passiveinjection shows TL→Sionblack easily to cross→#rota A challenging case in which the guidewire could not cross the lesion initially, but following successful #HDR , guidewire passage was facilitated without difficulty. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LAD #CTO #MHA #singleaccess #HDR Sionblue→＃HDR→IP? ,#Passiveinjecton show TL→XT nonTIP→TL

LAD #CTO #MHA #singleaccess #HDR Pilot200→HDR→EPand IP→XT nontip→HDR→EP & TL→Corsair pull back during passive injection→TL→sionblack→TL IVUS shows GW is in all IP. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LAD #CTO #HDR #TDHDR #MHA #singleaccess TDHDR with ST→PC punctured→HDR→#starrysky→XT non tip buckled→2nd HDR→XTnon tip was buckled at same point→3rd HDR→Sionblack→TL→GW is in all IP CB failed→stent @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

RCA #CTO #HDR #singleaccess 7Fr G2 punctured→HDR→XTnontip→2nd HDR→XTnon tip backled→sionblack buckled→3rd HDR→Gradius advancing→4th HDR→XT non tip advancing→5th HDR→Type2A→sioblack→TL @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

#LCX #CTO #MHA #singleaccess #HDR #TDADR #TDHDR #TDAW I got TL with using #TDAW finally . PC was punctured by ST→#HDR→XT nontip→2nd HDR→IP stains Type 2A&2B→XT & sionblack failed →HDR →EP→#KWT→#TDADR failed→#STAR and crossed DTL→#TDHDR →EP & IP modulation →Sionblack failed→#TDAW with G2→Get TL @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

#CTO #MHA #TDHDR #HDR #singleaccess PC punctured →G2 failed→ST→HDR→EP IP stains→XTnonTIP→buckled→passive injection →IP stains and EP stains→#HDR*3→IP stains→sionblack get TL #IVUS shows EP and IP stains after crossing GW/ GW is all in IP. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LCX #CTO #HDR #singleaccess #IVUS guided G2 punctured for PC→#HDR→EPstains→IVUS shows EP and IP stains→Corsair was pulled back → XT non TIP →TL If it was EP stains, Corsair was pulled back and Check passive injection during advancing GW, if stain was disappeared , that is good sign for success of IP #contrast modulation. @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

LCX #CTO #MHA #HDR planned #singleaccess Sometimes,It happens. Sionblack failed→G2 penetrated for PC→Corsair advancing →Corsair happened to go into TL→CB and DCB @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @UmihikoKaneko @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin

Great. Singleaccess #HDR. Stain seemed to be IP and EP . Nonstop XT works well.

#CTO #HDR #singleaccess #MHA Gradius→#HDR→XT nontip→no advanced→#HDR→IP or EPlike stain?→sionblack with tip bend→crossed TL Stain guided retouting @realarainmd　@cto_chip_japan　@DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 @rotamonster @OpolskiMP @jcspratt @KambisMashayek1 @LAzzaliniMD @AgostoniPF @skat_ct @mornei2011 @uziyahya46 @DrBIqbal @Bernard_TW_Wong #MedTwitter @akbarul @K_DeSilva @evandrofilhobr @MichaelMegalyMD @asaadnakhle @SCVC2023 @girishviswa1　@baijazvascular @ErwMulia @jbspadoni @GTawade84　@drAliyor @SandyCTO #cardiotwitter @PCRonline @SCAI　@ikki1127 @CtoEuro @SPyxaras　@JuradoRomanAl　@JiunnWen_Lin @MLCTOAcademy @shci_sec　@drdharmarajk @sapporohunt @ogoktekin