JIM Today 2018 - Friday - page 3

Issue 2 
Friday
 23 February 2018 
JIM today
3
wiring [the Rotablator] that was the problem, or
spinning it without the brake.”
The operators and Dr Stone agree that the
STAR (Subintimal Tracking And Re-entry) technique
would be worth attempting, but there were other
possible solutions, albeit compromises, moving
forward. “You could put a stent in the proximal
CX, and do a two-stent technique,” said Dr Stone.
“I think it will recanalise.”
Dr Colombo added: “I think the circumflex is
lost, for now.”
Delving deeper into the solutions ahead, Dr
Stone relayed that he would focus on stenting
the left main, add a stent in the proximal CX, and
perform an ultrasound to make sure there is no
pericardial effusion.
The panel and the operators all agreed that
leaving the CX for now would be wise, followed
by reassessment in the near future to see if it
recanalises. “I’d give it at least four weeks,” said
Dr Stone. “I think you have flow in the circumflex,
which is good.”
Dr Colombo commented: “The problem is, if
we go down with the wire into the haematoma,
we are just going to make it bigger … the fact that
it is open is a good sign.”
Imaging confirmed the haematoma was local-
ised to the epicardium, and the both the operators
and the panel began wrapping-up the case. With
consensus being to leave the CX and re-assess in
the coming weeks, one final question was posed as
to how long to leave the Impella device in place.
“I’d leave the Impella in overnight, for sure,”
said Dr Stone, adding: “Then I would do another
ultrasound of course.”
LIVE CASES @ JIM 2018
Take a seat in the Main Hall Washington for this year’s
series of live case sessions.
Friday
08:00–09:45
BONN, GERMANY
University Hospital
10:30–12:15
MILAN, ITALY
Columbus Hospital
14:30–15:45
BONN, GERMANY
University Hospital
17:00–18:00
ROTTERDAM, NL
ThoraxCenter,
Erasmus University
Medical Center
Saturday
08:30–09:30
MILAN, ITALY
Columbus Hospital
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