Houston IC & Structural | Alum @BrighamWomens @harvardmed | Via @emory_heart @EmoryCCRI | #ShearStress #ComputationalImaging 🇮🇳Cricket
Houston, Texas
Joined March 2009
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When the #CTO cap says no, & the side branch says yes: fighting wire bias on an angulated, calcified occlusion.
Prior CABG, refractory #angina, PET showing reversible #ischemia in the RCA territory.
One case, multiple techniques — learnt from mentors, colleagues, and friends.
#CTO #CTOPCI #CABG #ADR #HDR #Atherectomy
#CardioTwitter #MedED #MedTwitter
@Murmur_MD @DLBHATTMD @HadyLichaaMD @YChatzizisis @iamritu @CASivaram1 @purviparwani @Pooh_Velagapudi
Calcified CTO with a proximal side branch
#AWE with Supercross — wire kept biasing into the side branch
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Wire-based #ADR using G-Next over angled microcatheter
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True lumen confirmed after improving distal flow + probing the PDA & PLV (lack of L-R collaterals)
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#HDR helped microcatheter delivery across the distal CTO cap
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0.9 Excimer Laser facilitated crossing
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Balloon predilatation
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Cutting balloon to decompress the hematoma
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#Shockwave IVL + DES
Curious to hear how others would have played this differently. @realarainmd @AshishPershad @DocSavageTJU @AllaqabanSuhail
#CTOPCI — Pt Late 80s, refractory angina + reversible #ischemia on PET
Fielder XT crosses the lesion — microcatheter & balloons won't follow.
→ 0.9 Excimer Laser — limited crossing, but penetrated the cap.
→ #HDR confirms true lumen — Minamo can't advance.
→ Re-wire with Fielder — Takeru crosses.
→ Re-laser #atherectomy → Serial predilations — Shockwave over Minamo → #IVUS guided Stents ✅
#CardioTwitter #InterventionalCardiology #MedTwitter
#CardioEd
Escalated to #Impella 5.5.
Staged #PCI — LAD-Diag bifurcation: crossed LAD→diag with Fielder, Rota, re-crossed into true LAD.
Days later: LCX-OM PCI.
Impella 5.5 enabled early ambulation → weaned off. Discharged home. Rpt echo @ 3 months pending. #CardioTwitter @DLBHATTMD #CHIP
Here is the angiogram sent to us.
@realarainmd @AlpeshShahMD @AllaqabanSuhail
@MichaelMegalyMD @DocSavageTJU @mmamas1973
@HeartOTXHeartMD @Pooh_Velagapudi @iamritu
#CardioTwitter #CHIP #HighRiskPCI #MedTwitter
Pt: late 50s, previously active, one wk SOB.
LVEF 15%.Transferred for high-risk PCI.
On arrival, CMR viable LCX and diagonal, but transmural scar distal LAD—small apical LV Thrombus.
>> Turned down for CABG.
Angiogram from referring attached below.
What would you do?
43%Medical management
22%LVAD/Transplant
35%High-risk PCI
228 votes • Final resultsHere is the angiogram sent to us.
@realarainmd @AlpeshShahMD @AllaqabanSuhail
@MichaelMegalyMD @DocSavageTJU @mmamas1973
@HeartOTXHeartMD @Pooh_Velagapudi @iamritu
#CardioTwitter #CHIP #HighRiskPCI #MedTwitter
Arnav Kumar, MD, MSCR retweeted
• IMPELLA OFF-LABEL USE: ECMELLA.
It is one of the most common off-label uses of Impella CP.
Although not FDA-approved, LV unloading during VA-ECMO has become common practice in experienced shock centers, particularly when left ventricular distension is detected. #impella
Arnav Kumar, MD, MSCR retweeted
What’s YOUR next move?!
@Grok may well be the wisest #CTOPCI guru to have never set a foot in the cath lab! 😂
A great f/u question. My 1st move is almost always to build up support. This is by far the most common reason devices won’t cross.
Option #2 is modify the cap/plaque.
Thanks for the clean version and video shoutout! That algorithm from Lombardi & Tiwana is a timeless CTO/CHIP gem for wire-crossed but device-uncrossable lesions.
The Javelin?? addition is spot-on — Shockwave’s forward IVL catheter was literally designed for exactly these calcified, tight spots where nothing else advances. Perfect modern update for both coronary and PAD/CLI cases.
What’s your first-line move when small balloons + grenadoplasty fail?
#MitraClip — device time <15 min — structural MR, no surgical options. Patient woke up feeling 100% better.
This is why structural heart intervention matters.
@AbbottCardio @ACCinTouch @HCAHouston @DLBHATTMD #TEER #StructuralHeart #InterventionalCardiology
Is even mild PVL no longer acceptable in #TAVR?
Our editorial on the #OCEAN-TAVI trial is now published in JACC: Interventions.
authors.elsevier.com/a/1m7M3…
Arnav Kumar, MD, MSCR retweeted
RTIG Cap Puncture Tutorial
Here is a ‘self learning’ real time IVUS guided cap puncture tutorial as requested by several colleagues.
It has two parts - one for the angio and another for the IVUS. The primary operator usu. goes back and forth bet. them in real time.
Questions, comments and suggestions welcome!🙏🏼
Arnav Kumar, MD, MSCR retweeted
#HDRanalysis - Happy New Year Edition! 🧵
The first #HDRanalysis of 2025!
The case was posted earlier by @evandrofilhobr - a man who needs no introduction here.
There were three #HDR injections - with three(!) different patterns.
Case below, my analysis to follow…
#CTO101 #HDR #CTOPCI
Interesting RCA CTO PCI
@realarainmd maybe I get honor to get your inputs in this case...
Still don't know how to name the crossing technique lol !😅 (I'm sure the patient don't care!)
Arnav Kumar, MD, MSCR retweeted
💧#HDRanalysis 🧐 - Case 027
An CTO Intervention Unlike Any You Have Seen! 🧵
Here is an unusual CTO for most. The patient is a 48 year old woman with systemic sclerosis (SSc), Raynaud’s, and non-healing ulcer of the left 3rd digit.
Here is the patient’s hand. More…👇🏼
Our first attempt #HDR #CTO Technique @Houston Heart with @pranav_loyalka & Dr. Omar Hadidi last month after #AWE didn’t cross ..
66 M, NSTEMI, second admission w active chest pain despite maximum medical Rx ..
Credit @realarainmd for describing the technique ..
@DLBHATTMD
Slightly harder contrast injection through micro-catheter since #ISR. Crossed with Mongo, however balloon uncrossable, Micro-catheters won’t reach since long SVG… 0.9 Laser worked .. Ballooned and stented ..
Reminded me of the #NoLookSix from @msdhoni7781 to win us the @cricketworldcup in 2011! #Whatachampion #WhataThrow #NeerajChopra #WorldAthleticsChampionships2023
Fenkon toh aise fenko ki chaar log bole Kya fekta hai yaar.
88.17 mtr door Bhaala phenka and a World Athletics Championship Gold for our Champion #NeerajChopra . The mega run continues .
Arnav Kumar, MD, MSCR retweeted
🤔Do you know how to classify, assess, and treat non-left main bifurcation lesions with PCI?
New #USCardiology Review by @ANazmiCalik, @mirvatalasnag et al. @radcliffeCARDIO
🔗uscjournal.com/node/21745?ch…
Join us today at 5pm CST/6pm EST.
Be ready to ask questions! @docHJ @YChatzizisis @CathElectroSurg @DavidWienerMD @PradeepYadavMD @PrakritiGaba @drmeghaprasad @Allison_Dupont @WondrMedical @kashishgoelmd @iamritu @docbhardwaj @mmamas1973 @modeldoc @habib_samady
Join us for the first episode of TAVR Trainers Season 2, as we discuss the basics of TAVR planning and execution. Featuring live discussion with @PinakShahMD, @arnavkumar and @jcl3md
➡️ Register now: wondrmedical.net/ch/TAVR-Tra…
