Sanjay Kunapuli MD FACC

@AlphaBetaAnil Anil- this problem is pervasive in academia- while constantly shunning communal practice, often times preaching from ivory Towers, talking about equality while their actions often times counter everything that they preach

Hard truth from years in shiny ivory towers and underfunded wards: some ‘experts’ are just overconfident storytellers with white coats. They don’t know what they don’t know, but they’ll still go on TV, on panels, and on X to defend their priors and call it science.

@krisvancleave @carlquintanilla @krisvancleave- total mess @ Hobby today. We stood in line for 21/2 hrs, missed our flight . Finally able to get on after 6 hrs. Terrible for families with kids and elderly

TSA wait times are Houston Hobby are showing at least 2hrs and we are hearing reports of similarly long lines at the New Orleans airport. TSA officers are going without a check this pay period as the partial Govt shutdown impacting DHS continues.

@AustinBourgeois This is a technique that I used to do in the past. Worked but multiple sticks . Now I just go up and over.

I have a partner who has spent the last couple years refining a technique of posterior tibial vein access using large-bore devices for DVT intervention. Intent is to clear popliteal inflow. The method involves PTV access, 7mm balloon angioplasty of the PTV, 16Fr suction and/or clottriever through the pop and PTV. Then, as in the case shown, a separate access of the popliteal vein for treatment of the iliofemoral segment and stent placement. It seems arduous but this case took just shy of an hour. What are your thoughts? #iRad

@Hragy I started left TRA , switched to right TRA, tried/used DTRA, but then stopped- I still think left TRA is something all operators need to mean- esp if venturing into radial

2019 Ferdinand Kiemeneij Came to Cairo where I learned distal radial access from him. After he left I considered but found no real personal need for distal radial access for me, but was good to meet again, to learn something new,and since then using US guidance and more left side

@AustinBourgeois Left side of thrombus, especially in the left upper lobe or in a distal left main has always been problematic, but my go to is a T 24 curve

6 years after large bore thrombectomy became mainstream, left-sided predominant thrombus remains the challenge in PE intervention. Coaxial T24 and T20 curve is my comfort zone, what's your go-to? #iRad #PERT

@realarainmd @MichaelMegalyMD Excellent case. @realarainmd I’ve used #HDR in venous cases and it gets the job done . Thanks for spreading #HDR

An #HDR Of A Different Color #HDR is great for partially organized thrombus, be it in the coronaries, the peripheral arteries, the pulmonary vasculature, and yes, DVTs! A brilliant #contrast1st case by @MichaelMegalyMD. 👌🏼

@jtsaxon @djc795 Last year, we had 2 IC Job Openings in our group. We interviewed a total of 20 fellows, 19 of them who wanted to practice SHD- only one wanted to practice IC. Even better one of the candidates stood us up and never showed up to the interview.

Hearing a lot of talk about unfilled Interventional Cardiology fellowship positions. Anyone heard the same? What could possibly be the factors driving this? #accfit @djc795

@mcuban @mcuban - why not have a two tier system: a government supported mini Medicare type which gives everyone from 18 to 65 -4 preventative MD visits/yr,and 2 visits to the ER covered, and anything more can be bought through HSA

Curious what healthcare geeks think about the idea of a short-term response to the ACA premium subsidies discussions: put $100 per month into an HSA that can only be used for a Direct Primary Care monthly subscription, and the balance of the expected subsidies to be used as originally planned for premiums. Having DPC should lower the plan's cost, which should allow premiums to be lowered rather than raised. Thoughts? What am I missing? @SenRonJohnson @SenBillCassidy @SenRickScott

@realarainmd @realarainmd thanks for the excellent tutorial. What’s your experience with OPN a balloons for vessels with just an arc of calcium? (one quadrant)?

My Best OCT Image! 🧶 This image is ‘one in a million’ - literally, because I looked at 100s of 1000s of imaging frames this week. 😂 This shows the final appearance of an LCX treated with scoring PTCA, NC 🎈, and DCB. Analysis to follow…

@DeepValueBagger Nicely said - Home run - wait for it , hit it out of the park . Always appreciate your posts

I think about this a lot in regards to growing my portfolio and without taking on more risks. There's a sweet spot somewhere. Opportunity comes in very short time span, and I always think of different strategy to maximize returns. This is equivalent of me at a good fishing spot, and using triple hooks to catch 3 good size fish, or 1 big hook for the big grouper fish -- or do both. As a side note, I unfollowed a bunch dividend accounts recently.

@realarainmd Nice case. Completely agree DCB are changing the landscape. In my practice, I have shifted too DCB for mid/distal LAD lesions- not burning any bridges to CAB

Drugs On The Mind As my #TCT2025 comes to an end, here are 3 🔑 takeaways: - DCBs are the future - Or, perhaps it is BVS - Eitherway, vessel prep and physiology matter! Here is the last case I did before I came to #TCT2025. As they say, the future is now. 38 y/o w CAD + DM1!

@jedicath As senior cardiac surgeons are retiring, it’s becoming increasingly difficult to find cardiac surgeons that have adequate volume and as a result outcomes for suffering. Obviously big centers still have higher volumes, but the issue is much more prevalent.

Heard at #TCT2025 “avoid sending young patients to surgery” (Sreenivas Kumar) 𝚊𝚜 𝚝𝚑𝚎𝚢 𝚊𝚛𝚎 𝚋𝚊𝚌𝚔 𝚒𝚗 𝟷𝟶 𝚢𝚎𝚊𝚛𝚜 𝚊𝚗𝚍 𝚘𝚙𝚎𝚗𝚒𝚗𝚐 𝚗𝚊𝚝𝚒𝚟𝚎 𝙲𝚃𝙾𝚜 𝚒𝚜 𝚎𝚡𝚝𝚛𝚎𝚖𝚎𝚕𝚢 𝚍𝚒𝚏𝚏𝚒𝚌𝚞𝚕𝚝 𝚊𝚏𝚝𝚎𝚛 𝚂𝚅𝙶 𝚏𝚊𝚒𝚕𝚞𝚛𝚎𝚜. 𝚃𝚎𝚗𝚍 𝚝𝚘 𝚊𝚐𝚛𝚎𝚎

@jedicath CABG volumes ↘️,#cases/surgeon⬇️🙃graft failure rate ↗️

@AndrewJSauer @AndrewJSauer -so well written and so true. The biggest flex is to have no debt. It makes a big difference in how we approach our work and also the choices we make. Financial freedom is priceless. I call it financial nirvana.

In 2014, when I started my first real job as a cardiologist, I didn’t even know how deep in debt I was. After years of deferral and forbearance, the total hit me: $350,000 in student loans, car loans, credit cards, and an underwater condo. My net worth was –$350K at age 32. Over the next decade, we attacked every form of debt using the snowball method—while also saving and investing aggressively in retirement and real assets. We focused on cash flow, avoided lifestyle inflation, and even froze our credit to keep ourselves honest. It wasn’t easy. Early on, I watched peers take European vacations, buy 6-figure cars, and build dream homes. We drove older cars and paid down debt instead. A few years ago, we crossed zero. Now our only debt is our primary home—at 3.125%, less than half its value. The sense of freedom is hard to describe. Debt quietly suffocates you, and you don’t realize it until you can breathe again. I still keep my credit locked, which means I can’t buy a car unless I have the cash. It’s a built-in speed bump against impulsive spending. Some say I’m foolish for not “leveraging” more debt to build wealth. Mathematically, they might be right. But psychologically, the peace of mind and flexibility have been priceless. It’s let me choose work that’s meaningful, not just lucrative. If you’re deep in the hole and grinding your way out, stay the course. Ignore the noise about what you “should” buy because of your income. The freedom is worth more than the car, the house, or the trip. That said, you can indeed enjoy those eventually, just a bit more delayed after the disciplined years. Not financial advice—just lived experience. Take it for what it’s worth.

@jedicath It’s unfortunate that in 2025 with all the evidence of image guided PCI, imaging is still utilized- I see this everyday . 🤷🤦

“IVUS is useful but not essential” “IVUS is available but we won’t use it” “We didn’t want to waste time with IVUS” -said during live cases. At different times and places - 2024

The rocket came back from space at hypersonic speed and then hovered at a precise position

@realarainmd @Laserrman Excellent tutorial. Thank you @realarainmd , @Laserrman

A state of the art tutorial on 3D wiring for #CTOPCI. Sensei @Laserrman has greatly simplified 3D wiring in this tutorial. It is impressive (but not surprising) how much he packs into 11 minutes! For CTO and 3D wiring aficionados! 😀

@SuperLuckeee @grok what does this mean ?

TSLA a massive cup & handle forming now (you'll see how this goes)

@realarainmd @realarainmd . Very interesting data, esp re:LIMA. How much of this do you think is related to surgical volume? With decreasing surgical volume especially in the US, don’t you think this is going to be a bigger problem?

This is the original post by Alex. I have just reformatted the table for better readability. After the paper, read the entire discussion - and let me know your thoughts! x.com/agtruesdell/st…

Post CABG Graft Failure Rates At One Year These are the graft failure rates by conduit and treated vessel from a paper shared by @agtruesdell earlier today. The numbers for combos listed in parentheses are small <50 Not likelihood ratios, but still food for thought!🤔

@AlphaBetaAnil @AmineKorchiMD @Heartflow High likelihood

@HoustonHrtDoc @AmineKorchiMD @Heartflow Probably Siemens?

@Heartflow went public recently at a $2.3B valuation, and many asked me if I bought the stock. I spent some time last weekend diving into their S-1, and here are my thoughts. A thread about $HTFL #IPO 👇