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How do you navigate tortuous coronary vasculature? In this episode of BackTable Cardiology, Dr. Hady Lichaa hosts Dr. Alexander Truesdell, an interventional cardiologist with extensive experience in overcoming complex cases of vessel tortuosity. --- SYNPOSIS Beginning with Dr. Truesdell’s background and expertise, the discussion delves into best practices for evaluating and navigating tortuous anatomy both diagnostically and interventionally, the use of various wires, guides, and support techniques, and how to effectively use imaging and atherectomy tools. They also touch on practical aspects of tackling coronary tortuosity, like procedural preparation, equipment choices, and the importance of continuous learning in an evolving area of medicine. --- TIMESTAMPS 00:00 - Introduction 02:07 - Approaching Cases of Extreme Tortuosity 14:04 - Defining Tortuosity of the Coronary Vessels 18:40 - Guide Size and Equipment Strategy in Complex PCI 35:04 - Distal Guide Extension Catheter Use and One Potential Risk 43:16 - Using Imaging Catheters 49:25 - Discussion of Avoiding Complications 57:40 - Selecting Stents 01:04:00 - Guide Extension Use Through Pseudo Lesions to Decrease Ischemic Time 01:11:00 - Parting Advice for New and Mid-Career Interventional Cardiologists --- RESOURCES Dr. Alexander Truesdell’s Provider Profile: https://www.virginiaheart.com/find-a-... Dr. Hady Lichaa’s Provider Profile: https://healthcare.ascension.org/find... Transradial Peripheral Vascular Intervention: Challenges and Opportunities: https://www.openaccessjournals.com/ar... --- BackTable Cardiology is a podcast for clinical and interventional cardiologists, cardiac surgeons, and other healthcare professionals involved in cardiovascular care. This show brings together expert voices from across the field to explore the latest in cardiology—from evolving guidelines and innovative devices to real-world case discussions and multidisciplinary collaboration. Get notified when new episodes drop! Subscribe to the BackTable Cardiology Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular updates. ► https://www.backtable.com/shows/cardi... #CV3 #pci #coronaryarterydisease #interventionalcardiology