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Richard Sohn MD @RSohnMD

Interventional cardiology, CTO & CHIP operator. Coronary microvascular dysfunction (CMD), vasospasm angina (VSA) & myocardial bridge (MB) #ANOCA #INOCA #MINOCA

Joined November 2019
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Richard Sohn MD@RSohnMD
17 Feb 2022
Doing solo-operator ROTAPRO (rotational atherectomy) STARTING POSITION (after testing & adjusting burr speed): Dynaglide ON, wire inside clip inside โ€œbrake defeat slotโ€ (make sure to insert clip while pressing black button) #RadialFirst
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#ANOCA โ€” Best medical therapy ?? See these ๐Ÿ‘‡๐Ÿผ fantastic references 1๏ธโƒฃ Toleva et al, JSCAI 2025 2๏ธโƒฃ Miner et al, Eur Heart J 2026 * I routinely copy๐Ÿ‘‡๐Ÿผ into my reports #vasospasm @Hragy #MicrovascularDysfunction #MyocardialBridge @mirvatalasnag
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Do any of you do SuperSaturated O2 (SSO2) for anterior STEMI? โžก๏ธ What are your thoughts on this therapy?
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Young woman w/ VF arrest This ๐Ÿ‘‡๐Ÿผ angiogram after ROSC ๐Ÿ‘€ Hemos stable, no CP What is the etiology, and what next?
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When seeing #SCAD, weโ€™re tempted to minimize & flee. But NTG solves the riddle here ๐Ÿ‘‡๐Ÿผ ๐Ÿ‘€ Take-homes: 1. If you think SCAD, try NTG first 2. Coronary #vasospasm can be lethal ! #MINOCA #SCD @CannanCharles
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Richard Sohn MD retweeted
Richard Sohn MD@RSohnMD
9 Feb 2025
1/ MYOCARDIAL BRIDGES (MBs) ANOCA mechanisms: - Slow early diast relaxation - Diast vessel restriction /- neg remodeling - Branch steal (Venturi effect) - Proximal atherosclerosis - Associated vasospasm, CMD (common!) (see next for MINOCA)
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Calcium score CAC = ZERO โžก๏ธ But this ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ ๐Ÿ‘€ (Class 3 angina on meds) PCI or CABGโ“
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Just doing elective PCI w/ #Shockwave (red) Then this ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ โ€ฆ ๐Ÿ‘€ #R-on-T #ventricularfibrillation #defibrillation
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Simultaneous SCAD TAKOTSUBO SCAD-subo or tako-SCAD โ€” which came first ?? ๐Ÿ‘€ 60F w/ NSTEMI Echo โžก๏ธ takotsubo Angio โžก๏ธ prob SCAD of ramus note coronary AK microvasc staining in distribution of #takotsubo (eg AP cranial washout) @rajivxgulati
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What an UNDERSIZED STENT looks like by #OCT ๐Ÿ‘€ ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ
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ANSWER: Undersized AND partially undeployed See next ๐Ÿ‘‡๐Ÿผ for details @TWilsonMD @doc_ecmo @DrWhyWho @champion_slayer @mlbalbinotti @mmamas1973 @mirvatalasnag
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During difficult delivery in crazy RCA (๐Ÿ‘‡๐Ÿผ), stent got stuck but stent balloon catheter pushed few mms farther downstream โžก๏ธ Most of stent deployed (albeit undersized๐Ÿ‘‡๐Ÿผ) BUT proximal end un-deployed (๐Ÿ‘‡๐Ÿผ) Not apparent b/c NO imaging โ€ฆ until recurrent STEMI 3 wks later ๐Ÿ‘€
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Richard Sohn MD retweeted
Richard Sohn MD@RSohnMD
12 Sep 2023
1/ Step-by-step โ€œCORONARY FUNCTION TESTINGโ€ for #ANOCA #INOCA PREPARATION: 1. Hold all vasodilators for 48 hours (exceptions = hydralazine, clonidine, doxazosin) 2. Hold caffeine for 24 hours (for adenosine) #CardioTwitter
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Intra-plaque hemorrhage (IPH) โ€” involving 12 mm of LAD ostium โ€” another great example showing #OCTโ€™s ability to clarify ACS mechanism
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Always consider #ANOCA 50M w/ debilitating episodes of โ€œatypicalโ€ CP at rest. Non-exertional โžก๏ธ normal vasodilator nuclear stress Before & after acetylcholine ๐Ÿ‘‡๐Ÿผ ๐Ÿ‘€ #coronaryvasospasm
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The LADD OSTIAL Lesion ๐Ÿ‘€ โžก๏ธ perfect target for #DCB? 60 yo man w/ NSTEMI IVUS = 3.8 mm prox-LADD, bifurcates 6 mm downstream into 2.7 mm limbs ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ Cutting balloon 3.5 mm DCB (75 s)
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60 yo woman w/ acute severe CP EKG & cath below ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ How would you approach this? #CardioTwitter #STEMI
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Ok, Iโ€™ll end the suspense โ€” โฌ‡๏ธ ic NTG solves the riddle ๐Ÿ‘€ Amazing case of severe coronary #vasospasm true #Printzmetal
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Sometimes cutting balloon is enough for CALCIUM NODULE (non-eruptive MLA 1.4 mm2) OCT pre- & post CB ๐Ÿ‘€ โžก๏ธ good expansion MLA 7.8 mm2 See next for DES result ๐Ÿ‘‡๐Ÿผ๐Ÿ‘‡๐Ÿผ
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DES โžก๏ธ MSA 8.6 mm2
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1/ MYOCARDIAL BRIDGES (MBs) ANOCA mechanisms: - Slow early diast relaxation - Diast vessel restriction /- neg remodeling - Branch steal (Venturi effect) - Proximal atherosclerosis - Associated vasospasm, CMD (common!) (see next for MINOCA)
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more replies
4/ Reference: ahajournals.org/doi/10.1161/โ€ฆ

Impact of Diastolic Vessel Restriction on Quality of Life in Symptomatic Myocardial Bridging...

Graphical Abstract Background: Despite optimal medical therapy, a myocardial bridge (MB) can cause life-limiting symptoms in a subset of patients. While surgical unroofing has been shown to improve...

ahajournals.org
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5/ Association of MB w/ spasm & CMD jscai.org/article/S2772-9303โ€ฆ #CardioTwitter #vasospasm #CMD #microvascular #MyocardialBridge #ANOCA #MINOCA @mirvatalasnag
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