@RakanINazer Di you have cardiologist?

@Obisht Last time I checked, stents don’t work in multivessel disease with sever dysfunction 😉

@RakanINazer Good point Surgery has a high mortality in STEMI Angiographic MVD may be normal in IFR/FFR In the last 10 years i have never seen a patient with STEMI leaves the lab with occluded LAD, it never happened and won't happen...

@Obisht I do agree with you that operating on STEMI is not the best option. Sometimes we’re faced with a patient who has multivessel disease or left main and presents acutely. We always have a discussion on the Cath table.

@RakanINazer I am interested to know your door to LIMA time?

@Obisht Definitely not 90 min. I do accept selected shocked patients if we can get them to the OR within 6 hrs of the onset of chest pain.

@RakanINazer Occlusion of ostial/ proximal dominant lad is considered "widow maker".

@MarcVorpahl That is very proximal and tight.

@RakanINazer Widow maker heart attack is a significant blockage or total at proximal LAD, left main major blockage is the mother of all wood maker. For urgent coronary angioplasty 🤪 @MustafaAhmedMD

@Dralkutshan @MustafaAhmedMD Unless you have a capable surgeon 😉

@RakanINazer Dr rakan we don't underestimate your skills as a surgeon but a patient with closed LAD don't leave the lab with closed LAD, no one will ever accept this in germany .....

@Obisht It’s all possible. My only issue is opening the LAD and putting stents in multivessel disease patients will preclude them from having a LIMA and survival benefit. We always have a discussion with our interventionist in the Cath lab. Sometimes they will only open with a ballon.

@RakanINazer Nice pictures! Where did the LIMA graft land on the native LAD in the end?

@yeh_james3 We had an extended debate in the OR. The apex and part of the distal septum were infarcted. There was a big diagonal. We opted to graft the Lima on the distal LAD and veins on the other territories. The estimated EF was 15%. This went ok.

@RakanINazer @MustafaAhmedMD

@RakanINazer Highly recommend