Ryan Watson

GfbgfgffgfffffbmnHgjfhHjjxmnbmjv app.givebacks.gives/winterbreakfas…

@LeivaOrly What’s worse is when the anatomy is defined and then you find severe disease as the interventionalist and say medical therapy when they have >70% stenosis and usually 90 plus percent. As the IC in these cases we are ridiculed if we stent and ridiculed by patient if we dont

Stress tests in asymptomatic patients, in most cases, are unnecessary. What’s concerning is that a fourth of people said define anatomy even when he went 13 min on the Bruce. How is that going to make him live longer or feel better? It won’t.

@SVRaoMD Bigger concern for this study is how high the failure rate of these grafts are at 24 weeks….25 percent in the diltiazem arm is alarming

Very interesting study - seeing a lot more radial grafts for CABG but their long term patency in clinical practice remains unclear. This RCT shows that vasodilators help keep these grafts open. #RadialFirst (but for grafts...)

Go birds

@agtruesdell @MichaelMegalyMD Important for all when they take a new job or first job. Know where the equipment is. Most have never deployed coils or dealt with perforations. Need to know your supplies. 0.14 coils are not the norm in most labs

@MichaelMegalyMD #11 Practice-rehearse with Team via elective non-emergent SVG coiling…so when “emergency” time comes…it’s reflex/muscle-memory👍…

A quick primer on wire perforation coiling. A must know for any #CTO #PCI enthusiast 1-Hemodynamic stability. IV fluids/pressors/emergent pericardiocentesis if needed. 2-Identity where the perf is coming from quickly (review what you did and images). Not always easy. Can take another zoomed cine to help 3- wire the branch you want to coil, advance microcatheter 4-use 0.014 compatible coils (this one was penumbra ruby LP), mostly 2X4 would be good enough for most wire perforations 5-reconfirm by injection through MC 6-Pull coil out of the hoop, use introducer to advance in MC (small bites-avoid kinking as it might deploy the coil inadvertently) 7-push coil out then pull in before fully advancing to confirm it was not deployed inadvertently. 8-push coil until u r satisfied, then deploy with the deploying device or by kinking the back end of the coil shaft. Pull the shaft out. 9-Confirm with injection through MC or puffing 10-Add more coils if needed, mostly packing coils would work to seal whatever is left. #CardioX #ACCIC #ACCFIT

@PedroMDMSc @LaiLeoDr @CraigBasman @HFHCardioFellow @kentso987 @MichaelChiangCS @fangjonathanx Any concern for central MR when going that big with the balloon?

@RWatsonMD @LaiLeoDr @CraigBasman @HFHCardioFellow @kentso987 @MichaelChiangCS @fangjonathanx Valve expansion . Pinwheel in low flow states in my opinion not ideal. I use smaller valves with more volume in general for VIr

TMVR VIR with Batman @HFHCardioFellow Master Pedro @PedroMDMSc @kentso987 @MichaelChiangCS @fangjonathanx

@LaiLeoDr @CraigBasman @HFHCardioFellow @PedroMDMSc @kentso987 @MichaelChiangCS @fangjonathanx If your going 26 + 5 why not consider a 29 at that point? What is your main factor in that decision?

@CraigBasman @HFHCardioFellow @PedroMDMSc @kentso987 @MichaelChiangCS @fangjonathanx Thanks ! It’s a 30mm ring No, still based on the CT annulus What’s your view?

@jbspadoni @Laserrman @evandrofilhobr @UICcardfellows @KhalilIbrahimMD @spiritus_bah @mividovich @AdhirShroff @Babar_Basir @SarojNeupaneMD Agree with others. Stent looks deformed but oddly based on the proximal edge not looking deformed but immediately after. Agree angio here would be interesting but probably looks ok. NURD artifact very interesting thought

@RWatsonMD @Laserrman @evandrofilhobr @UICcardfellows @KhalilIbrahimMD @spiritus_bah @mividovich @AdhirShroff @Babar_Basir @SarojNeupaneMD Yes. This ivus is immediately after stent. Ivus pre not that much calcium. Post dilation was 4.0 or 4.5 NC

IVUS quiz: What would you do next? This is a repeat IVUS after the operator post-dilated the stent w/ NC at 22 atm. LAD lesion #FIT @Laserrman @evandrofilhobr @UICcardfellows @KhalilIbrahimMD @spiritus_bah @mividovich @AdhirShroff @Babar_Basir @SarojNeupaneMD

@PurumittalDr Would probably leave under expansion marinate in heparin plus 2b3a and then bring back in a few days to optimize stent.

7F, fem. easy crossing with runthrough thrombosunction. LCX wiring. prediat with NC, Aperta 2.5 *10 mm for LAD os. Mid LAD stent 3.0*40, LM - LAD Cross over 4.0*28. LMCA  POT with 4.5*10 NC would you prefer risking thrombus exrrusion by doing POT or un opposed stent in LM

@markiewicz_md @jcgeorgemd @mmamas1973 @JayMathewsMD Have the same patient less than one month ago. Switched to warfarin and will know soon whether it did anything. Good luck and I’ll keep you updated

Question: 74 yo no surgical patient . Mg 6 mmhg after 34 evolue Oct 2023 now46. Was on eliquis entire time 5 bid due to Afib . Now comes in chf and pedal edema . Ct c/w halt . Do you change Coumadin ? Will that do anything or Viv? @jcgeorgemd @mmamas1973 @JayMathewsMD

@baijazvascular @vascularIR @JimGMelton @jcgeorgemd @JayMathewsMD @JVargheseMD @VladLakhter @AmputationSuck If worried about treating and want larger sheath two options are brachial (don’t know if you can get atherectomy there) or pop access. CSI solid crown followed by IVL. Not sure anything is going to look great there due to recoil

If CFA endarterectomy is not an option, how would you treat this heavily calcific CFA CTO? Note the challenging up and over, due to calcification and tortuosity.

@aspergian1 @HeartOTXHeartMD Not only that but then when the patient is not sent home on dual antiplatelet with a diagnosis of NSTEMI it triggers a trigger saying patient not appropriately treated by coders……

Patient is admitted with AKI & shock (septic). Elevated Troponin triggers a cardiology consult. Card consults and concludes that it does not represent ACS. Yet every noncard note & DC summary all list NSTEMI as a diagnosis. Am I the only one bothered by this? @HeartOTXHeartMD

@ISeropianMD @skat_ct @imedCV @djc795 @KardiologieHH @saia_francesco @mirvatalasnag @evandrofilhobr What size balloon are you using and what type of balloon?

FU 15 d after #radialBAV 🎈 valvuloplasty Can u tell which radial was used for 8Fr balloon? Contral was 6Fr for gradient measures Radial #BAV has become our standard approsch … thanks @skat_ct !! @imedCV @djc795 @KardiologieHH @saia_francesco @mirvatalasnag @evandrofilhobr

@CardioNerdsJC Do people have concern about generalizability of people adhering to Ticag? People usually good in trials but the shortness of breath and discontinuation is concerning to me #cardiojc

Are the benefits of single therapy with Ticagrelor in patients with ACS observed in this trial believable? #CardsJC

@MelissaJoy1228 @CardioNerdsJC There is plenty of data for ACS patients in general. ACS is not all the same. UA vs NSTEMI vs STEMI. Would love a trial that doesn’t include UA but would be hard to get enough patients

@CardioNerdsJC Data should not be extrapolated to ACS

With previous trials such as SMART-DATE & STOPDAPT-2 STEMI suggesting potential harm with shorter DAPT in STEMI, & with the current population consistent of only 30% STEMI, how do you feel about extrapolation of this data to your STEMI population? #CardsJC

@CardioNerdsJC Strongly believe that STEMI patients are a different subset. TICO-STEMI also showed a problem with monotherapy. Would not advocate to shorten DAPT in these patients unless absolutely necessary or very HBR

@CardioNerdsJC Yes this is standard but does BARC 2 bleeding have the same morbidity and mortality as 3 and 5? Is there any signal that BARC 2 is an important marker of problems to come?

How do you think the inclusion of non-major (BARC 2) bleeding in primary outcome impacted results? #CardsJC

@CardioNerdsJC STOP DAPT 2 - ACS failed to meet noninferiority. Problem with clopidogrel is the heterogeneity of response with 25% non responders. #cardiojc

Do you think these outcomes would be reproducible with other, potentially less potent, antiplatelet agents such as Clopidogrel? 💊 #CardsJC

@DrEugeneYang @CardioNerdsJC Plato done at a time before high sensitivity troponin. Do we know the assay used in this trial #cardsjc

@CardioNerdsJC The trial design seems typical for similar DAPT studies IMO. #CardsJC

To the Trial! Let us look at our inclusion criteria Does anything catch your eye? 👀 #CardsJC