Timm Matthiesen 📯

Summary of all Late-Breaking Trials at #ACC2026 – take home points @ACCinTouch @ACCmediacenter @JACCJournals 1. HI-PEITHO: Ultrasound-facilitated catheter-directed thrombolysis led to a lower risk of PE-related death, cardiopulmonary decompensation or collapse, or recurrence of PE. vs anticoagulation alone in intermediate-high risk PE.

#IVIguided PCI in ectatic LAD. #Episode 17. 📌 Imaging is key! 📌 Stent selection is important! #InterventionalCardiology #intracoronaryimagine @esbrilakis @realarainmd @stefan_harb @sbrugaletta @dautov_MD @jbspadoni @NievesGonzalo1 @SarahFairley7 @MdSomov @Pooh_Velagapudi @evandrofilhobr @ziadalinyc @AlbertoCereda1 @FranceskAlbs @MohammedAlo @Hragy @mmamas1973 @aspergian1 @mirvatalasnag @Abdul_alkindy @whitfieldlewis6 @TWilsonMD @ShadiYaghi2 @jedicath @rotamonster @Laserrman @Sh_Zaynobidinov @GopalKkoduru @DrMarthaGulati @nadig_cardio @iamritu @ArielRoguin @nicolasamabile @bostonsci

OPTIMAL suggests that using IVUS in unprotected left main PCI may cost you 22 minutes with no clinical benefit. One might think it’s an outlier. Yet, the same day, IVUS-CHIP reports no advantage of IVUS over angiography in complex high-risk PCI. Either we have been fundamentally misinterpreting the evidence so far, or we urgently need to reconcile these data. #ACC26 nejm.org/doi/full/10.10… nejm.org/doi/full/10.10…

Aptly named ALL RISE trial at #ACC26. Wire based FFR vs conventional Angiogram based FFR. Despite large data Physiological assessment in lab still low for well known reasons. With non-inferiority of trial, probably it's time to quickly adopt the angiogram based FFR and move away from percent stenosis that leads to occulo-stenotic PCI. Hopefully implementation is not expensive.

1/16 🧵 ORBITA-CTO: The first randomized, placebo-controlled trial of CTO PCI. 📰 Published in JACC, presented at #ACC26. 🔬 Finally, sham-controlled evidence for what we do in the cath lab every day. One of the best designed studies I have ever seen! A biostatistical deep dive. Let's go. 👇

HI-PEITHO key takeaways #ACC26 🫀 Intermediate-risk PE = stable patients with RV strain + positive biomarkers ⚖️ ultrasound-facilitated catheter-directed thrombolysis + AC vs AC alone in this “gray-zone” group 📉 ↓ Early clinical deterioration: 4.0% vs 10.3% 🚑 Benefit driven by ↓ hemodynamic collapse—not mortality 🩸 No ↑ major bleeding or ICH → supports selective early intervention

Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis at 10 Years: @NEJM 🥸 Asymptomatic severe AS - more evidence accumulate 😱 Let's summarize the RECOVERY trial 👇👇👇👇

Welcome to the Side-Arm Technique on Perclose (STOP) technique: a simple, low-cost method to prevent or stop bleeding from large bore indwelling catheters by activating Perclose sutures for complete entry site sealing onlinelibrary.wiley.com/doi/full/10.10… @ccijournal

Young woman w/ VF arrest This 👇🏼 angiogram after ROSC 👀 Hemos stable, no CP What is the etiology, and what next?

ROLLING STONE: Intravascular lithotripsy or mechanical debulking in complex calcified coronary arteries 🔗pcronline.com/PCR-Publicatio… Journal Club: @aayshacader reviews ✍️this multicenter, prospective study 📊 that compares IVL and atherectomy (rotational and orbital) for treating heavily calcified coronary arteries, assessing real-world safety and effectiveness in PCI. #clinicaltrial #science #interventionalcardiology #cardioX

@realarainmd @DrJayMohan @KPujdak @DrRajeshG1 @SrihariNaiduMD @MichaelMegalyMD @djc795 @jl35wilsonMD @rational_doc how many times have you seen this variant? 1,0,0 LAD-RCA lesion!

This state-of-the-art review outlines current evidence on the mechanisms, prevalence, clinical relevance, and management of TAVI thrombosis and highlights ongoing clinical trials investigating this condition. eurointervention.pcronline.com/article/transc…

62 year old male with Severe AS undergoing preop coronary angiogram before AVR. Fellow says Catheter is not going up. What could be wrong here?

Intra- and extra- cardiac shunt can coexist. Differentiate mainly via flow pattern not cycle timing. •PFO: transient/intermittent bolus which can be late if RAP>LAP occurs late. •Transpulmonary: continuous trail of bubbles; can occur early for example in liver cirrhosis patients with large stroke volumes.

Must-read perspective on different strategies for managing ostial stent protrusion in the latest issue of Catheterization and Cardiovascular Interventions onlinelibrary.wiley.com/doi/full/10.10… @ccijournal

A case of ischemic MR.If there is a 90% lesion in mid part of dominant LCX with other vessels normal,what is the management option?(A) CABG with MV repair (B) PTCA to LCX and watch regression of MR (C)PTCA to LCX followed by Mitra clip later (D) CABG with mitral valve replacement

Transcutaneous pacing (TCP) is used to treat unstable bradycardia. In this multi-center study of TCP performed by paramedics, only 9.7% had sustained electrical capture, suggesting the procedure is frequently performed ineffectively. @ResusJournal share.google/KoRFnO6XMfUkKI…

Ten rheumatology clinical pearls every doctor should know. • Normal ESR does not exclude rheumatoid arthritis • Ferritin >10,000 → think MAS/HLH • CK can be normal in inflammatory myopathies • Severe headache >50 yrs → rule out GCA • Persistent monoarthritis → septic arthritis until proven otherwise Early recognition prevents irreversible organ damage. #Rheumatology #MedTwitter @DrAkhilX @IhabFathiSulima #ClinicalPearls #MedicalEducation

An Impossible Argument! Today I was pleased to speak at Houston Shock Symposium #HSS26 The topic: CTO Interventions in AMI CS! 😳😅 This could have been a 1 slide presentation - not indicated! 😂 But I didn’t want to disappoint @JumeanMarwan, good friend and gracious host!

#JADEL I've read about this. I know this exists. But, I still never thought I'd see it: Now in CASE @CASEfromASE (now in SCOPUS) Must read: doi.org/10.1016/j.case… A. Bridge B. Anomalous C. SCAD D. Other Follow thread for the Echo, CCT, CMR & OR findings ... @ASE360