Evandro Martins F. MD @evandrofilhobr Twitter profile

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Evandro Martins F. MD

3 months

#CTO101 - How would you tackle this CTO? (yes, we have a good clinical indication to open this...) JCTO3, lots of px cap ambiguity (caput medusae), mild-mod calcium, no clear left to right channels? @LAzzaliniMD @rickytiago @jbspadoni @OpolskiMP @AJuradoRoman

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Evandro Martins F. MD

@evandrofilhobr

7 months

Halloween case ?? 👻 Patient with hx of SAVR with metallic prosthesis 20y ago. Presented in ER with hx of acute onset of shortness of breath and cardiogenic shock (80x40) and EKG showing LBB (interpreted as new one). Referred for emergent cardiac catheterization. (findings

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Evandro Martins F. MD

@evandrofilhobr

4 years

Have you heard about “dry tamponade” ? Maybe yes. Have you seen one? I don’t think so… Here's a magical troubleshooting sequence for a rare life threatening complication Handled by a friend in Vietnam called Duc (Nguyen Huy Duc)

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Evandro Martins F. MD

@evandrofilhobr

2 years

Beautiful article “Percutaneous Transaxillary”

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Evandro Martins F. MD

@evandrofilhobr

2 years

Interesting device (Radiaction Shield System) to reduce scattering x-ray in cathlab.

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Evandro Martins F. MD

@evandrofilhobr

4 years

Friday night, last case NSTEMI w/ ongoing chest pain - did diagnostic angiogram. Going to start PCI to Mid LAD and mid LCX (focal disease) w/ EBU 3.5 from #RadialFirst approach. Yes, 💩 happens 🤦🏻‍♂️

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Evandro Martins F. MD

@evandrofilhobr

2 years

Can’t stop laughing 😂

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Evandro Martins F. MD

@evandrofilhobr

2 years

#radialfirst but no!!! 👻

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Evandro Martins F. MD

@evandrofilhobr

4 years

Interesting case for friday afternoon. My last case of 2019. LAD/Dg bifurcation with very difficult SB access. “Streamline Reverse wire technique” followed by IVUS guided mini-crush. Hoping the best for all my #cardiotwitter friends.

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Evandro Martins F. MD

@evandrofilhobr

5 years

Best PCI bench-lab I’ve ever been. Great for mindset changing 👍🏻👏🏻👏🏻 OFDI, bifurcations, CTO simulator (true cathlab simulator).

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Evandro Martins F. MD

@evandrofilhobr

2 years

Very cool & innovative 👏🏻👏🏻 Great demo @jaccjournals

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Evandro Martins F. MD

@evandrofilhobr

3 years

Platelet aggregation.

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Evandro Martins F. MD

@evandrofilhobr

2 years

STEMI call. Can you guess the culprit?

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Evandro Martins F. MD

@evandrofilhobr

2 years

Coronary “laceration” during PCI for extensive calcified lesion. Ping-Pong technique. Papyrus to bailout.

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Evandro Martins F. MD

@evandrofilhobr

6 years

76 y/o lady, frail, COPD, CKD, MV coronary disease scheduled for elective LAD PCI. Very tortuous subclavian artery tackled with “Power” BAT technique (4.5x12 balloon) #RadialFirst

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Evandro Martins F. MD

@evandrofilhobr

8 months

Tip for the #calciumcrackers using @ShockwaveIVL I’ve been prepping the SW balloon the same way I do w/ Stingray balloon. Very fast and effective. - 20cc empty luer lock syringe for vaccuum generation - 3cc luer lock syringe with pure dye - simple stopcock (blue one is my

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Evandro Martins F. MD

@evandrofilhobr

4 years

Nice slide with all covered stents available around the world! #cto101

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Evandro Martins F. MD

@evandrofilhobr

4 years

Yesterday woke up like a truckload passed over me. Started with mild fever, headache and joint pain.... no respiratory symptoms so far. I was still working in frontlines of #COVID19 doing cathlab work, probably I got from one of our technicians God bless all of us

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Evandro Martins F. MD

@evandrofilhobr

4 years

Not so common procedure but patient declined CABG. LAD px CTO + LM trifurcation with severe lesion at ostial ramus. #RadialFirst 8F - EBU 3.5 8F

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Evandro Martins F. MD

@evandrofilhobr

3 years

Reducing you DTB in STEMI calls... 👊🏻

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Evandro Martins F. MD

@evandrofilhobr

1 year

AL guides for RCA engagement. They are not the same! From Dr. Kazuaki Mitsudo’s book.

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Evandro Martins F. MD

@evandrofilhobr

2 years

40s. Happy to be healthy! Cathlab crew party. They wrote on the cake “Get me a Runtrough” 😅 No COI.

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Evandro Martins F. MD

@evandrofilhobr

3 years

"thinking outside the box" CTO px cap modification using Shockwave across a SB! #EuroPCR #EuroPCR2021

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Evandro Martins F. MD

@evandrofilhobr

3 years

Asked for a patient to bring a copy of his catheterization CD film previously done in outside hospital 🏥 for a second opinion. He promptly gave it to me 😎

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Evandro Martins F. MD

@evandrofilhobr

3 years

Just lost a 38y/o cousin to C19! He was on ECMO for a couple of weeks! Fought the good fight against this damm disease! I have good childhood memories playing with him. He had many dreams and was planning to get married. That's very sad. Wish God to keep him in heaven.😭😭

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Evandro Martins F. MD

@evandrofilhobr

5 years

Displaced TR Band 🤦🏻‍♂️ so sad 😭 #radialfirst

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Evandro Martins F. MD

@evandrofilhobr

4 years

Very nice article. Follow-up of iatrogenic aorto-coronary "Dunning" dissections by cardiac computed tomography imaging. DOI 10.1186/s12880-017-0227-3

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Evandro Martins F. MD

@evandrofilhobr

4 years

One of the days you are the luckiest man and probably blessed Inotropes gave me few minutes before patient total crash Cullote stenting was made in speed of light Shock spiral was stopped by PCI and flow restoration Patient came out from cathlab talking...

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Evandro Martins F. MD

@evandrofilhobr

5 years

How clever and wise operators can be? Amazing technique from an japanese operator. “Streamline reverse wire technique” #CardioTwitter

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Evandro Martins F. MD

@evandrofilhobr

9 months

My worst nightmare in the last 10 years practicing interventional cardiology. Annular rupture during TAVR with BEV. Emergent surgery was triggered but the patient couldn’t get out of extracorporeal circulation after valve replacement.

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Evandro Martins F. MD

@evandrofilhobr

2 years

#ICFIT #CTO101 Benchtop example of knuckle wire technique from my friend Dr. Antônio Carlos Botelho.

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Evandro Martins F. MD

@evandrofilhobr

2 years

We still believe IABP can buy some precious time for patients in some scenarios allowing us to fix heart problems. So for the time being we didn’t throw our console on the trash bin.

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Evandro Martins F. MD

@evandrofilhobr

4 years

#orbitalfirst 😂😂

Mario Martínez-Galdámez

@DoctorGaldamez

4 years

Transorbital endovascular embolization of a dural carotid-cavernous fistula. Thank you to @FelipeTrivelato @mts_rezende @neuroabud for showing us so many technical details during years 🇧🇷 🇪🇸

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Evandro Martins F. MD

@evandrofilhobr

4 years

if you’re in a very difficult situation and no covered stents avaiable (hope no to happen) here’s a “homemade” covered stent-regular DES+tegaderm cut piece.Muramatsu sensei workshop.Nothing to judge but 1000+ retro cases experience since 2004. Just listen then make your judgment

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Evandro Martins F. MD

@evandrofilhobr

3 years

Takotsubo triggered by marriage proposal. 👰‍♀️🤵‍♂️

Dr. Huge

@DrHuge2

3 years

Si mi postura con respecto al matrimonio era ambigua, imagínense ahora que hicimos el Dx de esta cardiomiopatía por estrés (Takotsubo o síndrome del corazón roto) en una joven que empezó con angina, luego de que le pidieran matrimonio.

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Evandro Martins F. MD

@evandrofilhobr

4 years

1/4 2 weeks ago I was doing provisional stenting for LAD bifurcation lesion in outside hospital helping a collegue. 5min since case started during stent positioning LAD appeared with huge acute thrombosis probably due heparin problems. ACT wasn’t checked. Pt collapsed with CS.

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Evandro Martins F. MD

@evandrofilhobr

1 year

16👨‍🦰, complex ASD anatomy (very floppy rims, aneurismatic septum >10mm, absence of aortic rim). Failed attempt of percutaneous closure. ASD18 embolization (33/29 LA/RA discs) to the aortic arch. Successful snaring from the pin-hub after 2h trial. Upsized to 16F arterial sheath.

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Evandro Martins F. MD

@evandrofilhobr

4 years

Indeed a very fast angiogram 🤣

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Evandro Martins F. MD

@evandrofilhobr

6 months

Probably my most challenging case this year… RCA ISR CTO - AW Corsair Pro 135 w/ Gladius / GN 3 / CP12 / Astato 20. Poor progression (15mm progression in 1 hour attempt). Very very fibrotic. GZ 7F. 1.25 / 2.0 balloons (rupture). Retro through S1. Mamba Flex & Sion Black to PL.

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Evandro Martins F. MD

@evandrofilhobr

2 years

Failed to crack this rock. 2 burrs, NCs and CBs. The revenge will come with IVL.

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Evandro Martins F. MD

@evandrofilhobr

3 years

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Evandro Martins F. MD

@evandrofilhobr

2 years

Which wire and PCI strategy would you choose?

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Evandro Martins F. MD

@evandrofilhobr

1 year

RCA aorto-ostial - ISR CTO with older overhanging under-expanded stent. Impossible to engage with any guide. Retro through septals w/ Mamba Flex 150. Samurai RC. Retro crossing with Hornet 14 (2x). MC uncrossable. Tip in H14 into JR in aortic arch. Trapping. Externalization.

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Evandro Martins F. MD

@evandrofilhobr

5 years

When your catheter has Wi-Fi broadband connection to the coronaries 😂😂 #Radialfirst

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Evandro Martins F. MD

@evandrofilhobr

2 years

What’s wrong ?

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Evandro Martins F. MD

@evandrofilhobr

3 years

The importance of IVUS in STEMI PCI. It’s beautiful but it’s not.

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Evandro Martins F. MD

@evandrofilhobr

1 year

Shocking news. Looks like Damar Hamlin suffered a commotio cordis. Hope he recovers asap.

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Evandro Martins F. MD

@evandrofilhobr

3 years

Happy to make a small contribution to the complex coronary field. Please access and take a look. Reverse Wire Technique for Angulated Side Branches on @cardiacinterv

Reverse Wire Technique for Angulated Side Branches - Cardiac Interventions Today

A detailed description of how to perform the reverse wire technique (and its new variations), anatomic considerations, and potential complications.

citoday.com

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Evandro Martins F. MD

@evandrofilhobr

4 years

Reverse “Kart” technique 👌🏻

Atul Gupta, MD

@AtulGupta_MD

5 years

The most awesome way to play video games- EVER! No not FDA or CE approved 😁. Just for fun! Pole position car racing using #Azurion FlexArm to drive! Our @PhilipsHealth innovation team having some fun in the lab after hours! @AGRadaelli @LifeAtPhilips

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Evandro Martins F. MD

@evandrofilhobr

4 years

Still see people struggling and making this type of lesion much more complex than they really are. This is a LM lesion at least you should treat as it...

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Evandro Martins F. MD

@evandrofilhobr

2 years

Sunday mood! Go big or go home 👌🏻😎

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Evandro Martins F. MD

@evandrofilhobr

2 years

Poor’s man DLC. Possibily to track SB few millimeters.

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Evandro Martins F. MD

@evandrofilhobr

1 year

#imagefirst lovers IVUS Quiz What is this???? Hint: pullback done inside an SVG!

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Evandro Martins F. MD

@evandrofilhobr

4 years

84 👨🏻‍🦳, arrived at ER with excruciating CP. Brought to cathlab. IVUS guided provisional LM stenting.

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Evandro Martins F. MD

@evandrofilhobr

5 years

Japanese catheter to reach LIMA from Right #radialfirst approach 👏🏻👏🏻👏🏻👏🏻

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Evandro Martins F. MD

@evandrofilhobr

4 years

Balloon-block technique to access difficult SB.

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Evandro Martins F. MD

@evandrofilhobr

3 years

😉🎯

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Evandro Martins F. MD

@evandrofilhobr

3 years

Amazing technology. @TeleflexMedical Ringer Perfusion Balloon for Cors perforation. So many possibilities, distsl vessel evaluation, unlimited ballooning, 2nd wire through balloon and device delivery… Expecting the need of CS to decrease.

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Evandro Martins F. MD

@evandrofilhobr

3 years

L & R heart catheterization.

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Evandro Martins F. MD

@evandrofilhobr

4 years

😂😂

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Evandro Martins F. MD

@evandrofilhobr

4 years

Good example of bi-radial approach for CTO recanalization. Simple but very well paced procedure. Today we treated a lady of 47 with heart failure and post-ACS. Glad our team could help her in a safe manner. #radialfirst

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Evandro Martins F. MD

@evandrofilhobr

2 years

68 👩🏼‍🦳, limiting angina under OMT and anterior wall ischemia by SPECT. Came to my office for an opinion. What would you do?

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Evandro Martins F. MD

@evandrofilhobr

1 year

Demanding case, invited to help a colleague in a different state (2000km away - 4h flying). 82👵🏼 extremely symptomatic w/ MVD w/ dx LM calcified & severe lesion extending to LAD. RCA TO. Terrible peripherals we judged not feasible for MCS. Good outcome 🙏🏻

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Evandro Martins F. MD

@evandrofilhobr

4 years

Good one 👇🏻 When your stent want to dance and bounce like Rihana... stop the music! Learned this with the master @RinfretStephane

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Evandro Martins F. MD

@evandrofilhobr

2 years

Very simple EKG trick:

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Evandro Martins F. MD

@evandrofilhobr

5 years

We did it 💪🏻💪🏻💪🏻 🙏🏻🙏🏻🙏🏻

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Evandro Martins F. MD

@evandrofilhobr

3 years

Indeed an annoying anatomy 🤦🏻‍♂️

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Evandro Martins F. MD

@evandrofilhobr

3 years

@esbrilakis always bringing new good ideas 👏🏻

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Evandro Martins F. MD

@evandrofilhobr

3 months

R.I.P Professor Cribier 🙏🏻 “What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others”

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Evandro Martins F. MD

@evandrofilhobr

2 years

Shockwave IVL & Eccentric calcium.

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Evandro Martins F. MD

@evandrofilhobr

2 years

Cool things I’m working on for CTO PCI education. Developing realistic simulation! More to come! #CTO101

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Evandro Martins F. MD

@evandrofilhobr

3 years

@jackdeliuc Causes of methemoglobinemia

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Evandro Martins F. MD

@evandrofilhobr

1 year

84🧑‍🌾, CCS IV angina despite all the OMT you can imagine. CABG turndown. 3VD (2 CTOs RCA-LCx & calcified LAD). MRI all viable territories, EF 40s. High-Risk PCI to the left system w/ IABP support. Giving some hope to the ones most in need. Superseletive OM injection, ping-pong

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Evandro Martins F. MD

@evandrofilhobr

2 years

This is bad! #CTO101 Septal laceration & hematoma Never leave something like this without treatment.

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Evandro Martins F. MD

@evandrofilhobr

5 months

4 snaring tips for CTO PCI. “Capturing the retrograde wire” 1. Never snare a CTO wire since you can run into serious trouble if snared wire locks/ties into the guide and you can’t untie it (stiff CTO wires bends inside the guide and make a tied knot). Snare long dedicated

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Evandro Martins F. MD

@evandrofilhobr

4 years

72🧔🏻, single vessel disease. Large bunden ischemia @ inferior/lateral wall. CTO PCI of RCA. AWE w/ Finecross & P200. 3 overlapping DES.

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Evandro Martins F. MD

@evandrofilhobr

3 years

For those using long femoral sheaths in complex procedures. Good chart from @esbrilakis book.

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Evandro Martins F. MD

@evandrofilhobr

3 years

Sumitsuji’s J-Anchor technique for extreme backup support.

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Evandro Martins F. MD

@evandrofilhobr

4 years

What do you think about this big collateral from PDA to LAD - is it septal or epicardial?

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Evandro Martins F. MD

@evandrofilhobr

2 years

Go big or go home! 🏡 RCA CTO PCI -> Ended up with 6.0 BSC Sterling 🎈 @ high pressure. 🐍 anaconda RCA.

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Evandro Martins F. MD

@evandrofilhobr

1 year

“Fossa ovalis” is oval in 82%; average transverse diameter is 14.53 mm and vertical 12.60 mm. So many possibilities in such small space! Always fascinating!

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Evandro Martins F. MD

@evandrofilhobr

5 years

Focal, very tight lesion (Ca++ plaque), crossed with workhorse wire and pre-dilatation with 2.0x15 NC 🎈 . In a blink of an eye operator lost wire control removing the balloon. Re-wire -> sub-intimal space / big hematoma / unable to re-wire / procedure lost. There’s no easy PCI.

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Evandro Martins F. MD

@evandrofilhobr

5 months

My year in CTO PCI. Personal rough data of the cases I have joined this year, 2023 (home hospital+outside hospitals). In small steps I’m trying to improve my practice. My sincere thanks to the operators throughout Brazil who kindly invited me to their hospitals as a proctor to

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Evandro Martins F. MD

@evandrofilhobr

5 years

Myocardial 🌉 #RadialFirst

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Evandro Martins F. MD

@evandrofilhobr

5 years

51👱🏻‍♂️. ATO work. INFERIOR STEMI - 4hr since beginning of CP. 30min door-to-ballon time. Radial 7F System. JR4 7F guide. 2 Runtrough wires.Thrombectomy with Terumo Eliminate 7F was not enough. Dottering gave me flow. 4.0 balloon + GZ 7F marination + actilyse 10mg for 5min.

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Evandro Martins F. MD

@evandrofilhobr

4 years

How do you teach someone to do STAR technique? 1stly give him some confidence saying: “it’s gonna work, no you will not blow this artery… believe me..” 2ndly give him a soft polymer jacketed wire… 3rdly - SCREAM: - PUSH! PUSH! PUSH!

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Evandro Martins F. MD

@evandrofilhobr

2 years

R.I.P Dr Sousa. (1934 - 2022) A legend ahead of his time. My heartfelt condolences.

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Evandro Martins F. MD

@evandrofilhobr

3 years

Not only glories at #cardiotwitter PCI complicated with AMI due to SB closure after MB stenting. During attempts to cross SB and regain flow - wire knuckle perforated a small branch. To contextualise: 70's/M. CABG refusal by the patient. Referred for PCI.

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Evandro Martins F. MD

@evandrofilhobr

2 years

Last angiogram of the day. “STABLE HEART DISEASE” progressive angina and SOB with LV dysfunction (decaying EF)

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Evandro Martins F. MD

@evandrofilhobr

3 years

#CTO101 This is a 54👨🏾 with single vessel disease. Recurrent CP and ischemia @ inferior wall revealed by SPECT. Having angina despite OMT. Conventional angio showed a CTO of RCA with some ambiguity. Doubt was if this is a recanalization or bridging collaterals.