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Abbott @AbbottCardio
, 7 tweets, 6 min read Read on Twitter
1/Welcome to our third #OCTober #Tweetorial 🎃🤓. Here we’ll talk
about how #OCTImaging can help detect the mechanisms of in-stent
restenosis (ISR) to guide treatment. #imagefirst #imagelast

Important Safety Info: abbo.tt/2GyBrZ1
2/ What causes ISR? Stent underexpansion and neointimal hyperplasia (NIH) are the two predominant mechanisms of stent failure, as cited in this expert consensus document of the European Association of PCI: bit.ly/2PdMGtt

Important Safety Info: abbo.tt/2GyBrZ1
3/Here’s how stent underexpansion and NIH are seen on angiography and OCT respectively. To spot NIH, look for a large layer of growth on top of an already fully expanded stent.

Important Safety Info: abbo.tt/2GyBrZ1
4/ Full screen view: From the longitudinal section, you can see the tight area. Looking at the cross-section aligning to it, you can see it’s NIH. The stent rendering feature is only picking up on areas w/o NIH. TY @ZiadAliNyc  

Important Safety Info: abbo.tt/2GyBrZ1
5/Here’s a video screen capture of an ISR due to NIH using the OCT playback mode. While examining the run on the system, you are able to scroll through at your own pace to examine the morphology. Video courtesy Rich Shlofmitz, MD.

Important Safety Info: abbo.tt/2GyBrZ1
6/Because of its high resolution (10x greater than IVUS), #OCTimaging allows you to see not only NIH, but also the number of stents, stent malapposition, tissue protrusion, and edge dissections.

Important Safety Info: abbo.tt/2GyBrZ1
7/By using #OCTimaging to diagnose the mechanism of ISR, you can select the right treatment strategy, as seen in this chart developed by @ZiadAliNyc

Important Safety Info: abbo.tt/2GyBrZ1
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#OCTober #Tweetorial #OCTimaging #imagefirst #imagelast

More from @AbbottCardio see all

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1/Welcome to our second OCTober #Tweetorial 🎃🤓. We’ll talk about diagnosing and treating calcific plaque with #OCTImaging. #imagefirst

Important Safety Info: abbo.tt/2GyBrZ1
2/The absence of intravascular imaging may lead to underestimation of calcium and improper diagnosis, as seen in the chart below, courtesy of Richard Shlofmitz, MD. #OCTImaging #imagefirst

Important Safety Info: abbo.tt/2GyBrZ1
3/Calcific plaque is characterized as having low attenuation (light penetrates deep, can see tissue) & clear, delineated edges (appear as “islands” or “rocks”). In this image, calcific plaque is observed from 12 o’clock to 3 o’clock.
Important Safety Info: abbo.tt/2GyBrZ1
Read 12 tweets
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1/Welcome to our first OCT #Tweetorial! We'll cover a few key
concepts and share a step-by-step guide on the basics of image
interpretation 🤓 #imagefirst #OCTimaging

Important Safety Info: abbo.tt/2GyBrZ1
2/First things first, what is OCT?

OCT stands for optical coherence tomography which is an imaging modality that uses near-infrared light to provide high definition images of the artery.

Important Safety Info: abbo.tt/2GyBrZ1
3/What are the basic elements of an OCT image? Here's what you see in a radial cross-sectional view:

Important Safety Info: abbo.tt/2GyBrZ1 #OCTImaging #imagefirst
Read 8 tweets

Related threads

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#Tweetorial on hypoxemic #respiratoryfailure. #FITSurvivalGuide #FOAMed
1️⃣ Shunt
2️⃣ V/Q mismatch
3️⃣ Low FiO2/low O2 tension
4️⃣ Alveolar hypoventilation
5️⃣ Diffusion limitation
6️⃣ Venous admixture
#CriticalCare
1️⃣Shunt - can be intra or extrapulmonary. No V, only Q. Does not respond to O2 - shunt fraction not exposed to o2. Inflamm alveolar dz (eg PNA) can p/w shunt (imp. vasoconstr.) Think abt PFO w R➡️L shunt in PE, ARDS (elevation in R sided pressures), check bubble study. Aa grad ⬆️
2️⃣V/Q mismatch. More Q than V but regions with low V not entirely excluded from gas exchange. Can improve w increasing FiO2. Probably 75-90% of hypoxemia cases. Wide Aa gradient.
Read 7 tweets
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#Help Personally #Verified
I met Shyla last year in a meeting. Her father had dreamt of making her a doctor. But his dreams drowned in the sewer he had died in. This is her story. (ruralindiaonline.org/articles/my-mo…)
Ten years later, Shyla is almost close to realising her father’s dream. She is doing her nursing course, and she needs help. As a society that sent her father down the sewers, I think it is our responsibility to see that she becomes a nurse.
When I met her again last month, Shyla was exuding confidence. “I will soon be a nurse and if you need anything, call me over” she told me and i cant wait.
Shyla’s course fee for third year comes close to Rs 1 lakh. I already have someone pledging Rs 10,000.
Read 4 tweets
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1/
What happens after you inhale Histoplasma into your lungs? Is #histoplasmosis always a deadly disease?

Here’s a #tweetorial or #pathtweetorial

You are at risk if you live in the Ohio or Mississippi River valleys, go spelunking, or work with chicken coops
2/
Many (maybe most) people who inhale Histoplasma remain asymptomatic. Many have symptoms that mimic “the flu” and are treated as such. Only a minority of immunocompetent folks are seriously and acutely ill at first exposure. This is called acute pulmonary histoplasmosis.
3/
What do you think happens next in the vast majority of infected individuals?
Read 31 tweets
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#Tweetorial on #Diagnostics and #Screening interpretation.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
The test is over 99% accurate in people with the disease. For those without disease, the test is only wrong 5% of the time.

You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
Assuming they weren't immediately fooled by the "test is only wrong 5 % of the time," most I've asked correctly recognize the stats provided are Sensitivity = 99% and Specificity = 95%, and that the objective is to determine the Positive Predictive Value.
Read 21 tweets
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1/
Let’s continue with Day 7 of the cardiology #FITSurvivalGuide #tweetorial! Today we will talk about basics of stress testing for diagnosing CAD.

#ACCFIT #CardioMedEd #FOAMed @ACCinTouch @ACCCardioEd
2/
 Let’s start with a case: 55 y/o woman with CV risk factors presents to clinic with mild CP for 3 months. What is the next test if you want to diagnose significant CAD?
3/
 Not enough info. History/physical critical. Starting meds ok but get a diagnosis if case not clear cut. Exercise testing is better but not appropriate for every patient. Cath first if you believe unstable/high-risk disease or if symptomatic + high-pretest probability.
Read 13 tweets
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Hi everyone thank you for all your support and empathy in the past few days.
To minimize further injuries, the original voicemail with the intended subject's name has been removed, but I am reposting here with name obscured: soundcloud.com/user-251012259… (thanks for tech help!)
I am also reposting my entire Twitter message regarding this incident, with other important ideas I forgot to include:
four days ago my work phone got a rambling but confrontational 3.5 min voicemail from someone questioning my legitimacy to teach based on my presumed #citizenship and #ethnic identity. You can hear the actual message here: soundcloud.com/user-251012259…
Read 15 tweets

Trending hashtags

#US #causalinferencebook #ideals #Tweetorial #CTA #Kavanaugh #WithPanicComesMistakes #TWEETORIAL #TTE #targettrial #DueDiligence #forces #FLYJOHNNYFLY #tweetorial #PeerReview #Chinese #IVUS #pathtweet #cirrhotic #ML #FITSurvivalGuide #pathology #echo #Daraa #modern

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