We discuss expert recommendations on how to switch between oral P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel) as well as the intravenous P2Y12 inhibitor cangrelor. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Bifurcation PCI cases become especially challenging when the side branch becomes flush occluded. In this video, we discuss different techniques to recover the side branch, including the use of angled and dual-lumen microcatheters as well as the use of IVUS-guided techniques. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss a case of SCAD (spontaneous coronary artery dissection) that resulted in a STEMI. We go over PCI techniques for SCAD, which are often opposite for what we normally do for PCI. We also review the mechanism for SCAD formation as well as strategies for medical management and SCAD prevention. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss a case of microcatheter entrapment, an extremely unusual complication involving a Turnpike Gold microcatheter that became stuck in a coronary artery. We discuss several strategies to free an entrapped microcatheter. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Flowchart for Cath Lab Emergencies - Approach to Coronary Wire Fracture Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Flowchart for Cath Lab Emergencies - Approach to Stent Loss Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We review two ominous T wave abnormalities that are important to recognize early: the de Winter T waves (STEMI-equivalent indicating acute LAD occlusion) and the better known Wellens T waves (suggesting severe LAD stenosis). We discussed diagnostic criteria and management. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss a case of iatrogenic catheter dissection of the LIMA. We review an important early angiographic sign of dissection, and go over stenting techniques as well as pitfalls to avoid when stenting dissected vessels. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss Finet's Law (2/3 rule), Murray's Law, and Mitsudo's Proposal for how to size kissing balloons and POT balloons in bifurcation PCI. We also give specific example for how to use these rules in PCI cases. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Flowchart for Cath Lab Emergencies - Approach to Coronary Perforation. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Countdown of the top 3 most popular videos on 6-in-the-A from 2023! Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Patients with pre-existing Left Bundle Branch Block are a challenge when they present with chest pain. The Sgarbossa criteria are often cited, but are frequently used incorrectly. We look at the original Sgarbossa criteria as well as the Smith-modified Sgarbossa criteria and go over how they should be used. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Flowchart for Cath Lab Emergencies - Approach to No-Reflow Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

What do you do when your stent is stripped off the balloon in the middle of a STEMI? We review a case of stent loss during STEMI and go over a systematic approach for how to deal with this situation. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss the latest available evidence from the AFTER EIGHTY STUDY looking at invasive vs. conservative approaches for NSTEMI in elderly patients 80 years or older. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We discuss a simple technique - the floating wire technique, also known as the ""sepal technique"" - to precisely stent the ostium without needing multiple shots and extra contrast. This is useful in ostial dissections when contrast injections should be minimized. The technique can be used in aorto-ostial lesions and for lesions at the ostium of a side branch. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We review a tough STEMI requiring a dual-lumen catheter, bifurcation stenting, and complicated by thrombotic no-reflow, and finally by a defective balloon that does not deflate. We discuss how to approach a malfunctioning balloon that fails to deflate. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

PCI post-TAVR can be very challenging, especially with the CoreValve, due to difficult catheter engagement through the valve. We review tips and techniques, including performing PCI using a diagnostic catheter. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

We go over criteria for wiring the side branch in cases involving a provisional stenting strategy in bifurcation PCI. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital

Whether or not a patient is having a STEMI is a critical factor in deciding whether to take a cardiac arrest patient immediately to the cath lab. However, the post-ROSC ECG can often be difficult to interpret due to global myocardial ischemia. We discuss evidence for the optimal time to wait to perform an ECG post-ROSC to reduce STEMI false positive rates. Chao-Wei Hwang, M.D., Ph.D. Johns Hopkins University School of Medicine Cardiac Cath Lab, Frederick Health Hospital