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 - Introduction02:07 - Approaching Cases of Extreme Tortuosity14:04 - Defining Tortuosity of the Coronary Vessels18:40 - 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 Complications57:40 - Selecting Stents 01:04:00 - Guide Extension Use Through Pseudo Lesions to Decrease Ischemic Time01:11:00 - Parting Advice for New and Mid-Career Interventional Cardiologists --- RESOURCES Dr. Alexander Truesdell’s Provider Profile:https://www.virginiaheart.com/find-a-provider/physicians/alexander-g-truesdell Dr. Hady Lichaa’s Provider Profile:https://healthcare.ascension.org/find-care/provider/1336267533/hady-lichaa Transradial Peripheral Vascular Intervention: Challenges and Opportunities:https://www.openaccessjournals.com/articles/transradial-peripheral-vascular-intervention-challenges-and-opportunities.html