Tim Simpson

@MarekRadomski71 Nice result. What’s been your experience with HDR adjacent to bifurcations? Assume it follows more compliant limb of the CTO, much difficulty reentering into side branch?

#CTO #HDR #PCI #CardioTwitter 68yo female with RCA CTO. AWE (#Gaia2Next #TurnpikeSpiral) > last 1 cm HDR (#Finecross #FielderXTA )

@realarainmd @agtruesdell Could well be- will keep a closer eye on it

Depends on the case Tim. Difficult to generalize but SB closure AFTER post dilation is usually related to either: a) the POT balloon being to deep into the carina, or b) the DOT balloon being too proximal. In both cases it is the encroachment of the balloon shoulder on the carina that causes additional plaque shift after stent placement.

So much to say, not enough time in the day! We did our 4th CTO of the week today - and the 4th #HDR! But what I want to talk about is #JSBT. This is a mini tweetorial - dedicated to @agtruesdell. Set up - 68 year old man with angina + lat. wall ischemia. LAD apical scar with peri-infarct ischemia.

@agtruesdell @realarainmd Thanks for sharing- homework for the weekend.

@TimSimpsonMD @realarainmd 👍I favor Balloon 🎈that extends proximal to the Stent: pmc.ncbi.nlm.nih.gov/articles/PMC85……

@realarainmd Interesting work- thanks for sharing.

12/ Anyway, coming back to #HDR, the principle is the same - contrast can go where wires won’t, at least not easily. This is the last detailed #HDRanalysis for the 2024! I wanted it to be a special one. 🤩 Hope you are enjoying talking about #HDR as much as I am. I look forward to keeping the conversation going! 🙏🏼

💧#HDRanalysis 🧐 - Case 027 An CTO Intervention Unlike Any You Have Seen! 🧵 Here is an unusual CTO for most. The patient is a 48 year old woman with systemic sclerosis (SSc), Raynaud’s, and non-healing ulcer of the left 3rd digit. Here is the patient’s hand. More…👇🏼

@AaronGoodman33 Incidental coronary artery calcification checking in

@drbharatsambyal @RSohnMD No stent, put her on b-blocker and Asa, FMD workup negative. No further ischemia or angina and discharged home

@RSohnMD @TimSimpsonMD Great run sir. The interesting question is, what was done next? Please do share the plan and final outcome

Beautiful OCT of LAD #SCAD … … BUT what other potentially relevant OCT finding do you see ?? 👀 See thread 👇🏼👇🏼👇🏼 for answer case shared by @TimSimpsonMD

@Teebi_MD @YaleCardiology Congrats buddy! Yale is luck to have you… Looking forward to watching all your successes from afar

Graduating Cardiology Fellowship🎓 Officially a Cardiologist✅ Wrapping up a 3-year journey in Cardiology at OHSU. Grateful to my family, mentors, and educators for unwavering support ♥️ Final stop? Cardiac Electrophysiology (EP) at Yale University 🫀⚡️@YaleCardiology @OHSUCardFellows #cardioTwitter #Epeep #Cardiology #NewHaven @OHSUNews

@MichaelMegalyMD If no ischemia could let it marinate w more IIbIIIa if ischemia CatRx, image, stent. Had a recent anurrysmal RCA w huge thrombus and catrx just couldn’t clear it- used Angiojet and worked beautifully followed by 5.0 stent

@DrJayMohan @rajivxgulati @RajTayalMD @Babar_Basir @ShariqShamimMD @LAzzaliniMD @evandrofilhobr @Almanfi_Cardio @SandeepNathanMD @mirvatalasnag @DrBillLombardi Can’t make sense of the LM. I’d try an undersized MP from above, possibly w guideliner. If LM find a surgeon if not laser/dcb ramus depending on availability

Mid 70s patient (hx of IVDU) presented with chest pain. Hx of “prior procedures” from outside hospital. NSTEMI so took to the cath lab and found this… Looks like chimney stent with S3 and previous trifurcation stent with severe ISR. What would you do next? #Cardiotwitter

@yassersadeknhi Why not go b/l radial? This seems like excessive risk with minimal benefit.

Completed 100 CTO cases dual access (radial and ulnar) soon will show our results

@DOM_UCLA @HsuePriscilla @UCLAHealth @dgsomucla Congrats @HsuePriscilla! Well deserved.

Pleased to announce that Priscilla Hsue, MD will join @dom_ucla as the new chief of cardiology. She is a distinguished physician-scientist leading groundbreaking research in HIV-related CVD, with a commitment to mentoring future leaders in medicine. Info: bit.ly/3TgVsGj

#LateBreaking science from #CRT2024! Read key #InterventionalCardiology takeaways from 5 trials featured at this year’s meeting with top takeaways drafted by SCAI experts ➡️ bit.ly/CRT24Takeaways @CRT_meeting @FarshadForouz @chadialraies @TimSimpsonMD @bkolskk @Allison_Dupont

@evandrofilhobr @ShariqShamimMD Agree- there was already faint staining, probably from flush and filling w con.

@ShariqShamimMD The vessel is already injuried by catheter and the following hydraulic dissection propagation

Fellows watch it carefully. Catheter is against the inferior wall pushing the proximal RCA. If you see this either withdraw or exchange with different catheter. Watch how catheter moves towards the Shepards hook dissecting the RCA. Published in PCR.

@RSohnMD @TWilsonMD Absolutely re: ostial lesions. Had a recent mid RCA w a poorly chosen under supportive guide (you know the one) and delivered 5.5 extension down within stent to deliver post balloon. Painful and risk LSD taking extension in and out to IVUS- this would have been perfect.

@TimSimpsonMD @TWilsonMD To clarify, should use IVUS for ostial PCI. OCT can't see in aorta so you won't see protruding struts or efficacy of Ostial FLASH. But every so often, the ostium needs to be covered and already have OCT on table. This was 7F w/ 1:1 Guideliner, so refluxed contrast

POP QUIZ! Intracoronary Imaging 1. Besides metal, name 4 things that OCT can’t see through 2. Besides metal, name ONE thing IVUS can’t see through Answers 👇🏼

@RSohnMD @TWilsonMD Are you using a 1:1 sized guideliner and relying on reflux from guideliner injection or can you go smaller and fill contrast around guideliner?

@TWilsonMD Guideliner:

@AlanHeldman @rajivxgulati @abouzaki_md What are the super wiggles? You add some bends proximally to get even more support?

@rajivxgulati @abouzaki_md But you may have to shape additional super-wiggles into the wire. If you plan well, you can put a wiggle right where you need it to get around an obstacle. And only deliver the wiggle wire through an exchange catheter.

Gamechangers 👍Guide extensions 👍Rota 👍Wiggle wire 👍Dest slender 65 cm 👍Double Perclose

@oqabdoc @mmamas1973 @MedCrisis @rajivxgulati @minhaskh @djc795 @KPujdak Usually well intentioned but I’m not comfortable w it and call it out by saying “it’s going to be 20 minutes of boring question. I’ll summarize the plan at the end and happy if you want to record that part of the conversation”

#medtwitter what do you think about patient or family members audio/video recording your interactions? I normally don’t mind if I was asked but recently noticed an “under-the-table” recording which made me think about this issue! It shouldn’t but changes behavior/content I think.

@olsonplanner 2001 Toyota 4Runner w 200k miles. When it explodes I’m going to leave it on the side of the road and buy a 2010 4Runner.

What kind of car do you own now? What kind of car would you like to own?

@SantoRicceri @ECGcases @Maz_EB @PendellM @smithECGBlog @chartierlucas 100% agree!

@ECGcases @Maz_EB @PendellM @smithECGBlog @chartierlucas Nice study, but the OMI definition seems a bit broad w/ inclusion of non-occlusive disease on cath, where dif management strategies may be appropriate. “culprit lesion with TIMI 0–2 flow, or with TIMI 3 flow and peak trop > 10K ; or, if no angiogram, peak trop >10K with new WMA”

#STEMI criteria miss most OMI, and discharge diagnoses change to highlight false positive but not false negative STEMI. "Missing occlusions: quality gaps for ED patients with Occlusion MI", new study with @Maz_EB @PendellM @smithECGBlog @chartierlucas sciencedirect.com/science/articl…