Angiography of critical ostial left main

[RickyBob911]

New fellow with a question,

One of the recent cases involved a 90+ probably was 99% the more I look at it ostial left main stenosis

How do you tackle this technically? In the case I was in, there was no damping or ventricularization, attending took control of the catheter and manifold and did the injections himself, was uneventful.

Is there any particular manipulation of the catheter that would make it safer to inject? Or if there is no damping is it reasonable to stay engaged and perform slow careful contrast injections and just hope for the best?

Conversely lets say pressure is damped, what are the typical catheter manipulations you perform, sub-selective if you cannot engage without it damping?

Thanks in advance

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