Discover and read the best of Twitter Threads about #RadialFirst

Most recents (23)

#HongKong Complex Case Series

Global representation..thank u for the invitation
Hoping more women next year
@DrSaritaRao2 @drsonyaburgess
Case 1: Hydraulic exchange of the roto wire thru a microcatheter & this is the next picture..what's happening?
#ACCIC #EAPCI @mmamas1973 @evandrofilhobr @saraceciliamtz @AntoniousAttall @atunuguntla1 @ArasiMaran @djc795 @sbrugaletta
Case 2: Retrograde #CTO101 w snaring of wire
Case 3: Double balloon inflation to treat #PVL & change #TMVR morphology
Read 6 tweets
🧵 1/8 Myocardial bridging is present when part of coronary artery dips into & underneath heart muscle. Let’s dig deeper. 📖
Educational thread 🧵 1/8
#MedEd #CardioEd #CardioTwitter #MedTwitter #radialfirst @JACCJournals @YoungDgk @DGK_org @AGIKinterv @CardioNerds @escardio
📍2/8 Myocardial bridging is a congenital coronary artery anomaly, in which a segment of the artery (tunnel segment) dips into the myocardium (myocardial bridge).
📍3/8 Methods of detection vary greatly in sensitivity.
Myocardial bridging is seen in

🥇30% of pts in autopsy
🥈20% of pts in coronary CT-scan
🥉5% of pts in coronary angiography
#CardioTwitter #MedTwitter #RadialFirst
Read 9 tweets
Interventions for Frailty in Older Adults with Cardiovascular Disease – A Comprehensive Review

The first author @NailaIjaz_MD is a humble, hardworking, and just outstanding.…

Summary of this @JACCjournal state-of-the-art review is in 🧵below:


The aging of the United States population is one of four major areas that will change science, clinical medicine, and business in the coming 50 years

@anatlechner @NYUStern

1 in 4 Americans will be above 65 years of age by 2060…

Think about the implications of this on everyday life...

Read 20 tweets
*Logical vs. Emotional Truths on the JACC Cardiovascular Intervention Study*


Let me summarize below...

From @JACCJournals…


The study used the NCDR CathPCI registry to examine

a.The proportion of patients who met the inclusion criteria for ischemia (versus 4 other groups that did not meet the Ischemia-trial criteria).

b.The association between each group with all-cause mortality


Patients in the CathPCI registry were categorized into:

1 ACS + Arrest + Cardiogenic Shock (n=538K)
2 Not Ischemia High Risk (n=71K)
3 Not Ischemia (low risk) (n=67K)
4 ***ISCHEMIA-like (n=125k) +stress OR abnormal FFR***
5 Not classified (n=123k)
Read 15 tweets
Awesome first day of presentations.

Some of the key slides below from Chapter 1 - Left Main PCI

 #TCTAP2021 #APVALVES2021 #COMPLEXPCI2021  @summitmd_cvrf @aayshacader @mirvatalasnag @AmitSinghMD @YongcheolKim2
#CardioTwitter #CardioEd #RadialFirst #ACCFIT #ACC @BotPci @APSIC6
1/4 Left Main bifurcation and PCI by Dr Mario Gaudino ImageImageImageImage
2/ ImageImageImageImage
Read 24 tweets
Watch here tomorrow for the launch of a new accredited tweetorial on use of P2Y12 inhibitor monotherapy after PCI! Earn 0.5 CE/CME credits: physicians, nurses, pharmacists! Expert faculty @SVRaoMD. #medtwitter @academiccme #cardiotwitter
1) Welcome to a tweetorial on the use of P2Y12 inhibitor monotherapy after PCI! Accredited for 0.50 credits by @academiccme: physicians, nurses, pharmacists! I am @SVRaoMD. Image
2) This series is supported by educational grant funding from Abbott, AstraZeneca, Bayer, Chiesi, and NovoNordisk. Follow this thread for credit. And here is a case …
Read 25 tweets
1. Today is #WorldCancerDay our analysis led by @dr_mosama & @hvanspall… with @AnaBaracCardio @islamelgendy83 @DLBHATTMD @adnanalkhouli @safinmc @dataevan studies disparities in care & outcomes of cancer pts presenting with STEMI @DrMarthaGulati @ShrillaB
2. #WorldCancerDay It builds on our work published last year led by @adityadoc1 showing pts with cancer less likely to be managed invasively, and when they are have better outcomes.… @MKIttlesonMD @ovidiogarciav @DrPeterOKane @SukhNijjer @CardioIAN
3. #WorldCancerDay The greatest incidence of AMI in cancer pts is within 30d of Ca diagnosis, many treatments can ⬆️risk aswell as shared risk factors. We sought to study whether STEMI pts with cancer are less likley to get PPCI & whether they benefit…
Read 8 tweets

➡️Arteria Lusoria or aberrant right subclavian artery (ARSA) is the most common congenital arch anomaly in which the right subclavian artery originates from the descending aorta, distal to the left subclavian at the ductus arteriosus.
(2/)On its course towards the R arm, the aberrant vessel travels retrotracheal +retroesophageal. The prevalence of ARSA ranges from 0.6 to 1.4%. The prevalence of ARSA rises exponentially to 26–34% in individuals with Down syndrome and other chromosomal defects. Pic: @Tesslagra
(3/) Rarely, ARSA can accompany Kommerell's diverticulum, an aneurysm of the descending aorta at the origin of the ARSA. This can present clinically as dysphagia, dyspnea, or subclavian steal syndrome, often requiring surgical intervention
Read 17 tweets
Today's 8 am #UFE begging to leave hospital at 10.30 am....we found a middle ground 11 am

The secret 🤫: #RadialFirst and #SHNB

#Tweetorial on technique and troubleshooting....

Relevant anatomy:
Sup hypogastric nerve plexus- sympathetic nerve plexus anterior to L5 body
Aortic bifurcation-L4
Venous confluence- L5, L5-S1 disc (*overlies the plexus 😱)

Although arterial opacification can be avoided with an angiogram, venous opacification is sometimes inadvertent and maybe seen in nearly 1 in 5 cases.

We still go ahead with #SHNB:
➡️ Adjust needle position
➡️ Multiple aspirations
➡️ Test dose

Read 7 tweets
When use #ldtra during a #radialfirst approach?

👌if no #STEMI and:
1⃣ dialysis or CABG w/radial graft likely (better
radial artery patency) or
2⃣ left radial preferred (e.g. prior CABG: better pt
and👩‍⚕️comfort) or
3⃣ pt has thick forearm (better hemostasis) When to use #ldtra (distal ...
❓How-to #ldTRA?

Twitterature: @ferdikiem and many others provide great tips from U/S guidance to compression and more

Literature is catching up:
ongoing studies➡️NCT03611725, NCT04232488, NCT04318990, NCT04194606, NCT04171570 Literature vs Twitterature
Read 3 tweets
#ESCCongress has ended. A unique conference! An unforgettable conference! These are my highlights!

Firstly, an amazing DIGITAL experience... Brining everyone together, breaking all barriers, diminishing borders.

@Barbara_Casadei @Steph_Achenbach @mmamas1973 @DrMarthaGulati
In an earlier (still ongoing) Poll from today... 77% wished to have a hybrid Digital and In Person conference... That would certainly have lots of attractions especially for those who wouldn't other be able to afford it #ESCCongress

...& now the science! In random order (depending on which I could find in my twitter thread most easily!)

No 1. #Covid and the HEART

HTN, Lipids, Diabetes, CAD, heart failure, ALL associated with worse prognosis (critical events & deaths)

Women have it less severely

Read 16 tweets
Check out the #MINOCA section in updated NSTE-ACS guidelines at #ESCcongress

Here is a tweetorial on #MINOCA
🧲Class I Recommendations🧲

-> Use of Diagnostic algorithm
-> Use of #whyCMR
-> Use of working dx & Rx according to the underlying Dx
MINOCA has MI in it-> DOES the definition allows for the inclusion of non-ischemic causes of troponin elevation?

Given this limitation of the troponin bioassay, the “Fourth 4th Universal of MI" defined Injury from infarction

The hallmark of myocardial injury ⬆️ troponin, However, these entities differ conceptually
▶️ myocardial injury = nonischemic mechanisms of myocyte injury (eg, myocarditis),
▶️MI = ischemic mechanisms (eg,
plaque disruption or supply-demand mismatch).

Read 10 tweets
Understanding Invasive Coronary Angiography:

What it is? Where it is? Where it goes?

🧵 w/ several (usual) projections (full video link at the end).

#CardioEd #CardioTwitter #RadialFirst @PCRonline
@INC_CathLab @EduardoAArias1 @moisesjimenezs @sergiopatronMD
The 3D model:
Coronary arteries segmentation and reconstruction of a patient with left dominance and their relationship with both ventricles (different patients in the CT and the invasive angiography but both with left dominance for an illustrative correlation).
Left coronary: LAO + Cranial.
Good exposure of the LAD and diagonal branches/bifurcations. This case also good for the PD (plus: there is a severe stenosis after the 1st Diag branch).
Read 12 tweets
#cardiotwitter -need help how would you manage this case. Attempting in 2 hours. EF normal and advanced Parkinson’s 68 yr old male @rwyeh @DKarmpaliotis @ajaykirtane @JAG24851 @mmamas1973
1- support no support 2-bifurcation strategy
Read 8 tweets
1/6 #Cardiotwitter - check out this #Tweetorial

"CV considerations & #COVID19"

💥Viral cell entry using ACE2
💥ACEi/ARB - don't stop - no evidence of harm/benefit

#ACCFIT #MedEd #Medtwitter #HMHFellow @HMHCardioFellow @HMethodistCV #StayHomeSaveLives #FlattenTheCurveTogether

💥Increased #COVID19 mortality with CVD
💥Association between elevated troponin and mortality
💥#COVID19 + elevated troponin -> older patients, more co-morbidities, higher acuity

💥ACC: Measure troponin & BNP if considering ACS / HF clinically
💥Based on studies, ?consider using troponin as prognostic marker
💥ACS: GDMT, consider cath lab staff exposure, ?fibrinolytics in low risk ACS

Read 6 tweets
Kicking off @CRT_meeting #CardiogenicShock sessions: Pathophysiology by @drmortkern...
Don’t forget the RV: by #DrJamesGoldstein...
Trials and evidence (presence and absence) in #Shock treatment: by @thiele_holger...
Read 25 tweets

Drs @SukhNijjer, @jerd10 and @RicardoPetraco. What are your views on @DavidLBrownMD fallacies of FFR?

As a budding interventional cardiologist, I like to hear all opinions and sides to the story :)
“In conclusion, FFR in isolation is of no proven clinical value in the evaluation of patients with suspected ischemia. The ESC guidelines continue to promote an outdated paradigm for the evaluation of suspected ischemia that focuses on the focal epicardial stenosis.”
The 4 fallacies

1/4 - The first fallacy is the foundational premise of FFR that ischemia caused by a focal obstructive epicardial coronary stenosis is on the direct pathway to death or MI and therefore should be a target of revascularization
Read 7 tweets
Hypertrophic Obstructive Cardiomyopathy #HOCM🚧

Profound exertional dyspnea

▪️SAM/LVOT obstruction #whyCMR
▪️Classic #Doppler🗡#echofirst

▪️Brockenbrough-Braunwald-Morrow sign, explained

▪️Alcohol🍷septal ablation #RadialFirst
Why wouldn’t more filling time⏱ prior to post PVC beat lead to less obstruction, less gradient, & ↑ arterial pressure?

After all, doesn’t ↑LV volume in #HCM ↓gradient and improve symptoms?

Cornerstone tx is hydration/💊s that ↑ diastolic filling time ...
Read 6 tweets
#WeeklyCardioReview Left main: #PCI or #CABG? A methodological review of #EXCELtrial and #NOBLEtrial, research in context and final answer to what should I do with my patient with #LMdisease. Stay tuned, enjoy and comment
#EXCELtrial Intended population: 2010-2014
1. LM >70% visually, or >50% hemodynamically significant
2. Heart team suitable for both Tx
3. SYNTAX score <32
Actual population:
Core lab detected high SYNTAX score (≥33) in 24.2%
Distal LM 80.5%
2 or 3 VD 51.3%
Most common exclusion criteria: Disease too complex for PCI (31.9%)
1905 pts randomized, small cross overs, balanced LTFU
Read 32 tweets
I had a balloon-uncrossable lesion the other day and wanted to share a potential new tip that I hadn't heard described before (though it's not rocket science). It was a mid-LAD CTO. I was #RadialFirst, 7F EBU 3.75 guide, 6F guidelines as far as it would go.1/x
I could get a 1.2 x 20 mm balloon to cross the lesion and inflated it to 20 atm, but nothing larger would get across, and all the gear kept backing out. I had excellent wire purchase. I suspected there was one spot that was providing the resistance, possibly a spicule of Ca. 2/x
I had asked the crew in the lab to start setting up for rota, but I tried one more thing as they were prepping. I took a 1.5 x 20 mm Rx balloon and pushed it gently as far as it would go. Maintaining gentle force with my L hand, I clockwise turned the balloon with my R hand. 3/x
Read 8 tweets
1/10 “To PCI, or Not to PCI, That is the Question” Will Shakespeare, MD
*Per many contentious #cardiotwitter discussions I realize this is loaded topic but I’m going to attempt an early stage #ACCFIT overview while recognizing there is a lot of nuance.
2/10 Why not “See lesion Fix lesion”?
Poor correlation between est'd visual stenosis & quantitative stenosis. And, without noninvasive ischemic data, coronary angio has limited accuracy w/ regard to identifying significance of many stenoses
*STEMI PCI already done @KhandelwalMD
3/10 COURAGE trial (OMT vs OMT and PCI of visually-estimated significant stenoses): No difference death/MI between OMT & OMT/PCI. PCI demonstrated clinical benefit only when treating relevant myocardial ischemia determined by noninvasive testing.
Read 14 tweets
Intro/10 #STEMI #tweetorial #FITSurvivalGuide for #ACCFIT. Organized by @dr_chirumamilla. @ACCCardioEd @ACCinTouch
1/10 #STEMI from ruptured plaque, less plaque erosion. @BraunwaldEugene pic demonstrates LDL oxidized, glycated➡️cytokines release express adhesion molecules➡️monocytes roll, diapedesis➡️ingest LDL, become foam cell➡️SMC migrate, proliferate➡️some apoptosis➡️plaque Image
2/10 Why #STEMI on #ECG
1. Diastolic current of injury: current away from relatively depolarized injury➡️TQ depression➡️normalized on ECG➡️ST elevation
2. Systolic current of injury: current towards injury due to early repol➡️ST elevation Image
Read 19 tweets

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