Live and Online: 1 Complex Intervention Per Month

Join labs around the country in an online forum as Dr. Samin Sharma and his team tackle a complex case, and discuss tips and techniques for successful outcomes. When is the next live case? The next live case will be on January 19th. It is always the third Tuesday of every month, and we have been doing our live case series since early 2009. The only exception we have made is in March 2010, because the American College of Cardiology meeting is on the 16th, in the third week, so for March, we have made it on the second Tuesday, March 9th. Viewers should join us online from 9-10am at www.ccclivecases.org. There is no cost for registration. Tell us about upcoming cases. The patient we are planning on January 19th will be a 58-year-old male patient with left main bifurcation disease with a decreased ejection fraction of 25%. He has already had an automatic implantable cardioverter defibrillator (AICD) and will be coming to have a stent placed for the left main bifurcation. February 16th will be a total occlusion case and March 9th will be a rotational atherectomy case. The goal of the live case series is to feature a complex case, because simple cases are something everybody can do. There is very little role for technique because stents are very easy to do and often can be done within a few minutes. However, some of the more complex cases, particularly calcified left main total occlusion bifurcations or trifurcations, require extra technical tips to be done safely, correctly, and more importantly, to have good, long-term outcomes. Our one-hour presentation starts with a history of the patient, then an angiogram and a review of the topic, which is related to that particular case, such as unprotected left main stenting, rotational atherectomy, bifurcation lesions, stent types and various anticoagulant therapies. Each presentation has about 12-15 slides, and then we do the case over the next 30-40 minutes, with real-time online questioning available to viewers. People who have logged in often ask questions and we encourage them to do so. A moderator mediates the questions from a conference room and communicates them to me while the case is being done. We answer and explain what we will be doing to get correct results and make various points in terms of technical tips. Why should viewers choose to watch the case live? Live cases are a very good resource for training and education for anyone working in the lab, particularly for staff and fellows. Several people could watch together and discuss the case. If viewers have questions or want to share an opinion about the technique being used, they can type in a question or comment, which reaches us through the moderator. I am then able to answer the question or, in some cases, change my strategy. I may originally intend to do something in a different way, but we’ve had cases where an important suggestion comes in to modify the technique. So it’s not a one-way street, but a discussion, incorporated in the performance of the case. We discuss pros and cons, and if it is a beneficial suggestion, we will incorporate it while the case is ongoing. The interaction is the key. There is a lot of educational value in our archived cases, but tremendous value comes from the live cases. Being involved in the discussion as the case progresses in front of you increases learning for everyone. Can you share more about the February 16th case? The February case is a 53-year-old male who has a chronic total occlusion of the ostial left anterior descending artery (LAD). It’s a large LAD. The patient presented with crescendo angina and a positive stress test in the inferolateral as well as the anterior wall. He had disease in the circumflex obtuse marginal and total occlusion of the ostial LAD, with near-normal left ventricular function. We inserted a stent in the obtuse marginal, and the patient was discharged home with a plan to come back on February 16th to have a revascularization of the chronic total occlusion (CTO) in the ostial LAD. We plan to use a two-catheter technique, what’s called a contralateral injection. Once the wire goes beyond the total occlusion, we cannot see it by injecting antegrade, but we can always follow it through the retrograde, via the collaterals. This case will have a puncture of both the groins and this procedure will go step-by-step, using a stiffer wire to recanalize the total occlusion with the help of the contralateral injection. If there is a problem in crossing the balloon, let’s say the wire goes in, but the balloon does not, then we can use either rotational atherectomy or a Tornus microcatheter. Once the balloon can be inserted and the lesion opened, it will be followed by a drug-eluting stent, preferably the Xience V stent. Mount Sinai has always pushed the envelope; here, it is in terms of education and teaching. We offer a June symposium annually, but by making a live case series, we have the opportunity to educate, train and enrich all our viewers on a monthly basis. We cover all different topics and are also inviting suggestions. If any special type of procedure would be of particular value, we can select that as a future complex case and really delve into all points of the technical components. Dr. Sharma can be contacted at Samin.Sharma@mountsinai.org __________________________ Live Cases Calendar All cases are shown live at www.ccclivecases.org, from 9-10am. Tuesday, January 19th: Left main bifurcation disease Tuesday, February 16th: CTO of the ostial LAD Tuesday, March 9th: Rotational atherectomy of LAD The live case series will continue through the end of the year, on the third Tuesday of each month, from 9-10am. Registration is free at wwww.ccclivecases.org. Archived cases from the series are available at www.cathlablive.com.

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