Tom Wilson
2.4K posts
Tom Wilson
@TWilsonMD
Interventional Cardiologist, CTO-PCI, CHIP, Peripheral vascular disease, acute PE. Views & opinions are my own.
Rapid City, SD Katılım Şubat 2021
373 Takip Edilen1.1K Takipçiler
It’s losing its luster
Srini Tummala MD FSIR FSVM@SriniTummala
𝗟𝗜𝗩𝗘 𝗔𝗧 𝗗𝗥 𝗧𝗨𝗠𝗠𝗔𝗟𝗔’𝗦 𝗩𝗔𝗦𝗖𝗨𝗟𝗔𝗥 𝗖𝗛𝗔𝗡𝗡𝗘𝗟 —> 𝗖𝗙𝗔 𝗦𝗨𝗥𝗚𝗘𝗥𝗬: 𝗦𝗧𝗜𝗟𝗟 𝗧𝗛𝗘 𝗚𝗢𝗟𝗗 𝗦𝗧𝗔𝗡𝗗𝗔𝗥𝗗 𝗢𝗥 𝗜𝗦 𝗜𝗧? ▶️ Watch now on Dr Tummala’s Vascular Channel: youtu.be/_NxCaVi9huI?si… A focused discussion on why surgery still represents the optimal treatment strategy for CFA disease: • Durability • Long-term outcomes • Patient selection • Real-world clinical decision-making @SIRspecialists @ACCinTouch @VascularSVS @NCVHonline @VIVAPhysicians @BSIR_News @SIR_ECS @SIRRFS @SeminarVascSurg @_backtable @AaronFrittsMD @SDhandMD @kmadass @thefibroidlady @thegestgroup
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@alex1708ander If AVA > 0.9-1 I would try crossing up front. Otherwise BAV with a small balloon then insert.
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You are called in from home ☎️ on a weekend for a 60 yo patient with DCMP and LCO who is admitted from external hospital for urgent Impella support. The patient is not intubated. In the OR you perform preop TTE and see this. Would you proceed with Impella? #echofirst
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@jedicath @aspergian1 @jl35wilsonMD @Hragy Unless the 85+-year-old patient is an excellent physical and mental shape, a “99 percentile 85+” I would strongly consider leaving it alone for now.
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More importantly this 85+ patient has an ostial LCX lesion. How would you treat it? @aspergian1 @jl35wilsonMD @Hragy @TWilsonMD
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2005 cypher stents. Patent at 21 years!
Pt is now over 85. Symptoms due to a new coral reef calcium nodule between the stents.
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@MichaelMegalyMD @mirvatalasnag @nyalborgesmd @realarainmd @JWMoses @jl35wilsonMD @Hragy @PSandesara_MD @AtriumHealth @BSCCardiology @evandrofilhobr @ShariqShamimMD Personally I think it’s a talking point. I could be wrong.
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@mirvatalasnag @nyalborgesmd @realarainmd @JWMoses @TWilsonMD @jl35wilsonMD @Hragy @PSandesara_MD @AtriumHealth @BSCCardiology @evandrofilhobr @ShariqShamimMD It kind of makes sense, if u have a freshly painted wall u dont want to keep touching it
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More DCB conversations! @realarainmd @JWMoses @TWilsonMD @jl35wilsonMD @Hragy @mirvatalasnag @PSandesara_MD @AtriumHealth @BSCCardiology @evandrofilhobr @ShariqShamimMD
Murmur MD@Murmur_MD
Before you reach for the DCB, how do you decide the vessel is ready? A discussion with @nyalborgesmd and @PSandesara_MD on their approach. • <30% residual stenosis • No flow-limiting dissection • No EKG changes or angina • Adequate side branch result What’s your personal threshold for proceeding with DCB after angioplasty?
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@nyalborgesmd @realarainmd @JWMoses @jl35wilsonMD @Hragy @mirvatalasnag @PSandesara_MD @AtriumHealth @BSCCardiology @evandrofilhobr @ShariqShamimMD “Make sure you don’t IVUS after DCB!” Personally I think that dogma is total BS. Just a talking point. I’ll watch soon thank you for sharing. FWIW not sure if you touched on this or not.
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@drAliyor @jbspadoni @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @aspergian1 @KateKearney4 @RhianEDavies1 Agree. Thank you. Will make sure to post-dil appropriately!
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@TWilsonMD @jbspadoni @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @aspergian1 @KateKearney4 @RhianEDavies1 Great case! In such cases for me PCI (attempt to recanalisation) is first option. Distal lesion will be reassesment after recanalisation if the prox segm. OM LCx-> OMT
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@jbspadoni @drAliyor @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @aspergian1 @KateKearney4 @RhianEDavies1 67M, SOB, CCS-3 Sx. AbN ☢️, EF 50%. PCI or CABG? Any surgeons have an opinion? My opinion: no LZ to land a IMA.
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@realarainmd Good points Sal. I would hope to DCB the distal lesion to preserve or improve the LZ for future use if needed. I think this strategy up front is superior to SVG + LIMA. Personal opinion of course. Robotic LIMA is a good thought but not available in my area.
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2/ IMO, the target is there - but the area it supplies is limited. I have seen surgeons use composite LIMA grafts for such cases, or perhaps an IMA for the distal target and a vein for the proximal one.
If the patient is diabetic, one could consider a CV surgery consult. However, the critical stenoses (occlusions?) are focal and the pt is young. So, a trial of PCI may be reasonable.
Another 'outside the box' option is a robotic LIMA with staged PCI of any areas that light up on a stress test.
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The Interrupted LAD - A Therapeutic Challenge
How would you approach this LAD -- CABG, PCI, or some combination thereof? I can think of several possible options. (My answer in the next post).
This excellent angio was shared by @TWilsonMD. Full points for the dual injection to beautifully delineate the LAD anatomy! 👏
Tom Wilson@TWilsonMD
@jbspadoni @drAliyor @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @aspergian1 @KateKearney4 @RhianEDavies1 67M, SOB, CCS-3 Sx. AbN ☢️, EF 50%. PCI or CABG? Any surgeons have an opinion? My opinion: no LZ to land a IMA.
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@ibalsaadi @assiri99 @CathGuy @Almohammadi_M Agree. Defer, consider options, come back another day. Surgeons almost never touch these in my experience.
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Interesting case
Defer ad-hoc PCI as the patient is stable and STE resolved
Admit to CCU for anti thrombotic and anti platelets DAPT
reschedule him for IVUS during same admission to evaluate thrombotic resolution
Or optimize medical therapy
If the aneurysm >20 mm or > 3 of the reference vessel or unsuitable for covered stent call the CS for surgical ligation
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65M inferior STEMI on 1st EMS EKG but on arrival to ED room CP resolved and STE subsided almost completely. This is the angio!What do you do ?
#SACISVoices #InterventionalCardiology #CathLab #VascularClosure #FemoralAccess #OneTeamOneVision
@CathGuy @assiri99 @Almohammadi_M @bandar2011_
@alotaibi
@chadialraies @YassineMedicine @Zill_cardio @ibalsaadi @alasmary31 @Nasser_Ghattar @Hragy @Dralkutshan @Dr_ShazaAlalawi @O_Azizy_MD @Sultanotb @alialmasood
@Dr_aldiri1 @DrAlsubei
@SACIS_SoMe @SACIS_KSA
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@SrihariNaiduMD What does lactate clearance, an unproven concept beyond simply being a marker of improving shock (which is why those who clear faster have better outcomes) have to do with any of that?
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@TWilsonMD @jbspadoni @drAliyor @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @aspergian1 @KateKearney4 @RhianEDavies1 Not a great target for a LIMA. Des for prox lad and dcb for distal lad.
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@aspergian1 @jbspadoni @drAliyor @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @KateKearney4 @RhianEDavies1 Agree Jack. LAD/Diag, maybe DCB distal LAD. Rx therapy to start w the OM. Curious if any surgeon disagrees.
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@TWilsonMD @jbspadoni @drAliyor @cardiojaydoc02 @cingolani_oscar @agtruesdell @HeartOTXHeartMD @TomVargheseJr @SachinGoelMD @DrIHHashmi1 @KateKearney4 @RhianEDavies1 I agree terrible targets. There is a lot of work to do! Work the LAD and leave the circ?
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Ops check and Garmin database updates. #Outreach in Gillette, WY, Philip, SD, and hopefully another site in ND or NE within the next 2-3 months.
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@olsonplanner Mortgage payment for an equivalent house is 4500. I rent for 60% of that. Snow and grass taken care of. Heated garage. No brainer. Rent for me. That doc is learning the hard way.
GIF
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A physician I know...
- graduated training in 2025
- immediately bought a $1mil home in the new city
- found out in 2 months times that the job was super toxic
- realized the non-compete radius was going to necessitate a move.
...and now he had to sell the house.
The cost?
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There are docs who see more I’m sure. It’s a somewhat data free zone, or data minimal zone. It’s a good topic, where the “only” treatment for quite some time was endarterectomy. Type B dissection is worthy of debate as well—though most data supports fixing in most cases. I’m 50% coronary 50% vascular, roughly.
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@TWilsonMD @farkomd @jmills1955 So you’re going to have a debate about something a busy interventionalist does 1-3 times per year for claudication? Can’t we find more something more critical? How about debating uncomplicated Type B dissection?
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Should @farkomd and @jmills1955 have a debate of ENDO versus Open for management of isolated CFA disease in which @jmills1955 is allowed to pick all the rules of the debate (of which I’m fine with). Would you find it educational and entertaining?
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@canuc_57 @farkomd @jmills1955 1-3x per year for me. Had a bilateral case not long ago. No incision, no wound, no antibiotics, no problem.
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@nadig_cardio @nbarry4 Never liked Samurai. Runthrough (extra floppy, not the izanai), Sion blue Minamo for me.
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Which is your favourite workhorse wire #CardioTwitter
And why is it Sion Blue 💙?
Remarkably versatile , handles majority of everyday lesions
Predictable tactile feedback and excellent trackability
Superb device delivery support
Forgiving , safe tip behavior ; no perf till date across 6k+ PCIs
Especially reliable in tortuous and moderately calcific anatomy
IMO, Japanese wires remain a class apart in terms of feel and engineering.
PS - No financial interest whatsoever for this post , just too much love for this beauty and felt it deserved a mention 🥰
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@farkomd CSI max, DCB. Transpedal or transradial. My go to strategy. +/- IVL.
Dansk
Another strong point for the Endovascular management of CFA disease
JVS-Cases Innovations and Techniques@JVascSurgCIT
⚠️ Groin complications are not just local problems. In > 129000 patients, wound complications after common femoral artery exposure were strongly associated with limb loss, AKI, respiratory failure, stroke, and mortality 👉 jvscit.org/article/S2468-… #LimbSalvage #Complications
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