Justin Cox

@TheNarulaSeries @dngibson2 @DrMauricioCohen @djc795 @jtsaxon @willsuh76 @Babar_Basir @joewalshmd @ziadalinyc @akcmahi @Dr_Bitar @SVRaoMD @Almanfi_Cardio @HashimKhan_1 @raghugollapudi1 Use tee now, hope to use ice more in the future

In order to cross the septum for a watchman, I will use: @dngibson2 @DrMauricioCohen @djc795 @jtsaxon @willsuh76 @Babar_Basir @joewalshmd @ziadalinyc @akcmahi @Dr_Bitar @SVRaoMD @Almanfi_Cardio @HashimKhan_1 @mucox25 @raghugollapudi1

@JonnyMoriarty It means 2x as much to me

VOTE! This immigrant did. And even though his vote is worth 1/57th that of someone in Wyoming, it still felt pretty good

@MKIttlesonMD In general I agree but in San Diego we take care of a lot of cross border patients. For some reason captopril is often what they can get in Mexico. Let’s all agree to talk to patients on discharge and prescribe them what they can get/afford

Please don’t prescribe captopril TID at discharge. Pass it on :-)

@gtheodosmd @tavrkapadia @SachinGoelMD @kerrigjl @akcmahi @CCFcards Who uses 18g anymore?

This is why @tavrkapadia had us using it way back in fellowship! @SachinGoelMD @kerrigjl @akcmahi @CCFcards

@TheNarulaSeries @agtruesdell @DrMauricioCohen @djc795 @DrSheilaSahni @joewalshmd @aidanraneymd @Almanfi_Cardio @JuliaAnsari1 @raghugollapudi1 @HashimKhan_1 @Babar_Basir I’m not sure why many are #radialradicals when we have data from safari now. Try radial first if you are good at it, if you run into issues move on. Keep in mind another access also takes some time though.

@agtruesdell How long do you stay radial before swapping to left radial or femoral during a stemi? @DrMauricioCohen @djc795 @DrSheilaSahni @joewalshmd @aidanraneymd @Almanfi_Cardio @JuliaAnsari1 @raghugollapudi1 @HashimKhan_1 @mucox25 @Babar_Basir

#RadialFirst ACS. Wire resistance? Stop. Angio. Diminutive Recurrent Radial artery inserting into Brachial artery. Rewire/navigate loop (with 0.014 in wire). BAT🦇 to advance Guide. Drive on. Minimal delay. No access switch...

@DVDaniels Did a few of these with saibal with the old gore helix. Always worked, always looked horrible

Another day at the office. Facilitated lateral commisuroplasty with an NTw #mitralclip and a 25 mm cardioform in the lateral commisure after. P1 flail, we couldn’t get a good clip result so we dropped clip medial and dropped the cardioform. This has worked well several times now

@grantham_aaron @DrBillLombardi @ajaykirtane @CAThompson99 MIZ

Great day with Dr. Taishi Hirai at Mizzou and Dr. Tony Spaedy at Boone Co hospital. Two highly successful CTO/CHIP programs in Columbia Mo pop 120K. "The people that say it can't be done should get out of the way of those doing it" @DrBillLombardi @ajaykirtane @CAThompson99

@SrihariNaiduMD @SCAI @NavinKapur4 @davebaran @DrMauricioCohen @thiele_holger @DrCindyGrines @cardiacpolymath @DrSethdb @jay_sreenivasan @ParijaSharedal2 @Drroxmehran @DrSheilaSahni @chadialraies @AnkurKalraMD @GruentzigSoc This is only worthwhile if the winner gets to wear the shock chain via @TheNarulaSeries

Submit a case and present live at SCAI SHOCK! scai.confex.com/scai/shock20/a… @SCAI @NavinKapur4 @davebaran @DrMauricioCohen @thiele_holger @DrCindyGrines @cardiacpolymath @DrSethdb @jay_sreenivasan @ParijaSharedal2 @Drroxmehran @DrSheilaSahni @chadialraies @AnkurKalraMD @GruentzigSoc

@TheNarulaSeries @raghugollapudi1 @joewalshmd @PSorajja @MayraGuerreroMD @ChetRihal @bkolskk @aidanraneymd @ElliottMGroves @HaddadRafid @HeartDrHanna @AdamGreenbaumMD Go wide or go home

How do you decide which clip for what pathology? What is your “go to” for most cases? @mucox25 @raghugollapudi1 @joewalshmd @PSorajja @MayraGuerreroMD @ChetRihal @bkolskk @aidanraneymd @ElliottMGroves @HaddadRafid @HeartDrHanna @AdamGreenbaumMD

@ekgpdx @TheNarulaSeries @Mustapja @FadiSaab17 @DrAFrangieh @JayMathewsMD @AmputationSuck @ajaykirtane @HeartDrHanna @joewalshmd @DrMauricioCohen @djc795 @raghugollapudi1 @HashimKhan_1 @Dr_Bitar I also like the hybrid closure.

@TheNarulaSeries @Mustapja @FadiSaab17 @DrAFrangieh @JayMathewsMD @AmputationSuck @ajaykirtane @HeartDrHanna @joewalshmd @DrMauricioCohen @djc795 @raghugollapudi1 @HashimKhan_1 @Dr_Bitar @mucox25 Nice rescue. Anecdotally I have seen several occlusions if a third (extra) Proglide is placed bleeding after sheath is removed and the preclose sutures aren’t adequate. Was that the case here? Anyone else see this? Now I use 8F Angioseal instead.

How do you deal with the perclose shut down after TAVR? @Mustapja @FadiSaab17 @ekgpdx @DrAFrangieh @JayMathewsMD @AmputationSuck @ajaykirtane @HeartDrHanna @joewalshmd @DrMauricioCohen @djc795 @raghugollapudi1 @HashimKhan_1 @Dr_Bitar @mucox25

@ChetRihal @adnanalkhouli @EleidMack Thoughts on the evoque valve?

@adnanalkhouli @EleidMack We desperately need advanced therapeutic solutions for patients with severe tricuspid regurgitation.

Independent leaflet grasping during Tricuspid clipping. Questions were raised re: the usefulness of independent leaflet grasping during Triclip with the G4 MitraClip system. Our initial experience suggest that it is quite useful as illustrated in this video. @ChetRihal @EleidMack

@TheNarulaSeries @GreggWStone @MKIttlesonMD @RajeevCMohan @jtheywood @HMehta__ @ajaysmd @RolaKhedrakiMD Could not agree more. The power of Coapt was how well the medical therapy was managec

@GreggWStone Why not a formal Heart Failure consult? Need to check the boxes of ACE/ARB/ARNI/BB/ICD checklist. If CTS will do this for FMR cool...as @GreggWStone says Med Therapy works well. @MKIttlesonMD @RajeevCMohan @jtheywood @HMehta__ @ajaysmd @RolaKhedrakiMD

Poll 2. Should a formal mitral surgery consult (with pt exam and discussion) be required for MitralClip payment for FMR?

@Dr_Bitar @TheNarulaSeries @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @HashimKhan_1 @DavidLBrownMD @drjohnm There have been a few small comparisons between iFr and FFR in LM (small numbers 50 and 90 patients) showing good correlation. That said I still think there are significant issues with either because we rarely see LM dz in isolation

@mucox25 @TheNarulaSeries @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @HashimKhan_1 @DavidLBrownMD @drjohnm I’m not sure iFR is validated in LM. DEFINE-FLAIR excluded LM, SWEEHEART was like <2% LM. I don’t know what the right answer is. IVUS and FFR have data behind them, just not sure about iFR

How do you assess the intermediate left main and why? Plaque morphology, luminal area, physiology? @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @mucox25 @HashimKhan_1 @Dr_Bitar @DavidLBrownMD @drjohnm

@Dr_Bitar @TheNarulaSeries @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @HashimKhan_1 @DavidLBrownMD @drjohnm You are of course correct about the data. However what about the LM would make you question the validity of a resting ratio?

@Dr_Bitar @TheNarulaSeries @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @HashimKhan_1 @DavidLBrownMD @drjohnm iFR or RFR for everything. I have a hard time thinking of a situation where I would use FFR instead unless I was interested in the response to adenosine.

@mucox25 @TheNarulaSeries @drmortkern @DrMauricioCohen @djc795 @ziadalinyc @GreggWStone @ajaykirtane @wfearonmd @raghugollapudi1 @HashimKhan_1 @DavidLBrownMD @drjohnm Would you do iFR or FFR?

@DrAmirKaki Can you share your labs pathway for no reflow. Do you think the flow improved due to the meds or as a result of normalization of the LVEDP?

Post TPA after IC epi, Thrombectomy, IC adenosine and IC nipride failed.

61 yo SCAI D/E Massive AMI Shock. CPO .3 MVO2 28 CI 1.0. LVEDP 50mmHG! Prohibitive Fem Tortuosity: Axillary Impella CP. No reflow, thrombectomy, IC Epi, IC Adenosine all failed. IC TPA 2mg worked followed by IVUS guided PCI. Where there is a will there is a way. #waronshock

@willsuh76 @waked_md Can I get a ct with calcium score? And data that non critical AS does not significantly increase non vascular operative risk

Interesting learning case raised by @waked_md during #TAVR meeting. Man in his 50s with liver cirrhosis and ESRD with dialysis. Referred for #TAVR prior to ostomy take down. Cath showed cardiac output 11 L/min, MG 46 mmHg, AVA 1.3 cm2. What would you do next?

Good discussion on why herd immunity right now is not going to work. apple.news/AEAfTPXYaRJ6aZ…

@joekallini @JonnyMoriarty @uclaVIR Why not do this radial?

First week of IR Fellowship @uclaVIR - 76 yoF w AMS, multiple TIAs, and un= arm pressures. CTA: prox R SCA 90%. Vasc US: Sawtooth waveform of distal R SCA. Reversal of flow in R vert compatible with steal.