70s 👨 ESRD presents with CHF and NSTEMI. Severe calcific left main and EF 20%. Surgical turn down. Rota with microcatheter protection. Ping-pong with 7Fr radial sheath and single access 6Fr Impella. #radialfirst #protectedPCI

RT @realarainmd: 9/ BONUS I am reposting my video of how to prep the MC for the best #HDR results. @evandrofilhobr doesn’t need this bu…

@nickmmark Because ulnar is deeper hemostasis is more difficult and hematoma and hand compromise more frequent. This is why we do radial artery cath much more frequently than ulnar artery.

@RadDrDuke @PenVascular How much is it or is it now included with flash?

@realarainmd Thank you for detailed explanation. I have always been hesitant to try but will do it at next opportunity

@realarainmd @agtruesdell Are there any precaution when you are doing this? Long MB stent? Heavy calcification. Do you worry about distorting MB stent when removing SB balloon? Do you need a very long SB balloon to avoid entrapment?

@comma_ai How come there is not support for a lot of 2025 cars? I’ve been a huge fan for the last 3 years but now that I have to lease a new car there are not a lot of options.

@Laserrman @realarainmd @cto_chip_japan @DaitaroK @calcbreaker @SKuramitsu0511 @tadano98 @rotamonster Masterful

@yasirakhtarMD Fantastic to hear that. What billing company do you use?

RT @AdamRodmanMD: Our first RCT on using an LLM on diagnostic reasoning is out! And the results are 🔥🌶️... adding ChatGPT did NOT improve…

@abadkhan2002 Can you show all of the images?

@KPujdak @AGIKinterv @PCRonline @agtruesdell @minhaskh @ShariqShamimMD @GreggWStone @LAzzaliniMD I doubt any intervention other than systemic medical therapy is going to be a value here. Might be worth repeating angiogram after a long period of medical therapy.

@gbiondizoccai @MedicalZoll Can you tell us more about your experience? Do you place a catheter after primary PCI is done?

@h_evald Great case!

@DrIHHashmi1 @SyedYNaqvi1 Vessel does not look calcified on angio. I think the stick was too high and because of that you were not able to get effective compression.

@carlatcole @Trevor4SF Getting ice cream to support a place that just got broken into is considered negative toxicity nowadays? 🤦‍♂️

@BrooksWalsh Good catch for a life or death situation.

@RobertHermanMD @BobTeskey @ShariqShamimMD @GEICC3 @willyhfrick @Hragy @smithECGBlog @PendellM @EM_RESUS @minhaskh Technology can potentially shave many minutes off door to balloon time if used routinely

@baijazvascular @vascularIR @JimGMelton @jcgeorgemd @JayMathewsMD @JVargheseMD @VladLakhter @AmputationSuck 1. Push hard for Endarterectomy 2. Stick SFA then jetstream + IVL. Results will not be great, but probably enough. I don’t think any stent has the radial strength for that burden of calcium.

An unusual cause of ST elevation on EKG

@suricardio I do not practice in India. Dapagliflozin generic costs $250 a month in US. Digoxin in the right patient population is a useful drug if you know how to use it.