Richard Sohn MD
@RSohnMD
Interventional cardiology, CTO & CHIP operator. Coronary microvascular dysfunction (CMD), vasospasm angina (VSA) & myocardial bridge (MB) #ANOCA #INOCA #MINOCA
Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside “brake defeat slot” (make sure to insert clip while pressing black button) #RadialFirst
Just doing elective PCI w/ #Shockwave (red) Then this 👇🏼👇🏼👇🏼 … 👀 #R-on-T #ventricularfibrillation #defibrillation
Simultaneous SCAD + TAKOTSUBO SCAD-subo or tako-SCAD — which came first ?? 👀 60F w/ NSTEMI Echo ➡️ takotsubo Angio ➡️ prob SCAD of ramus note coronary AK + microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati
1/ Step-by-step “CORONARY FUNCTION TESTING” for #ANOCA #INOCA PREPARATION: 1. Hold all vasodilators for 48 hours (exceptions = hydralazine, clonidine, doxazosin) 2. Hold caffeine for 24 hours (for adenosine) #CardioTwitter
Intra-plaque hemorrhage (IPH) — involving 12 mm of LAD ostium — another great example showing #OCT’s ability to clarify ACS mechanism
Always consider #ANOCA 50M w/ debilitating episodes of “atypical” CP at rest. Non-exertional ➡️ normal vasodilator nuclear stress Before & after acetylcholine 👇🏼 👀 #coronaryvasospasm
The LADD OSTIAL Lesion 👀 ➡️ perfect target for #DCB? 60 yo man w/ NSTEMI IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs 👇🏼👇🏼👇🏼 Cutting balloon + 3.5 mm DCB (75 s)
