Richard Sohn MD

Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside “brake defeat slot” (make sure to insert clip while pressing black button) #RadialFirst

@Iqbal48 @Umair2017 @imi_haf @DrHilal24718843 @mirvatalasnag @DrRajeshVijay @toreyj01 @aayshacader @IntervnCardio @sajannarayanan @PCRonline Focal hematoma between media & adventitia causing compression of lumen. Either SCAD (classic compartment in vessel wall, but unusual coronary location) but more likely guide trauma

44 Female, no risk factors for CAD. Admitted with AOE. damping of pressures and osteal RCA lesion. CAG and IVUS below. Your thoughts. @Umair2017 @imi_haf @DrHilal24718843 @mirvatalasnag @DrRajeshVijay @toreyj01 @aayshacader @IntervnCardio @sajannarayanan @PCRonline

#ANOCA — Best medical therapy ?? See these 👇🏼 fantastic references 1️⃣ Toleva et al, JSCAI 2025 2️⃣ Miner et al, Eur Heart J 2026 * I routinely copy👇🏼 into my reports #vasospasm @Hragy #MicrovascularDysfunction #MyocardialBridge @mirvatalasnag

@IhabFathiSulima @Abdul_alkindy Great example of a mid-LAD myocardial bridge. Usually not clinically important, but can in some patients be symptomatic. Also, many bridges cause diastolic restriction as can be seen subtly in your first screenshot 👀 More info 👇🏼

What is the Angiographic Finding?

Do any of you do SuperSaturated O2 (SSO2) for anterior STEMI? ➡️ What are your thoughts on this therapy?

@HeartOTXHeartMD @DocSavageTJU @iamritu @CannanCharles @Hragy @Obisht @jedicath @BaoGTran @saraceciliamtz @minhaskh @fischman_david @djc795 @mmamas1973 @DLBHATTMD @mirvatalasnag @SrihariNaiduMD @LeivaOrly @DrMarthaGulati @realarainmd @FaroucJaffer @rajivxgulati @DougDrachmanMD @ccijournal @aymanka @aayshacader @sbrugaletta @_radikalek @KardiologieHH @Pooh_Velagapudi @aspergian1 @timir_paul @SABOURETCardio LM spasm that didn’t resolve with NTG?

@DocSavageTJU @iamritu @RSohnMD @CannanCharles @Hragy @Obisht @jedicath @BaoGTran @saraceciliamtz @minhaskh @fischman_david @djc795 @mmamas1973 @DLBHATTMD @mirvatalasnag @SrihariNaiduMD @LeivaOrly @DrMarthaGulati @realarainmd @FaroucJaffer @rajivxgulati @DougDrachmanMD @ccijournal @aymanka @aayshacader @sbrugaletta @_radikalek @KardiologieHH @Pooh_Velagapudi @aspergian1 @timir_paul @SABOURETCardio I once sent a patient for CABG who had 90% ostial LM stenosis despite NTG. She was a colleague in my healthcare system. I saw her after again in the Cath lab after surgery. I apologized to her. She accepted. Lessons learned. #HumilityInMedicine

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

@DocSavageTJU @CannanCharles @Hragy @Obisht @jedicath @BaoGTran @saraceciliamtz @minhaskh @fischman_david @djc795 @mmamas1973 @DLBHATTMD @mirvatalasnag @SrihariNaiduMD @LeivaOrly @DrMarthaGulati @realarainmd @FaroucJaffer @rajivxgulati @DougDrachmanMD @ccijournal @aymanka @aayshacader @sbrugaletta @_radikalek @KardiologieHH @Pooh_Velagapudi @aspergian1 @timir_paul @SABOURETCardio Perfect reference for this case — thank you @DocSavageTJU ! Importantly, you found 50-50 split between genders, reinforcing that men too can have spasm

@RSohnMD @CannanCharles @Hragy @Obisht @jedicath @BaoGTran @saraceciliamtz @minhaskh 👍🏼 IC Nitroglycerin “the forgotten stepchild of interventional cardiology” @Hragy @BaoGTran @fischman_david @djc795 @mmamas1973 @DLBHATTMD @mirvatalasnag @RSohnMD @SrihariNaiduMD @minhaskh @LeivaOrly @DrMarthaGulati @realarainmd @FaroucJaffer @rajivxgulati @DougDrachmanMD

@BaoGTran @CannanCharles @Hragy @Obisht @jedicath @DocSavageTJU @saraceciliamtz @minhaskh No imaging done given the diagnosis

@RSohnMD @CannanCharles @Hragy @Obisht @jedicath @DocSavageTJU @saraceciliamtz @minhaskh What did intervascular imaging show?

@baijazvascular @evandrofilhobr @ShariqShamimMD @JayMathewsMD @SCAI Playing around w/ #heartflow app can be insightful. Watch this video 👇🏼 I made while scrolling around (angles displayed at bottom) ➡️ L-CRAN confirmed as best, and shows how caudal can be problematic

What’s your preferred angle to land LM ostium? RAO CRAN ~30/30 for me. I see others using spider view/caudal LM stent deployment sometimes but it often will lead to overhang. Add IVUS/floating wire to nail it.

@realarainmd @AsherElad x.com/rsohnmd/status…

Georgia O’Keeffe on my mind Oscar Wilde famously argued, “life imitates art far more than art imitates life.” The OCT image is from a case skillfully performed and shared by @AsherElad et al. The painting is Oriental Poppies (1928) by O’Keeffe. en.wikipedia.org/wiki/Oriental_…

@jbspadoni Fantastic case 👏👏 Btw, your #IVUS is another great example supporting “mechano-cardiac” (@rajivxgulati) causes for SCAD, eg takosubo, #myocardialbridge. Your patient’s bridge is exactly at proximal end of hematoma (bridges are not only found in LAD!):

SCAD is generally treated medically, but when you treat conservatively type IV you are only waiting for the infarct to complete. ivus> find the area hematoma/lumen compression -> fenestrate. Do not stent as this vessel will heal

@MichaelMegalyMD @MichaelMegalyMD So do you not modify your use of contrast in CKD patients, e.g limiting numbers of angiographic views, tending away from OCT, staging PCIs, etc?

Finally!!! I always believed contrast-induced nephropathy is just an urban myth

1/ MYOCARDIAL BRIDGES (MBs) ANOCA mechanisms: - Slow early diast relaxation - Diast vessel restriction +/- neg remodeling - Branch steal (Venturi effect) - Proximal atherosclerosis - Associated vasospasm, CMD (common!) (see next for MINOCA)

@DocSavageTJU @ChangeAtHeart @AlexandraLansky @HenrytTimothy @mmamas1973 @MyJSCAI @djc795 @TCTConference @crfheart @NishithChandra @ShariqShamimMD @heart_spasms @InocaInternati1 @Hragy @aymanka @aayshacader @AnastasiaSMihai @DrMarthaGulati @saraceciliamtz Such great work by @ChangeAtHeart, @samitshahmd and all the registry investigators! This should help reassure apprehensive ICs to begin their own #ANOCA programs. No doubt a great presentation— wait, that’s me in the headphones!

Safety of #Acetylcholine testing in the #DiscoverInoca registry - outstanding presention by @ChangeAtHeart #TCT2025 #iNOCA @AlexandraLansky @HenrytTimothy @mmamas1973 @MyJSCAI @djc795 @TCTConference @crfheart @NishithChandra @ShariqShamimMD @heart_spasms @InocaInternati1

@mmamas1973 Can’t wait for the 5-year superiority data!

SELUTION DeNovo - non inferiority for TVF at 1 yr demonstrated. Randomisation before lesion prep ➡️ 20% DES use in DEB arm ➡️ 50% non inferiority margin of overall tvf in both arms !!!!! ➡️ TVF 4.4 vs 5.3% in des and deb arms This is a landmark moment- analogous to introduction of DES (even with generous non inferiority margin) #TCT2025 @crfheart Wild clapping in audience @Hragy @jgranadacrf @mirvatalasnag @drptca @SrihariNaiduMD @realarainmd @DrAsifQasim @DavidWienerMD @sbrugaletta @alaide_chief

@SarahFairley7 @mmamas1973 17%

@mmamas1973 What was the intravascular imaging rate in the DES group @mmamas1973 if you don't mind me asking. Not there in person. Devils advocate could say that DEB is non-inferior to DES without imaging....

@jbspadoni Hmm, doesn’t look like bridge or SCAD / hematoma to me. Maybe a vein coursing around the coronary? @jbspadoni do you know what this is? (Why was IVUS done in this otw normal looking coronary?)

Ivus quiz: what do you see here?

@sbrugaletta @AntonioMariaLe2 @ehj_ed @ESC_Journals @escardio Our current terminology is problematic for these reasons but also because these same entities (ie vasospasm, microvascular dysfunction, myocardial bridges, etc) can often cause angina / ischemia in pts who ALSO have epicardial CAD, eg those who don’t improve with PCI / CABG

@AntonioMariaLe2 @ehj_ed @ESC_Journals @escardio I totally agree with you @AntonioMariaLe2. to improve also the inclusion of ANOCA and INOCA in a same pathway..."NOCA" syndrome? or "differently" obstructed coronary disease?

Angina with non-obstructive coronary arteries: coronary function testing or angiography alone to guide treatment? Clinical trial results are out. doi.org/10.1093/eurhea… #INOCA #MI #coronary #angina #cardiotwitter, @ESC_Journals, @escardio

Calcium score CAC = ZERO ➡️ But this 👇🏼👇🏼👇🏼 👀 (Class 3 angina on meds) PCI or CABG❓