Michael Megaly
@MichaelMegalyMD
Interventional Cardiologist #CTO #PCI #CLI.Alumnus @MHIF_Heart @HenryFordHealth Aspiring to make a difference
The importance of support. A Long 150 mm RCA #CTO with a mid-segment 12-year-old stent, tough 90-degree angle of attack proximal cap, and distal cap at the bifurcation. First attempt: radial femoral approach-no pushability antegrade or retrograde-aborted. The 2nd attempt used…
It was a great pleasure to be a part of @cvinnovations #CVI2025, learned a lot as usual and came back with multiple tips and tricks. Here are my top ones that I would apply in my next cases. 1- When freewiring the Rotawire in uncrossable lesions, a nice trick shared by…
Learning from the source @SVRaoMD and the 2025 very well written ACS guidelines #CVI2025 #CardioX
Filter entrapment with directional atherectomy. Can be daunting! Heavily calcified SFA/Pop, crossed with Mongo and Gaia PV, 6 mm filter in place. Shockwave after IVUS followed by directional atherectomy with the Hawkone LX device. Small puff showed filled filter and could not…
A wise man once said, its all about the curve you put on the wire. Diagonal wiring attempt 2 minutes didn’t work. Reshape into a new curve, didn’t have time to think 😀
Is it #HDR or not? Prox LAD #CTO, Gaia Next III just into cap (I thought), first injection, advance Gaia but a bit much into the body (could not resist) then stopped. Second injection lighted the distal vessel. Gladius into the LAD @realarainmd #CardioX
A lot of work has been done on the impact of #CTO #PCI on LVEF, which I believe is largely due to reversing ischemia and hybernation in true ischemic CM patients. This is most pronounced in LAD CTO PCI patients. Our new paper @AmJCardio studies the impact of Non-LAD CTO PCI on…
Complete revasc but in the legs! 3 vessel below knee CTO-completed with foot flow to heal the wounds. #CardioX
It might be subtle differences but sizing might be a bit better using IVUS. I wonder what OCT enthusiasts think.
Which imaging modality optimizes PCI, IVUS or OCT? We compared mechanical outcomes of coronary stenting using IVUS vs. OCT across 6 RCTs and 2,696 patients. Shoutout to my superstar friend @lshanmukh05 for leading this. @IJCardio 🔗Full paper: doi.org/10.1016/j.ijca… 1/4
Coronary aneurysms lack evidence in how we treat them, pooling the current literature shows surgery used more with LAD with similar mortality to CABG, while PCI has high mortality and used more in RCA. #cardioX
🚨Our latest study explores outcomes of surgical vs percutaneous revascularization ⚖️ for coronary aneurysms🫀. A rare but critical entity—insights that may guide future management 📚. sciencedirect.com/science/articl… #Cardiology #InterventionalCardiology #MedTwitter
Limb preservation is one of the most rewarding acts in the cath lab! Older patient presented with worsening bilateral foot wounds, rest pain, and inability to walk for a month. Bilateral SFA long CTOs, and not a good surgical candidate. Left SFA CTO treated with reverse CART.…
Introducing the CRISP technique…. Coils are frequently used for therapeutic graft closure to reduce competitive flow following native vessel intervention. Stable deployment of coils can be challenging with a risk of migration/embolization particularly if the graft is patent and…
More data to what we already know
Really important work by @SripalBangalore @JAG24851 @GreggWStone @esbrilakis on the effect of CTOs and revasc on outcomes from the ischemia trial. Link here: jacc.org/doi/abs/10.101… Editorial by @ziadalinyc @rallamee here: jacc.org/doi/abs/10.101…
Finally! Fluid restriction in heart failure is basically BULLSHIT
One of the most important trials at @ACCinTouch #ACC25 ! Compared fluid restriction to liberal approach in #HeartFailure. Why? This affects individuals w/HF EVERY DAY! ✨No benefit of Fluid Restriction ✨No HARM for liberal fluid intake ✨Improved QOL in liberal fluid intake