Kevin Kniery

Every oncologist and cancer researcher should watch this interview with @BenSasse: nytimes.com/2026/04/09/opi… Daraxonrasib, a “super poison for cancer,” shrank his metastatic pancreatic tumors by 76%, even though he says his skin feels and looks “nuclear.” When I learned of his diagnosis, I wanted him to get this drug (oral RAS ON inhibitor), which is poised to become first-line therapy in pancreatic cancer. I hope his experience on a clinical trial encourages more patients to enroll in studies, and pushes clinicians and researchers to keep advancing new therapies.

A carotid web, also called a carotid diaphragm, is thought to be an intimal variant of fibromuscular dysplasia. It appears as a thin shelf-like projection of the tunica intima arising from the posterior wall of the ICA just distal to the carotid bifurcation, projecting into the lumen. The size and angle matter. Larger webs, especially those ≥3 mm, and webs with a more vertical orientation carry a higher stroke risk. Carotid webs are more common in women and in African American patients. When should you suspect one? Most ischemic strokes come from common mechanisms, many driven by the downstream effects of metabolic syndrome in combination with aging vessels and heart: atherosclerosis, arteriolosclerosis/small vessel disease, or cardioembolism from structural or electrical heart disease. But when a young patient, especially under 40, with no major vascular risk factors presents with a large cortical stroke, you have to think beyond the usual causes. This is where carotid web comes in. Classic setup: young, otherwise healthy patient sudden large vessel stroke CTA read as “normal” unless the carotid bulb is carefully inspected How do we detect it? In routine practice, CTA is the most common noninvasive test of the cervicocerebral vasculature. It has the spatial resolution to detect the characteristic shelf-like projection at the posterior carotid bulb. I posted a CTA of a carotid web in the previous case (linked below). 👇👇 Can you spot the subtle shelf-like protrusion from the posterior wall? Go back and look closely. This is the kind of lesion that is easy to miss if you are not actively looking for it, or if you are not yet aware of this phenomenon. Over the next day or so, I’ll post a short voice-over explaining why this small anatomic abnormality can be such an efficient generator of embolic stroke. For now: Who can clearly explain why a carotid web is so good at producing emboli? Reference: Chen H, Colasurdo M, Costa M, Nossek E, Kan P. Carotid webs: a review of pathophysiology, diagnostic findings, and treatment options. J Neurointerv Surg. 2024;16(12):1294–1299. doi:10.1136/jnis-2023-021243. #Stroke #Neurology #Neuroradiology #FOAMed

Animal ➡️ human transplant. SciFi? Or primetime? Listen. Learn. Enjoy 👇🏼 Clinical Challenges in Transplant Surgery: How Xenotransplantation Will Change Our Lives app.behindtheknife.org/podcast/clinic… 💪🏼@maddie_cloonan

THE PRELIM PLAYBOOK: TIPS, TRICKS, & UNSPOKEN RULES FOR SUCCESS. In this 🫛🎧 we explore the grueling realities of the general surgery preliminary year—a high-stakes, one-year audition for surgical trainees operating without a safety net. 🗣️ app.behindtheknife.org/podcast/the-pr… 💪🏼 work from @DukeSurgery @DukeSurgRes BTK Education Fellow Ayman Ali, @KN__Shah, Louise Jackson

Healthcare Econ 101 - Ep. 2: Show Me the Money!!! Ever wonder why a complex gallbladder surgery only nets the surgeon about $350, while the hospital collects thousands? In this pod, @clarkninam @cchildersmd pull back the curtain on how the 💸💸🫰 actually flows in medicine 🏥. From the birth of the RVU to the "Two Midnight Rule 🌙," we’re breaking down the math behind your paycheck. 🗣️🎧app.behindtheknife.org/podcast/health…

An incredible photo of the insane finish by American Nathan Martin to come from WAY behind to catch Kenyan Michael Kamari in today’s ASICS L.A. Marathon. Truly capturing the thrill of victory and agony of defeat. 📷@CitiusMag

AMERICAN HERO: CW5 Eric Slover receives the Medal of Honor from @POTUS during tonight’s State of the Union Address.