Tom Wilson @TWilsonMD
Interventional Cardiologist, CTO-PCI, CHIP, Peripheral vascular disease, acute PE. Views & opinions are my own. blackhillscardiovascular.com Rapid City, SD Joined February 2021-
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@aspergian1 @Tesslagra @HeartOTXHeartMD @cardiacinterv Agree. Ambulatory procedure centers will continue to thrive.
@AsherElad OCT of all major vessels. Look for plaque rupture. Move on to less common findings if normal.
@DutchRojas To be fair many (not all) of these independent imaging centers have subpar CT and MR machines from the 2000s. Bought 2nd or 3rd hand.
@bmorecardiology @NEJM @drjohnm Same. 2-3 referred over past 4-5 years. Takes time to explain why, usually why not.
@ARKamathMD @RohangantiMD @UMN_CCCEdSummit @dpot29 @CardioNerds IABP has fewer complications when unloading the LV w VA ECMO. Compared to CP. IABP does have a role—I mentioned a couple. But by and large they are worthless.
@IR_Doctor @WillyRontgen You have to see the honey combing though
@StevePhillipsMD What would you recommend Dr. Steven?
@txsportsdoc @MaryBowdenMD I haven’t even considered heeding the advice of a surgeon general since C Everett Koop (last SG I could remember the name of). Does anyone? Position has largely been relegated to the history books. Perhaps that may change with a sound voice of reason and moderation.
@SriniTummala @farkomd @_backtable @JayMathewsMD @TomVargheseJr @drAliyor @cingolani_oscar @Obisht @IntervnCardio @SachinGoelMD Understood. One argument is 99% of the potential complications are handled percutaneously. I don’t think there’s a single answer as you alluded to. Failed first time—couldn’t re-enter. Came back 6w later and fixed. US 1 m later looked good.
@SriniTummala @farkomd @_backtable @JayMathewsMD @TomVargheseJr @drAliyor @cingolani_oscar @Obisht @IntervnCardio @SachinGoelMD would you attempt this case in an OBL? 70F, recent IMA/Celiac stenting for severe mesenteric angina/weight loss. Severe Ca++ ostial CIA-EIA. 110lb pt.
@ShariqShamimMD @FCademartiri @grok 3.4 mil was the price tag for the one next door to us. Smallest mkt in the US! I believe.
@tellopio1 @DutchRojas @noahkaufmanmd @HeartOTXHeartMD @jl35wilsonMD @txsportsdoc @nbarry4 @evandrofilhobr @BrentAWilliams2 @TomVargheseJr You don’t have the rent, regulatory expenses, taxes, staff costs, etc. But wonderful it’s that cheap for patients. Not sure how that’s possible.
@DutchRojas @noahkaufmanmd @HeartOTXHeartMD @jl35wilsonMD @txsportsdoc @nbarry4 @evandrofilhobr @BrentAWilliams2 @TomVargheseJr how many independent echo labs have definity? Hospital often gets >1k to do an echo. We get $200-300 at most. Same test, best machine, w Contrast, GLS, & 3D EF. Quality matters. EF down, can’t see without Definity. GLS aligns w Wall Motion.
@drAliyor @Sher_Intervent Nice case. Thoughts on upsizing the DCB to a 4.0 here? Wasn’t the stent diameter greater than 3.5 along the way?
@alex1708ander If AVA > 0.9-1 I would try crossing up front. Otherwise BAV with a small balloon then insert.
@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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