1/7 A thread 🧵Intravascular lithotripsy (IVL) can help modify calcified lesions - why doesn’t it harm soft tissue? Let’s dig deeper. A thread🧵@DGK_org @YoungDgk @AvrahamCooperMD @PCRonline @Dr_DanMD @SCAI @guilbon @Hannah_Billig_ @yourheartdoc1 #CardioTwitter #CardioEd https://www.hmpgloballearningnetwork.com/site/jic/original-c
2/7 Back in 80s extracorporal shockwave lithotripsy was introduced as a novel noninvasive treatment of renal stones. 40 years into the future we’ve taken this technique to the next level #IVL #MedTwitter

doi.org/10.1016/S0301-… https://doi.org/10.1016/S0301-5629(01)00345-3
3/7 Changes have been made to utilize shock waves intravascularly:
➡️emitters mounted on balloon angioplasty catheters delivering waves pulsatile & circumferential
➡️minimal peak negative pressure pulses (0.3 MPa)
➡️into target vessel via 0.014 wire
➡️balloon inflated to 4 atm
4/7 Shock waves are acoustic waves.
Upon reflection, positive turn into negative waves & vice versa. This leads to cavitation of water (formation of bubbles). As bubbles collapse, energy is released, generating secondary waves. This helps fragment plaques.
doi.org/10.1063/1.5092… https://doi.org/10.1063/1.5092317
5/7 Now that we’ve seen that energy is released mainly when acoustic waves are reflected, it’s clear why they don’t harm soft tissue:
Reflection takes place at border zones of different impedances. Water & soft tissue have similar impedances; Imped. of calcified plaques is higher
6/7
Disrupt-CAD III and Disrupt-PAD III showed that lesion preparation with #IVL is safe and effective in a follow-up of 1 year.
➡️Disrupt-CAD III: doi.org/10.1016/j.jsca…
✍️ @djkereiakes, @GreggWStone et al. @SCAI
➡️Disrupt-PAD III: doi.org/10.1016/j.jsca…
7/7 In summary:
🥇Borderzones of impedance are places of generation of secondary waves & energy impact
🥈Emitters are in angioplasty balloons to keep IVL cool, to work w/ low peak neg. press & to align impedance btw balloon & soft tissue
🥉Lesion prep w/ #IVL is safe & effective
Here’s the link to the whole thread 🧵

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More from @realdocdan

Aug 22, 2022
🧵 1/7 Ever wondered why the Osborn wave looks the way it does? Stay with me during my newest #tweetorial. A thread 🧵1/7
#cardiotwitter #EPeeps #CardioEd #MedTwitter @TRassafMD @YoungDgk @DGK_org @YoungDZHK @AaronGoodman33 @Steph_Achenbach @fuzzymittens @AvrahamCooperMD Image
2/7 History
First described in 1953 by Osborn (camel-hump sign) upon #hypothermia in dogs. Upon systemic analysis similar #ECG patterns have been described in
➡️ hypercalcemia
➡️ brain injury
➡️ SAB
➡️ vasospastic angina / ischemia
3/7 Emslie-Smith et al showed that Osborn waves manifested more in epicardial than endocardial leads. Others finally showed that 4-aminopyridine sensitive transient outward current (Ito) is responsible and predominantly located in epicardium. ⬇️ heart rate led to ⬆️ Ito current
Read 7 tweets
Jun 12, 2022
2/9 Being a fibroelastic sac the pericardium covers & protects the #heart

In constrictive pericarditis:
1️⃣healing of acute pericarditis
2️⃣granulation tissue
3️⃣obliteration of pericardial cavity
4️⃣loss of pericardial elasticity
5️⃣restriction in ventricular filling

#CardioTwitter
3/9
Correspondingly #cardiacimaging with #cardiacMRI in T1 mapping shows ⬆️ extracellular volume in myocardium, suggestive of global myocardial fibrosis, as shown by doi.org/10.1016%2Fj.jc… 10.1016/j.jccase.2018.06.001
Read 9 tweets
May 27, 2022
🧵 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). https://doi.org/10.1253/circj.cj-10-1278
📍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 https://doi.org/10.1253/circj.cj-10-1278
Read 9 tweets

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