Interventional Cardiologist/Director of Vascular Intervention | Outcomes Researcher | Associate Prof of Med | Proud Father and Husband | Opinions my own
1/Today published in
@JACCJournals
is the 1st global consensus document on IVUS use for lower ext arterial & venous revasc. This document involved >40 international multidisciplinary experts in vascular disease & was led by a 12 person steering committee.
Humbling findings to end a controversial year: we continue to fail our PAD pts, esp those at greatest need. We have to join as a vascular community, no matter speciality or site of service. Hoping for greater collaborations & bending the amp curve in '24.
Great day advancing hypertension treatment! We did 2 commercial Spyral renal denervation cases for patients who have been struggling with BP control and mediation intolerance for years. Tears by both afterwards. Exciting times!
@BIDMChealth
@BidmcCvi
@SmithBIDMC
@SCAI
@HyperAHA
Our Letter to the Editor for this recent JACC article, not accepted for publication:
Immortal time bias continues to be a pervasive issue w/observational studies. We have been doing our best to bring attention to this issue (see ).
PACLITAXEL TWEETORIAL
1/Brief tweetorial to provide context of the importance of today's NEJM paper showing no mortality difference at 1-4 years between patients with peripheral artery disease treated with paclitaxel-coated (PCD) & non-coated devices.
If you’re going to promote exercise therapy for PAD, then make sure you provide it. After CMS coverage, <1.5% of claudicants had claims for SET. We started 5 centers in ‘18 bc few existed in Boston. Its easy to tell people to stop smoking & exercise, its harder to help them do it
>4 years after the Katsanos meta-analysis & the PTX controversy comes to an end. Proud professional moment to have contributed to navigating this controversy. Congrats to
@US_FDA
@FDADeviceInfo
for getting this right. This important case will be remembered.
PACLITAXEL TWEETORIAL
1/Brief tweetorial to provide context of the importance of today's NEJM paper showing no mortality difference at 1-4 years between patients with peripheral artery disease treated with paclitaxel-coated (PCD) & non-coated devices.
Sick massive PE s/p systemic lysis. Residual shock w/blown RV, 2 pressors & rising lactate. Fast work by our
@PERTConsortium
team. Brought to lab for RHC & PAgram. PAPI 0.7. Team Felt residual right PE too distal for extraction. ProtectDuo placed for RV support. Great teamwork.
1/Couldn't be more thankful for this opportunity from the
@nih_nhlbi
. Honestly, as much as the K award is focused on the investigator, this was a major team effort from my amazing colleagues
@SmithBIDMC
. I aim to use this award to find better ways to inform & consult our PAD pts
Going to embarrass
@EricSecemskyMD
here, but this is too good not to share.
His NHLBI K23 was officially awarded today.
Quickly becoming THE PAD triple threat.
@SmithBIDMC
@BidmcCvi
Lots to digest from BEST-CLI. My early take - if most events are close to day 0, need to be thoughtful of interpretation. Agree that if good vein & suboptimal anatomical characteristics for endo, then bypass reasonable. But many events driven by immediate crossover or repeat PVI
Phenomenal 1st
@InariMedical
case. 90+ yo, prior SAH, massive PE, tubed in ED & pressors. Sa02 60% on Fi02 100%. PERT call->cath lab. Needed a lil local tPA as some chronic clot, but got a few big clots. Sa02 100% after. Big thx to IR buddy
#JeffWeinstein
& guest star
@duanepinto
3+ antihypertensives, recent HF admission, occluded left renal, creat 1.8. Still a role for renal artery stenting. Telescoped in & then 6x15mm Herculink w/
@WallyOmarMD
. In the future, I plan to denervate all these first and then stent...
@BaoGTran
@HadyLichaaMD
@JayMathewsMD
Multidisciplinary approach to care is the only way forward. We have a heart team for PCI/Valve decisions, PERT team for PE care, HTN program for renal stent/RDN, consult service for IVC filters. No turf wars. Need to change PAD approach & not use politics as reason for failure.
2nd RCT examining revasc strategies for CLI: BASIL-2 demonstrates better amputation-free survival with endo vs surgical vein bypass for BTK dx. Driven by ↓ in mortality w/endo. Differs from BEST-CLI, in part bc no major reintervention in primary endpoint
Second Prospective Randomized Control Trial Demonstrating the Benefit of Peripheral IVUS! 237 patients with fempop disease randomized to IVUS-guided DCB treatment vs angio-guided DCB treatment. 14% improvement in patency at 1 year, aligned with results from prior 150 person
The goal of the IVUS-DCB trial was to evaluate IVUS-guided drug-coated balloon angioplasty compared w/ angiography-guided drug-coated balloon angioplasty among patients w/ femoropopliteal artery disease.
Find out the results here:
#ACC24
Do paclitaxel-coated peripheral devices cause harm?
In our study of Medicare pts undergoing fem-pop revascularization in 2016, we found no evidence of survival difference between those treated with drug-coated and noncoated devices (median f/u 389 days).
Similar long-term survival after peripheral DES vs BMS. Our new study in
@JACCJournals
Diff patients than prior study, we examined DES vs BMS using ICD9 codes, median f/u 2 yrs, longest 4 yrs. Similar survival before & after adjustment
@VIVAPhysicians
Perc removal of MCS device. Was in place 4 days. These are terrifying cases. Fortunate to have some tools now but will need some real innovation here for future MCS devices.
@WallyOmarMD
@ReshadGaranMD
#BICath
What does a true multispecialty collaboration look like? Getting all involved specialties with societal backing to develop an Expert Doc on use of Peripheral IVUS. Sim pub in
@MyJSCAI
,
@JVIRmedia
,
@JVascSurg
. IVUS is integral for PVI. More training needed.
Thrilled to advertise our
@BidmcCvi
@BIDMC_Medicine
Complex Hypertension Clinic. Big shout out to
@jenniferlcluett
for all her leadership &
@AKrawisz
for helping grow this program. Please contact us for assistance with HTN mgmnt & interest in HTN RCTs.
1/In January 2021,
@SmithBIDMC
was engaged to see if timely, rigorous real-world evidence can be generated about a specific aortic stent graft that had concerns for complications but little long-term data. These data would be used for an Advisory panel later in the year.
@rwyeh
1/ Has discharge from US EDs 🏥 for low-risk acute PE changed over the last decade?
🧵Our latest in
@AnnalsofIM
aims to investigate this question:
@EricSecemskyMD
,
@SmithBIDMC
First day performing telemedicine visits. Can’t say I loved it at all. I enjoy the in-person interactions with my patients. Absolutely agree with televisits as a substitute during the COVID-19 pandemic. But certainly won’t become my new norm when we get back to routine practice.
Two filters out this week with graduating
@BidmcCvi
fellow
#PaulKatigbak
. Great use of the “hangman technique” for a posteriorly tipped and embedded IVCF. Anyone who puts in IVCFs must have a tracking system to get these out ASAP.
@Angiologist
Proximal brachioceohalic occlusion 1 yr after pacemaker implantation. Presented with left arm swelling & neck fullness. Seems to be an increasingly appreciated issue. Able to cross hostile occlusion & PTA w/
@WallyOmarMD
. Anyone seeing this a lot?
@HadyLichaaMD
@Vascularman
WOW,
@HadyLichaaMD
!!!
The “lend a hand” external bypass technique: External radial-to-femoral bypass for antegrade perfusion of an ischemic limb with occlusive large bore sheath
Follow
@CCIJournal
,
@SCAI
Official Journal
This expert review details the utility of intravascular ultrasound (IVUS) for the management of peripheral artery and venous disease, and provides contemporary examples and representative imaging to serve as a resource for the practising clinician.
Game changer. And couldn’t be more proud of my friend and mentor
@rwyeh
for leading this practice changing trial. Excited for the opportunity to introduce new algorithms for treating complex coronary disease.
Check out the great Tweetorial & work from our allstar
@BidmcCvi
CV/Vascular Med fellow
@AKrawisz
‘s work examining the contemporary risks of contralateral carotid occlusion. This work won her the 2021
@AHAMeetings
Jay D Coffman Early Investigator Award. Congrats Anna!
@ASchmaier
Pts w/ contralateral carotid occlusion (CCO) are high-risk for carotid revasc. How does CCO impact outcomes for undergoing carotid artery stenting (CAS) vs CEA?
Check out our paper in
@JACCJournals
and Tweetorial 👇!
@EricSecemskyMD
Use of multivessel PCI in STEMI has increased since 2013, but varies by institution. As clinical trials appear to influence operator practice, we anticipate that there will be further use of multivessel PCI following the positive COMPLETE trial.
Proud of our societies and
@SCAI
for helping protect our patients and patient care. Credit to EviCore for listening and being responsive. This hopefully sets the path for other insurers.
@kmadass
@FadiSaab17
@SIRspecialists
Dear Journal Editor-
If at all possible, please avoid sending rejection notices on: Fridays, weekends & holidays. Tuesday through Thursday is usually a fair time, as I’m typically distracted with other work.
Thanks,
A lowly researcher
@DocStrom
@rwyeh
@Angiologist
@hectortamezmd
Wonderful year thanks to a wonderful team. We’ll be posting soon for a post-doc position starting this upcoming academic year. Come work with a great team, learn some new statistical methods and get involved in cutting-edge cardiovascular research. Please message me if interested
2022 was a prolific year for the Interventional Cardiology & Vascular Research Section. Led by
@EricSecemskyMD
, they published 50+ times, attended 20+ national & international conferences, & welcomed 7 team members. Here's to 2023 being even better!
@rwyeh
@ASchmaier
@BidmcCvi
Reminder to my vascular colleagues who don’t do coronary interventions - this has been our issue for years. We have Global think tanks dedicated to increasing IVI use. We’re slowly getting there….perfect time for PVI to follow suit.
@SCAI
@VIVAPhysicians
@VMJ_SVM
@ACCinTouch
Why adoption of intracoronary imaging remains so low despite evidence? Worth investing time and energy in analysing the problem. Over the last months an outstanding group of think-out-of-the-box colleagues has been working on this, yesterday in Madrid in the first F2F meeting.🧵
I couldn't be more proud of the exceptional
@SmithBIDMC
team who executed this study from design to presentation in 10 months! The full manuscript is now available
@CircAHA
. Please reach out if interested in learning more about regulatory science using RWE
Here’s a question: is the internet going to be able to handle all this remote work, remote classes, remote clinic visits, simulcasted conferences, Netflix streaming while not working? Has there ever been a use test this large?
@rwyeh
@djc795
@jpirruccello
@ethanjweiss
@SVRaoMD
There have been so many thoughtful community fundraisers over the last few weeks, from a virtual 5K race to homemade art fundraisers to mask-making initiatives and more. We continue to be grateful & inspired! Start your fundraiser today:
#COVID19
2/I couldn't be more grateful to my mentor and friend
@rwyeh
. He has brought me along from the beginning of cardiology fellowship
@MGHHeartHealth
to faculty
@BidmcCvi
and none of this would have happened without his support and leadership. This is what a mentor looks like.