It was a pleasure to host our Western Canada CTO/CHIP rounds, featuring our guest speaker Dr. Mauro Carlino (@MauroCarlino3) to talk to us about the history of contrast modulation and #HDR in #CTO and #CTOPCI. We were joined by @realarainmd, and it was a great discussion about #HDR and #contrast1st concept. We reviewed 3 complex CTO cases from across Canada and had a fruitful discussion with #HDRanalysis. A fantastic online meeting with excellent turnout and a massive Canadian Interventional Cardiology audience. Would like to thank everyone for their support, involvement and interaction. Indeed this promotes learning and growth as a community.   @Can_CTO @dzavik_vlad @SanjogKalra @CtoEuro @MLCTOAcademy @DrDarshanDoshi @KambisMashayek1 @RinfretStephane @KovacicMihajlo @AgostoniPF @mornei2011 @swissCTO @A_B_Hall @SmithElliotjs @evandrofilhobr @YbarraLuiz @DrBillLombardi @esbrilakis @dautov_MD @ammozid @MohamadAlmutawa @BElbarouni @jcspratt @tomkaier @AnjaKsnes @RajaHatem @LAzzaliniMD @jedicath @Laserrman @FaroucJaffer @MohanedEgred @stefan_harb @BostonEdney @AHRavandi @DrIHHashmi1 @ogoktekin @OpolskiMP @K_DeSilva @MichaelMegalyMD @DrJMHill @sharmaine0206 @abagaimd @ignamatsant @agtruesdell @ziadalinyc @rickytiago @aspergian1

@BrianLi_MD Fantastic. 👏👏👏

Many ways to do this. Treat SVG only vs. treat SVG followed by staged native vessel PCI vs. native vessel PCI. Interesting use of hybrid approach with native vessel PCI for OM1 and SVG PCI for OM2. The graft is ectatic and there is further disease distal to the treated graft segment, so is likely to cause trouble in the future. Once you got through the OM1 occlusion would have been quite easy to wire and treat OM2 as there was a connection. So for me it would have been to treat native LCX/OM1/OM2 followed by therapeutic graft closure.

@jedicath Very nice @jedicath! I recently shared a long term followup of DCB. Great to see a persisting good result. Of course lesion prep was key!

@MichaelMegalyMD Would love to see some other views.

@LAzzaliniMD @sudhirtho @DrPrimeroNg Agree ping pong more efficient and safer in my opinion when working with ipsilateral collaterals, particularly with epicardial channels.

@Laserrman @realarainmd @cto_chip_japan @DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 Yes because in #TDADR, the IVUS for you replaces the retrograde injections and serves as your method of identifying the target distal vessel.

@MdM_Ochiai @realarainmd @Laserrman @cto_chip_japan @DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 Spot on! 💯

Thanks for sharing @Laserrman! Highlights the importance of a meticulous puncture with the first wire for #HDR. Great persistence with #HDR. Wow… 8 times! If you are EP then persisting with #HDR is only going to make the EP space and stains worse unless the contrast tracks back into IP. I’m comfortable working with stains, but those stains were large with real possibility of active perforation. So, I would have switched to alternative strategy early. For you that would be #TDADR. For me that #retrograde or just conventional #ADR. 😀

@realarainmd @evandrofilhobr And I say #JSKBT

@OpolskiMP @Laserrman @realarainmd @BarberoUmberto @MauroCarlino3 @esbrilakis @LAzzaliniMD @MarekRadomski71 @RobertoGarbo1 @skat_ct Maks has been hanging out everywhere. He was hanging out with @Laserrman last year and now @MauroCarlino3. Where to next, Maks? 😂

@AsifAdnanK @realarainmd @agtruesdell Yes Pantera Lux.

@AsifAdnanK @realarainmd @agtruesdell You can if you have a 7F guide. But I find the jailed DCB removal can be “tricky and sticky”! So I pretreat with DCB upfront . Then use a simple nonDCB compliant balloon for JSKBT during stent implantation.

@evandrofilhobr Great case @evandrofilhobr. Thanks for sharing!

@yassersadeknhi Thanks Yasser. 🙏 Hopefully see you soon!

@sharmaine0206 Great work Sharmaine. Been a delight to train you. A bright future ahead of you! I am sure @WythenshaweHosp is looking forward to your return back to UK and join them.

Good thoughts, but the 3 reasons to think the antegrade wire was EP was 1) a retrograde test which showed the wire was not IP. Did not capture that image. 2) we maintained the antegrade wire position upon which ballooning and subsequent RCART was performed and IVUS showed that area to be EP 3) the retro Gaia3 and antegrade wires were overlapping tightly likely in same space initially on orthogonal views so would think that antegrade wire was EP.