Podcasts about Stent

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

A severe blockage in the "widowmaker" artery sounds like an automatic trip to the cath lab but is it always? In this episode, Dr. Robert Todd Hurst, MD, FACC, FASE shares a remarkable real-world case that challenges conventional thinking about stents and heart disease treatment. He explains the difference between stable and unstable coronary artery disease, reviews the research behind stents versus aggressive medical therapy, and reveals how one patient with a severe LAD blockage improved his artery health without undergoing an invasive procedure. You'll also learn why understanding root causes, optimizing risk factors, and taking a personalized approach to prevention may be more important than many people realize. About Dr. Robert Todd Hurst, MD, FACC, FASE Dr. Robert Todd Hurst, MD, FACC, FASE is a board-certified preventive cardiologist, former Mayo Clinic physician, and founder of HealthspanMD. His mission is simple: that no one dies of a heart attack, ever. Through a proactive, precision-medicine approach, he helps patients identify hidden cardiovascular risk, reverse heart disease, and add strong, vital, mentally sharp years to life. In this podcast, he shares practical insights from more than two decades of experience helping people prevent and overcome cardiovascular disease. Key Timestamps 00:00 – Introduction: Do severe blockages always require a stent? 00:27 – Case study: A patient with a severe LAD ("widowmaker") blockage and no symptoms 01:14 – Why stress testing, echocardiograms, and symptoms matter when evaluating blockages 01:39 – What research shows about stents versus aggressive medical therapy for stable coronary artery disease 02:46 – The real risks of angiograms, stents, and invasive procedures 03:36 – Why the patient's condition did not automatically justify a stent 04:15 – Optimizing cholesterol, insulin resistance, and other root causes 04:42 – One year later: Severe blockage improves to moderate stenosis 05:04 – Evidence of plaque regression and why the results matter 05:35 – How cardiology thinking has evolved since the COURAGE trial 06:07 – When stents and bypass surgery may still be the right choice 06:41 – Questions every patient should ask before agreeing to a stent 07:02 – Long-term considerations and risks of living with a stent 07:20 – Why healthcare remains reactive instead of preventive 07:47 – HealthspanMD's mission: Moving from disease treatment to health optimization 08:08 – Final thoughts and invitation to learn more about HealthspanMD 08:34 – Medical disclaimer This episode is for educational purposes only and should not be considered medical advice. Always discuss treatment decisions with your healthcare provider. This information is for educational purposes only and is not medical advice. Don't make any decisions about your medical treatment without first talking to your doctor. Connect* with HealthspanMD :

The “Enhanced Games”, with no-holds-barred performance-enhancing drugs, yields scant advantages over “clean” contests; Does saturated fat increase insulin resistance? Can a heart attack victim avoid statin use with CoQ10? Omega-3 fish oil shows promise vs. type 2 diabetes; Motorized e-scooter use needs to be regulated NOW!

This week we're joined by Kiwi comedians Chris Parker and Brynley Stent! We talk Simcest, boobs being back, choir competitions, the irony of pegging and the Ninja Creamy. Follow Chris @chrisparker11 and Brynley @brynleystent Check out the bonus patreon exclusive episode with 40 minutes of extra content at https://www.patreon.com/posts/160059568 WE NOW HAVE MERCH! Get your Glue t-shirts, mugs and totes in time for Christmas here (discount code for Patrons is on the Patreon): https://visualanticsapparel.com/collections/glue-factory Olga's tour dates can be found here: https://www.rocknrolga.com/ Milo's tour dates can be found here: https://www.miloedwards.co.uk/liveshows Follow us online to get Glue-related clips and updates: https://linktr.ee/gluefactorypod Learn more about your ad choices. Visit podcastchoices.com/adchoices

May 22, 2026In this episode, Scott, Mark, and Dr. Ray Painter revisit ureteral stent removal and replacement coding after listener feedback highlighted the need for additional clarification on when cystoscopic codes versus fluoroscopic exchange codes apply. The discussion then shifts to emerging RAC audits targeting prostate artery embolization (PAE) claims involving CPT codes 37242 and 37243, emphasizing the importance of detailed documentation and medical necessity support. The episode wraps with a deep dive into Medicare's medically unlikely edit (MUE) for add-on code 55715 for additional prostate biopsy lesions—exploring why the edit conflicts with CPT guidance, how practices should report multiple lesions, and why appeals may be necessary to receive proper reimbursement. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.         https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ 

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Brad Leshnower, Director of Aortic Surgery at Emory University Hospital in Atlanta, GA, USA, about the first implantation of the Gore Ascending Stent Graft in the ARISE III trial for the treatment of an acute type A dissection. Chapters 00:00 Intro 02:26 New CTSNet Website 03:31 JANS 1, Thromboendarterectomy Fellowship 05:28 JANS 2, Sodium-Glucose Cotransporter 2 Inhibitor 07:36 JANS 3, Type A Acute Aortic Dissections 09:51 JANS 4, Asymptomatic Aortic Stenosis at 10 Years 11:46 Video 1, Nuss Procedure w Chrondrotomies 13:08 Video 2, Cardiac Redo Surgery 14:52 Video 3, Uniportal Lobectomy Bronchial Reimplantation 16:13 Dr. Leshnower, Ascending Stent Grafts 32:51 Career Center 33:52 Closing They discussed Dr. Leshnower's experience with this groundbreaking implantation, including the case details such as the patient's medical history, the assessment of the patient's high-risk status, and the criteria for determining their suitability for the procedure. Imaging techniques and the contributions of the other surgeons involved in the case were also highlighted. Furthermore, they delved into the use of the stent in previous ARISE trials and what Dr. Leshnower learned from those early experiences. The conversation also covered topics such as proximal placement, the innominate artery, and the preoperative planning required for the trial. Dr. Leshnower also shared what he learned from this case and discussed the future of the stent graft and this technique. Joel also highlights recent JANS articles on the safety and efficacy of a dedicated pulmonary thromboendarterectomy fellowship, sodium-glucose cotransporter 2 inhibitor use and outcomes after surgical aortic valve replacement, association between surgical timing and postoperative outcomes in type A acute aortic dissection, and early surgery or conservative care for asymptomatic aortic stenosis at 10 years. In addition, Joel explores the Nuss procedure with midline chrondrotomies in severe pectus excavatum, redo surgery for failed MVr, iatrogenic ASD, tricuspid valve regurgitation, and aorta replacement, and uniportal VATS left lower sleeve lobectomy with upper lobe bronchial reimplantation for typical carcinoid tumor. Before closing, Joel highlights upcoming events in CT surgery.   JANS Items Mentioned Safety and Efficacy of a Dedicated Pulmonary Thromboendarterectomy Fellowship: The UK Experience at a High-Volume Center Sodium-Glucose Cotransporter 2 Inhibitor Use and Outcomes After Surgical Aortic Valve Replacement Association Between Surgical Timing and Postoperative Outcomes in TypeAAcute Aortic Dissection Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis at 10 Years  CTSNet Content Mentioned The Nuss Procedure With Midline Chrondrotomies in Severe Pectus Excavatum  Redo Surgery for Failed MVr, Iatrogenic ASD, Tricuspid Valve Regurgitation, and Aorta Replacement  Uniportal VATS Left Lower Sleeve Lobectomy With Upper Lobe Bronchial Reimplantation for Typical Carcinoid Tumor  Other Items Mentioned ARISE III Trial of Gore Ascending Stent Graft Begins Enrollment How to Navigate the New CTSNet Website Career Center CTSNet Events Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

What if the real driver of aging isn't your mitochondria or your telomeres but the tiny capillaries you never think about? Double board-certified emergency and internal medicine physician Kenneth Ro returns to the show to make a compelling case that microvascular decline is the overlooked upstream force behind nearly every disease of aging. In this episode, based on his KevinMD article "How the microvasculature drives the human aging process," he explains why your body shuts down capillaries you stop using through a process called capillary rarefaction, and how that quietly starves tissues of oxygen long before symptoms appear. You will hear how microvascular disease connects diabetic complications, heart failure with preserved ejection fraction, and even sepsis under one unifying framework. He also shares why exercise works at a level deeper than most clinicians discuss, what GLP-1 agonists may be doing to your pericytes, and why VO2 max and heart rate variability are your best windows into microvascular health. This episode will change how you think about what it truly means to age well. Tune into our episode "2026 Cholesterol Guidelines: LDL goals, lipoprotein(a), and coronary calcium scoring," brought to you by Novartis Pharmaceuticals Corporation. For the first time in eight years, LDL cholesterol goals have changed, and preventive cardiologist Seth Baum says the new guidelines are a long-overdue course correction. He breaks down the new LDL targets for your highest-risk patients, why the LDL hypothesis should be retired in favor of the LDL fact, why lipoprotein(a) screening finally belongs in every patient's workup, what a coronary calcium score over 300 really means for how aggressively you treat, and how to talk to statin-skeptical patients without losing their trust. Listen now at KevinMD.com/cholesterol. VISIT SPONSOR → https://kevinmd.com/cholesterol Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let's work together to tell your story. PARTNER WITH KEVINMD → https://kevinmd.com/influencer SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Dr. Zohaib Siddiqi and Dr. Laurence Poirier discuss a complex stroke case associated with systemic vasculitis, highlighting diagnostic challenges and management strategies, including the role of endovascular therapy.  Show citation:  Poirier L, Brissette V, Shamy MCF, Maxwell JP, Drake B, Fahed R. Clinical Reasoning: A 70-Year-Old Man With Systemic Illness Related Strokes Refractory to Medical Treatment Managed With Intracranial Stent. Neurology. 2025;104(1):e210068. doi:10.1212/WNL.0000000000210068 

May 1, 2026In this episode, Scott, Mark, and Dr. Ray Painter break down key differences between ureteral stent removal and replacement codes—50385, 50387, and 50688—highlighting how anatomy, access (internal vs. external), and the requirement for radiologic supervision drive proper code selection. They also tackle a growing issue with ICD-10 coding for bladder cancer, where the correct use of “history of” codes during BCG maintenance therapy is leading to unexpected payer denials. The discussion explores when to follow strict coding guidelines versus when payer-specific rules may require strategic adjustments. The takeaway: understanding both the technical details of coding and the realities of payer behavior is essential to avoiding denials and protecting revenue. PRS Coding and Reimbursement HubAccess the HubBotox LCD AlertDownload the AlertFree In-Office Prostate Biopsy Calculator (Suppoted by UC-Care)Download NowPRS Coding CoursesFor UrologistFor APPsFor Coders, Billers, and Admins Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.         https://www.prsnetwork.com/joinuptpClick Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ 

Dr. Zohaib Siddiqi talks with Dr. Laurence Poirier about a complex stroke case associated with systemic vasculitis, highlighting diagnostic challenges and management strategies, including the role of endovascular therapy.  Read the related Resident & Fellow Section article in Neurology®. Disclosures can be found at Neurology.org. 

Paclitaxel-coated Versus Uncoated Balloon For Coronary In-stent Restenosis - Three-year Outcomes Of The Agent Ide Trial

A thoughtful, practice-shaping study in NEJM explores a long-standing clinical dilemma: can we truly move the needle in post-thrombotic syndrome?   The C-TRACT trial shows that endovascular therapy (iliac-vein stenting) significantly improves symptom burden and quality of life in patients with moderate–severe disease—measured rigorously using VCSS, VEINES-QOL, and SF-36. The magnitude of benefit is clinically meaningful.   But every intervention casts a shadow.  

Nesta edição, analisamos diretrizes globais de saúde e inovações em terapias personalizadas, começando pelas novas orientações da OPAS para fortalecer o cuidado de longa duração na América Latina e no Caribe, face ao acelerado envelhecimento populacional. Detalhamos os resultados do ensaio clínico C-TRACT, publicado no NEJM, que avaliou a eficácia da terapia endovascular na Síndrome Pós-Trombótica, demonstrando melhoria na qualidade de vida apesar do maior risco de sangramento. Por fim, abordamos no Radar o progresso das vacinas de mRNA como terapia oncológica de precisão, treinando o sistema imunitário para reconhecer neoantígenos específicos do tumor.Afya News. Informação médica confiável e atualizada no seu tempo.Fontes do episódio aqui:⁠https://portal.afya.com.br/podcasts/afya-news/16-04-2026

This week primary care physicians Kate Rowland, Mark Ebell, Gary Ferenchick and Henry Barry tackle 4 new POEM-worthy studies: new therapy for elevated triglycerides, cannabinoids for chronic pain in adults, the best antithrombotic for patients with AF + drug eluting cardiac stent, and lower versus standard LDL targets for patients with heart diseaseEssential Evidence Plus: https://www.essentialevidenceplus.com/ Lower triglycerides: https://pubmed.ncbi.nlm.nih.gov/41211918/Cannabinoids for pain: https://pubmed.ncbi.nlm.nih.gov/41429020/ Antithrombotics for AF + stent: https://pubmed.ncbi.nlm.nih.gov/41211917/ LDL target 55 vs 70 for CAD: https://pubmed.ncbi.nlm.nih.gov/41910315/

Opération annulée faute de stent à l'hôpital Jeetoo by TOPFM MAURITIUS

Send Zorba a message!Dr. Zorba looks at a new Pew Research study that shows 1 in 5 U.S. teens are on social media "almost constantly." He helps a caller with what to do when their doctor is not nice or helpful. Zorba deciphers a viral video going around about "parasite mania" in our kids, he tackles PPI use for GERD, and fields a dental question. The Grammar Cops chime in, and we hear a Mom Joke that mall rats might enjoy.Just Coffee Co-opUse Promo Code ZORBA10 for 10% off your orderDisclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showProduction, edit, and music by Karl Christenson Send your question to Dr. Zorba (he loves to help!): Phone: 608-492-9292 (call anytime) Email: askdoctorzorba@gmail.com Web: www.doctorzorba.org Stay well!

Send Zorba a message!Dr. Zorba looks at a new Pew Research study that shows 1 in 5 U.S. teens are on social media "almost constantly." He helps a caller with what to do when their doctor is not nice or helpful. Zorba deciphers a viral video going around about "parasite mania" in our kids, he tackles PPI use for GERD, and fields a dental question. The Grammar Cops chime in, and we hear a Mom Joke that mall rats might enjoy.Just Coffee Co-opUse Promo Code ZORBA10 for 10% off your orderDisclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the showProduction, edit, and music by Karl Christenson Send your question to Dr. Zorba (he loves to help!): Phone: 608-492-9292 (call anytime) Email: askdoctorzorba@gmail.com Web: www.doctorzorba.org Stay well!

Join Mark, Kate, Henry and Gary as they discuss 4 new POEMs (Patient Oriented Evidence that Matters, studies with the potential to change practice): a summary of the evidence on tirzepatide (Zepbound) for weight loss, using the Beers list with your patients, high vs standard dose flu vaccine and the risk of hospitalization, and whether stent or endarterectomy are better than maximal medical therapy for patients with asymptomatic carotid stensosis. Here are the links:Essential Evidence Plus: www.essentialevidenceplus.comTirzepatide systematic review: https://pubmed.ncbi.nlm.nih.gov/41015578/ Tirzepatide vs dulaglutide: https://pubmed.ncbi.nlm.nih.gov/41406444/Applying the Beers list: https://pubmed.ncbi.nlm.nih.gov/40697073/ High vs standard dose flu vaccine: https://pubmed.ncbi.nlm.nih.gov/41115437/ Another high dose flu trial: https://pubmed.ncbi.nlm.nih.gov/39230284/ Asymptomatic carotid stenosis treatment: https://pubmed.ncbi.nlm.nih.gov/41269206/

In today's episode, we sit down with Dr. Tamil Selvan Muthusamy, an interventional cardiologist trained in the UK and Europe, now practicing in Kuala Lumpur, to explore what may be the most important advance in cardiology in the last two decades: a new “bioadaptive” stent that actually moves and remodels with your arteries. We dive into why traditional rigid stents fail over time, how this new design dramatically cuts repeat heart events, and what it means for the millions of people worldwide living with coronary artery disease.Also, don't forget to subscribe to IE+ for premium insights and exclusive content!

New NEJM insights on asymptomatic carotid stenosis

Sirolimus-Eluting Balloon Versus Repeat Drug-Eluting Stenting or Balloon Angioplasty for In-stent Restenosis

Carotid artery disease management has come a long way. From the days when every stroke meant an endarterectomy to a modern era defined by precision, evidence, and evolving technology. With advances in medical therapy and newer techniques like TCAR, the vascular surgeon has even more to consider when choosing the best treatment for carotid disease. Join us as we break down the major landmark trials NASCET, CREST and the Asymptomatic Carotid trials, and discuss how their findings shape our clinical decisions in practice today. Hosts: ·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center ·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center ·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center ·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical Center Learning Objectives: · Review the key findings and clinical implications of the NASCET, ACST, and CREST trials. · Discuss patient selection for carotid endarterectomy (CEA) vs carotid artery stenting (CAS). · Understand how age, calcification, and aortic arch anatomy affect stenting outcomes or choice between stent and CEA. · Identify how advances in medical therapy have influenced management of asymptomatic disease.  · Discuss appropriate screening/ follow up plans for patients who do not meet criteria for intervention References: -       North American Symptomatic Carotid Endarterectomy Trial Collaborators. (1991). Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. The New England Journal of Medicine, 325(7), 445–453. https://pubmed.ncbi.nlm.nih.gov/1852179/ -       Brott, T. G., Hobson, R. W. II, Howard, G., Roubin, G. S., Clark, W. M., Brooks, W., ... & Howard, V. J. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England Journal of Medicine, 363(1), 11–23. https://pubmed.ncbi.nlm.nih.gov/20505173/ -       Halliday, A., Mansfield, A., Marro, J., Peto, C., Peto, R., Potter, J., & Thomas, D.; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. (2004). Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: Randomized controlled trial. The Lancet, 363(9420), 1491–1502. https://pubmed.ncbi.nlm.nih.gov/15135594/ -       Halliday, A., Bulbulia, R., Bonati, L. H., Chester, J., Cradduck-Bamford, A., Peto, R., & Pan, H., & the ACST-2 Collaborative Group. (2021). Second asymptomatic carotid surgery trial (ACST-2): A randomised comparison of carotid artery stenting versus carotid endarterectomy. The Lancet, 398(10305), 1065-1073. https://doi.org/10.1016/S0140-6736(21)01910-3 Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen Behind the Knife Premium: General Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-review Trauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlas Dominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkship Dominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotation Vascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-audio-review Colorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-audio-review Surgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-audio-review Cardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-audio-review Download our App: Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049 Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

Paul Hawksbee was joined by Charlie Baker for this afternoons podcast. Former world litter picking champion Sarah Parry, discussing Britain losing the top spot at the Litter Picking World Cup. Premier League chef Jonny Marsh, who discussed cooking for the stars of the Premier League and we had a birthday spread. Hosted on Acast. See acast.com/privacy for more information.

This week we review the results of the new pivotal trial of the 'Minima' stent by Renata Medical. What is special about this new device that makes it particularly desirable for use in small children? How strong is cobalt chromium and what evidence exists that it can be expanded repeatedly over 1-2 decades? Can this technology supplant surgery for certain diseases such as native coarctation? What are the limitations of this device? We speak with the first author of the pivotal trial, Dr. Patrick Sullivan of CHLA who is Associate Professor of Pediatrics at Keck Medicine at USC. DOI: 10.1161/CIRCINTERVENTIONS.125.015618

An estimated 2 million stents are implanted into people's hearts around the world each year – making it one of the key treatments for heart disease. The treatment was invented by Argentinian doctor Julio Palmaz, who credits a piece of metal being left by a construction worker in his home as inspiration for the structure of the stent. Collaborating with a US Army cardiologist and getting funding from the owner of a fast-food chain and a pharmaceutical giant; the coronary stent was approved for use in human beings in the 1990s. Julio Palmaz speaks to Tim O'Callaghan about his invention. Eye-witness accounts brought to life by archive. Witness History is for those fascinated by the past. We take you to the events that have shaped our world through the eyes of the people who were there. For nine minutes every day, we take you back in time and all over the world, to examine wars, coups, scientific discoveries, cultural moments and much more. Recent episodes explore everything from the death of Adolf Hitler, the first spacewalk and the making of the movie Jaws, to celebrity tortoise Lonesome George, the Kobe earthquake and the invention of superglue. We look at the lives of some of the most famous leaders, artists, scientists and personalities in history, including: Eva Peron – Argentina's Evita; President Ronald Reagan and his famous ‘tear down this wall' speech; Thomas Keneally on why he wrote Schindler's List; and Jacques Derrida, France's ‘rock star' philosopher. You can learn all about fascinating and surprising stories, such as the civil rights swimming protest; the disastrous D-Day rehearsal; and the death of one of the world's oldest languages.(Photo: Julio holding a stent. Credit: Julio Palmaz)

This week on The Heart of Innovation, our Save My Piggies series features a powerful story of courage, compassion, and cutting-edge care. Meet Benny, a Dallas patient who nearly lost his leg to advanced Peripheral Artery Disease (PAD) — and the physician who helped him reclaim his life. Dr. Marc Salhanick, a vascular specialist in Dallas, shares how a minimally invasive procedure using a new, retractable stent helped restore blood flow in the small vessels below the knee, giving Benny a second chance to walk and to live without fear of amputation. Benny opens up about the emotional toll of PAD, the frustration of delayed diagnosis, and the moment he finally found a care team that listened and acted. His journey highlights both the devastating gaps in PAD care and the hope that exists when awareness and access come together.

Send us a textIn this episode of our podcast DocTalk, host Debra Schindler sits down with MedStar Health interventional cardiologist Dr. John Wang, director of the Cardiac Catheterization Labs at MedStar Union Memorial Hospital and MedStar Franklin Square Medical Center in Baltimore, to explore how cardiac catheterizations have evolved, and why the transradial approach (through the wrist) is transforming catheterization procedures.Traditionally performed through the femoral artery in the groin, cardiac caths are increasingly going in through the wrist, offering: ·       Faster recovery Fewer complications Greater patient comfort Same-day discharge for many patientsDr. Wang explains:What symptoms may lead to a cardiac cathWhen the procedure is performed in emergencies (like heart attacks) vs. scheduled careWhy national cardiology guidelines recommend the transradial approachWhat patients should ask their doctors before undergoing the procedureIf you or a loved one may need a heart cath, this episode will help you understand your options, and why the accessing the heart through the wrist is a better approach.Learn more about interventional cardiology at MedStarHealth.org/MHVI To comment on this podcast, or suggest a topic for another episode send us an email: DocTalk@medstar.netFor more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.

Dr. Angela Stent, Senior Fellow at the Brookings Institution, examines the chances for diplomacy to win out as the war in Ukraine drags deep into its fourth year. Dr. Stent speaks with Bloomberg's Tom Keene and Paul SweeneySee omnystudio.com/listener for privacy information.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Stent-Retriever Thrombectomy in STEMI With Large Thrombus Burden: The RETRIEVE AMI Randomized Trial.

A client has a recently placed stent in their left anterior descending branch of the coronary artery. The therapist isn't clear about safety. What to do—get permission to work? Or get information to work safely? (You get two guesses, and one of them doesn't count.) This episode explores a helpful communication to establish client safety—and an example to us all!   Resources:  I Have a Client Who: Femoral Artery Stent (episode 77) I Have a Client Who: Cardiac Catheter (episode 297) I Have a Client Who: TAVR (episode 465) A Doctor's Note is Not Good Enough (and what is better) online self-paced CE class Helping Clients with Complex Conditions (no date). Available at: https://www.abmp.com/massage-and-bodywork-magazine/helping-clients-complex-conditions (Accessed: 13 June 2025).   Host Bio:                    Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.      About our Sponsors:    Anatomy Trains: www.anatomytrains.com    PMNT: www.pmnt.org   MassageBook: www.massagebook.com   Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.                      Website: anatomytrains.com                        Email: info@anatomytrains.com             Facebook: facebook.com/AnatomyTrains                       Instagram: www.instagram.com/anatomytrainsofficial   YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA    Precision Neuromuscular Therapy seminars (www.pnmt.org) have been teaching high-quality seminars for more than 20 years. Doug Nelson and the PNMT teaching staff help you to practice with the confidence and creativity that comes from deep understanding, rather than the adherence to one treatment approach or technique.   Find our seminar schedule at pnmt.org/seminar-schedule with over 60 weekends of seminars across the country.   Or meet us online in the PNMT Portal, our online gateway with access to over 500 videos, 37 NCBTMB CEs, our Discovery Series webinars, one-on-one mentoring, and much, much more! All for the low yearly cost of $167.50. Learn more at pnmt.thinkific.com/courses/pnmtportal!    Follow us on social media: @precisionnmt on Instagram or at Precision Neuromuscular Therapy Seminars on Facebook.   MassageBook is offering listeners $50 off when they sign up with coupon code ABMP50. Start your free 30-day trial today and transform your practice with tools designed to increase bookings and streamline client management.   Connect with MassageBook:   Visit their website: MassageBook   Follow MassageBook on Facebook, Instagram, LinkedIn  

Join Jay Gunkelman, QEEGD (the man who has analyzed over 500,000 brain scans), Dr. Mari Swingle (author of i-Minds), and host Pete Jansons for another engaging NeuroNoodle Neurofeedback Podcast episode discussing neuroscience, psychology, mental health, and brain training.✅ Topic 1 Explained: Can You Record Your Dreams?

In this episode of the Context Coaching Podcast, host dives deep with Shane Stent, a graduate assistant for men's volleyball at Menlo College and a master's candidate in Sports Performance Psychology. Shane shares his journey from being a student-athlete to facing a career-defining injury that pivoted him into coaching. They discuss the trials of high school and club volleyball coaching, parental interactions, the significant differences and similarities between coaching males and females, and the impact of his ongoing education in sports psychology. A must-watch for aspiring coaches and sports enthusiasts looking to understand the intricacies of coaching across different levels.00:00 Introduction and Guest Background00:46 Journey from Athlete to Coach02:08 Coaching High School and Club Volleyball06:50 Balancing Academics and Athletics12:35 Challenges and Lessons in Coaching16:52 Communication and Player Development21:21 Navigating Collegiate Coaching22:55 The Changing Landscape of College Sports24:18 Establishing Standards in Practice26:39 Measuring Communication and Hustle29:00 Learning from Different Coaching Roles32:31 Applying Lessons from Other Sports36:38 Failing Forward: Learning from Mistakes41:30 Challenging Beliefs and Coaching Differences

Remember when Coach Prime Deion Sanders nearly lost his legs due to below-knee blockages?  Many patients with severe poor circulation in their legs known as Peripheral Artery Disease (PAD) face the same “revolving door” of treatments with limited options… until now.  Watch “The Heart of Innovation” as Dr. Jay Matthews, the lead Principal Investigator behind the groundbreaking DEEPER REVEAL trial talks about a technology that just changed the game for peripheral artery disease treatment!  Dr. Matthews will reveal how Reflow Medical's breakthrough technology called "SPUR" —a temporary stent that achieves impressive early results—is offering new hope for patients suffering from debilitating leg cramps, pain, and neuropathy.  This FDA-cleared innovation specifically targets those challenging below-knee arteries—long considered the “Achilles heel” for vascular specialists—and could be life-changing for patients with diabetes and chronic kidney disease who suffer most from these difficult-to-treat blockages.  The DEEPER REVEAL clinical trial demonstrated a remarkable 99.2% technical success rate with this novel approach that leaves no metal behind! Don't miss this episode that could literally help save limbs and transform lives! If you have peripheral artery disease and have questions about treatment options, call the Global PAD Association's Leg Saver Hotline at 1-833-PAD-LEGS or go to PADhelp.org #MedicalBreakthrough #PADawareness #HeartOfInnovation #peripheralarterydisease #removablestent #retractablestent #reflowmedical #padtreatment #blockedarterytreatment #blockedarteries #stents #peripheralvasculardisease #padsupport #padsupportgroup #healthinnovation

Comparison Of Stent Geometry Achieved By Different Side-branch Ballooning Techniques For Bifurcation Provisional Scenting: The Randomized Crabbis Trial

Post Zeke: If you missed part one, you may need to relisten as we live in a post Zeke world now and attempt to get back into Dancing on Ice. Charlie: We get a return call from Charlie from episode 830 Part 2 back in August and he's still saying the same shit. The Return Of Zeke: Zeke is back, can we achieve a friendship arc? Then we have some palette cleansers. THE BEAR!, FUCK YOU, WATCH THIS!, FRIENDSHIP!, PAUL RUDD!, TIM ROBINSON!, MY BOO!, GHOST TOWN DJS!, STREAM ISSUES!, STAND UP!, 100 FOOT TALL!, NEW YORK!, CHARACTER!, HAVE A KID!, NICK!, CHARITY!, TOTS TURNT!, ZEKE!, GOOD DDUES!, DANCING ON ICE!, ROOTING FOR HIM!, FAIREST PODCAST IN THE GAME!, STREAM ISSUES!, ICE SKATING!, CHARLIE!, CALL IN!, LUCKY FRITZ!, SLEEVELESS!, WHITE HAT!, PREPARED CALL!, BRING TO THE TABLE!, UNIQUE!, IMPROV!, CHINESE RESTAURANT!, SPEAK ENGLISH!, STAND UP!, CLOWNVIS!, HALL PASS!, ANTHONY CUMIA!, IMPRESSIONS!, RONALD REAGAN!, WELL!, CUM HEAD!, JIM NORTON!, ZEKE!, HEADUCATED!, COMEDY SHOP!, JOKE STORE!, ROCKS!, INTEGRITY!, ADVERTISERS!, CANCELED!, COME AFTER YOU!, DETROIT!, DROP A PIN!, SMOKE LOUD!, IGGY POP!, RECORDS!, HEART ATTACK!, STENT!, CALM DOWN!, AMERICAN HISTORY X!, LIFE FLASHES BEFORE YOUR EYES!, FATHER'S DAY!, TEASED!, BULLIED!, DRUMMER!, INSTAGRAM!, KALEB ALL AROUND!, GREEN LANTERN!, IRON MAN 3!, TIKTOK!, BURGERS!, FOOD!, DROOL!, GROSS!  You can find the videos from this episode at our Discord RIGHT HERE!

In this episode, hosts Mitsuaki Sawano, MD, Nobuhiro Ikemura, MD, and Satoshi Shoji, MD, are joined by Dr. Yoichiro Sugizaki, MD, for an in-depth discussion on his landmark OCT-based study investigating chronic stent recoil (CSR) and its impact on target lesion revascularization (TLR) in the contemporary era of thin-strut, second-generation drug-eluting stents (DES). Together, they delve into the frequency, mechanisms, and clinical relevance of CSR—an underappreciated phenomenon increasingly observed in heavily calcified or eccentric lesions despite technological advancements in stent design. The conversation underscores why recognizing CSR is essential for interventional cardiologists and explores practical strategies to mitigate its impact.

Gaming the System: Cardiologists, Heart Stents, and Upcoding Cardiologists can criminally game the system by telling a patient they have a much more serious, unstable disease than they really have, fraud that results in unnecessary procedures, unnecessary cost, and unnecessary patient harm. Listen to today's episode written by Dr. Michael Greger at @NutritionFacts.org #vegan #plantbased #plantbasedbriefing #upcoding #stents #stableangina #unstableangina #cardiologists #heartstents ============================ Original post: https://nutritionfacts.org/blog/gaming-the-system-cardiologists-heart-stents-and-upcoding/  Related Episodes: Stents: 933: After a Stent at 32 I Reversed My Heart Disease https://plantbasedbriefing.libsyn.com/933-after-a-stent-at-32-i-reversed-my-heart-disease-by-karlynn-mccarrell-at-forksoverknivescom  840: My Aging Parents' Shocking Health Improvements Through Food https://plantbasedbriefing.libsyn.com/840-my-aging-parents-shocking-health-improvements-through-food-by-sandra-l-price-at-nutritionstudiesorg  Statins: 928: The 411 on Statins https://plantbasedbriefing.libsyn.com/928-the-411-on-statins-by-dr-michael-greger-at-nutritionfactsorg  922: Thanks to a Whole-Food, Plant-Based Diet, I No Longer Need Statins https://plantbasedbriefing.libsyn.com/922-thanks-to-a-whole-food-plant-based-diet-i-no-longer-need-statins-by-rainer-lucks-at-forksoverknivescom    ============================ Dr. Michael Greger is a physician, New York Times bestselling author, and internationally recognized speaker on nutrition, food safety, and public health issues. A founding member and Fellow of the American College of Lifestyle Medicine, Dr. Greger is licensed as a general practitioner specializing in clinical nutrition. He is a graduate of the Cornell University School of Agriculture and Tufts University School of Medicine. He founded NUTRITIONFACTS.ORG is a non-profit, non-commercial, science-based public service provided by Dr. Michael Greger, providing free updates on the latest in nutrition research via bite-sized videos. There are more than a thousand videos on nearly every aspect of healthy eating, with new videos and articles uploaded every day.   His latest books —How Not to Age, How Not to Die, the How Not to Die Cookbook, and How Not to Diet — became instant New York Times Best Sellers. His two latest books, How to Survive a Pandemic and the How Not to Diet Cookbook were released in 2020.  100% of all proceeds he has ever received from his books, DVDs, and speaking engagements have always and will always be donated to charity. ============================== FOLLOW THE SHOW ON: YouTube: https://www.youtube.com/@plantbasedbriefing     Spotify: https://open.spotify.com/show/2GONW0q2EDJMzqhuwuxdCF?si=2a20c247461d4ad7 Apple Podcasts: https://podcasts.apple.com/us/podcast/plant-based-briefing/id1562925866 Your podcast app of choice: https://pod.link/1562925866 Facebook: https://www.facebook.com/PlantBasedBriefing   LinkedIn: https://www.linkedin.com/company/plant-based-briefing/   Instagram: https://www.instagram.com/plantbasedbriefing/     

The "River" stent is a novel stent designed specifically to account for the anatomical and procedural requirements of venous sinus stenosis. A multicentre study of the device's safety and efficacy is underway, comprising 39 subjects across 5 US centres. The 1-year results have been recently published in JNIS. Editor-in-Chief of JNIS, Dr. Felipe C. Albuquerque, interviews Dr. Athos Patsalides¹, author of the paper: The River study: the first prospective multicenter trial of a novel venous sinus stent for the treatment of idiopathic intracranial hypertension 1. Department of Neurological Surgery, North Shore University Hospital, Manhasset, New York, USA   Please subscribe to the JNIS podcast on your favourite platform to get the latest podcast every month. If you enjoy our podcast, you can leave us a review or a comment on Apple Podcasts (https://apple.co/4aZmlpT) or Spotify (https://spoti.fi/3UKhGT5). We'd love to hear your feedback on social media - @JNIS_BMJ.

April 18, 2025 Scott, Mark, and Ray discuss questions that came into the PRS Helpdesk:For the past 8 months, I have been in an employed position with a county hospital system that provides inpatient and ambulatory services. Their coding consultants (acsteam.net) are telling the hospital that foley catheter insertions, bladder irrigations, and a list of other procedures commonly performed in urology clinics cannot be billed if they are not performed personally by the physician according to CMS. They reference a list of procedures from CMS and state that these services cannot be billed when performed by ancillary staff regardless of the level of supervision. They use https://www.cms.gov/status-indicators as their source citing the section on PC or TC indicators. Can this be true? Is it possible that this consultant is giving advice from a hospital perspective and not aware of differences between the ambulatory setting? The urology clinic I am working in is not a department of the hospital. It is freestanding. I have never worked in a clinic that did not bill for these services performed by ancillary staff with physician supervision.I look forward to your response.Good afternoon, my question is regarding "Incident to" required documentation. When we attended your seminar this past December, on Day 2, the new "Incident to Rule" was discuss. Can you please help clarify the new rule? My notes are not clear.We are in the process of CMS Review -"Targeted Probe and Educate Round 1". The letter states we were chosen for review because of being in the 60th percentile for our jurisdiction for code 99214.Our practice has the challenge of servicing and underprivilege community and estimated population of 590,142. We have 7 Urologist, 4 Apps and 1 Radiation Oncologist in our practice. Hence our volume is overwhelming.Earlier this year we submitted a batch of approximately forty records. Today we received a notification request "Incident to documentation: needed 2 previous office visits done by MD to support physician/supervising provider's initiation and continued involvement in treatment, and documentation to support direct supervision met.I appreciate any assistance with clarifying the “Incident to” rule.Thank you in advance for your assistance.Doctor did a stent pull in the ASC but not with Cysto scope. How would we go about billing this?Free Kidney Stone Coding CalculatorDownload NowPRS Billing and Other Services - Book a Call with Mark Painter or Marianne DescioseClick Here to Get More Information and Request a Quote Join the Urology Pharma and Tech Pioneer GroupEmpowering urology practices to adopt new technology faster by providing clear reimbursement strategies—ensuring the practice gets paid and patients benefit sooner.https://www.prsnetwork.com/joinuptp Click Here to Start Your Free Trial of AUACodingToday.com   The Thriving Urology Practice Facebook group.The Thriving Urology Practice Facebook Group link to join:https://www.facebook.com/groups/ThrivingPractice/ © 2025 Physician Reimbursement Systems, Inc.Home

Friend of the podcast Brynley Stent returns to discuss NZ Series 2! Brynley has some hot takes which include great BTS on the 'Eat the grape' task. Brybly and Ed discuss their approaches to escape rooms and why the Guy and Laura competitiveness is so fun to watch! You can watch Brynley's new digital series with Kura Forrester here: Bryn and Ku's Singles Club youtu.be/Opf4Zyz7CGMTo get all the latest Taskmaster news visit Taskmaster.tv To watch all UK and NZ Taskmaster visit channel4.com

N Engl J Med 2024;390:1481-1492Background: In patients with ST-elevation myocardial infarction (STEMI), opening the culprit artery improves outcomes. Nearly half of STEMI patients have disease in other coronary arteries. Whether revascularizing these non-culprit arteries improves outcomes remained uncertain. The PRAMI trial showed improvement in outcomes with complete revascularization but was relatively small, included 465 patients, and did not require the use of fractional flow reserve (FFR).Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The FFR-Guidance for Complete Nonculprit Revascularization (FULL REVASC) trial sought to assess if FFR-guided completed revascularization improves outcomes compared to culprit-only percutaneous coronary intervention (PCI).The COMPLETE trial was not published by the time the FULL REVASC trial started enrolling patients.Patients: Eligible patients had STEMI and were undergoing PCI or had high risk NSETMI undergoing urgent PCI. High risk NSTEMI included patients with dynamic ST–T-wave changes, ongoing chest pain, acute heart failure, hemodynamic instability independent of electrocardiographic changes, or life-threatening ventricular arrhythmias.Eligible patients had to have multivessel coronary artery disease, defined as one or more lesions in a nonculprit artery with a diameter of ≥ 2.5 mm and a visually graded stenosis of 50 - 99%.Patients were excluded if they had previous CABG, left main disease or cardiogenic shock.Baseline characteristics: The trial randomized 1,542 patients – 778 randomized to culprit-only PCI and 764 randomized to complete revascularization. Patients were recruited from 32 centers in 7 countries.Approximately 91% of the patients had STEMI and 9% had high risk NSTEMI.The average age of patients was 65 years and 76% were men. Approximately 51% had hypertension, 16% had diabetes, 23% were on treatment for hyperlipidemia, 8% had prior myocardial infarction, and 35% were current smokers.The number of residual coronary arteries with stenosis of 50-99% was 1 in 72% of the patients and 2 or more in the rest.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo culprit-only PCI or FFR-guide complete revascularization. The study was open label.Patients in the culprit-PCI only group did not receive further revascularization during the index hospitalization. Patients in the FFR-guided complete revascularization could receive further revascularization during the index procedure or during the index hospitalization. PCI of non-culprit lesion was recommended if FFR was 0.80 or less.Endpoints: The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The main secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularizationAnalysis was performed based on the intention-to-treat principle. The estimated sample size to achieve 80% with a two-sided alpha of 0.05 was 4,052 patients. This sample size would detect 0.75 risk ratio for the composite outcome of death or myocardial infarction at 1-year assuming 9.9% event rate in the culprit-only PCI. After the publication of the COMPLETE trial, the trial was stopped early due to ethical and feasibility concerns. Consequently, the original key secondary outcome (death from any cause, myocardial infarction, or unplanned revascularization) became the new primary outcome, and events after 1 year of follow-up were included in the primary analysis.Results: The trial was stopped after randomizing 38.1% of the original sample size. Among the patients assigned to the FFR-guided complete-revascularization arm, the procedure was followed in 95.9% of the patients, and among these patients, 17.9% underwent FFR-guided complete revascularization of non-culprit lesions during the primary PCI and the rest during the index hospitalization. Among the patients assigned to culprit-only arm, the assigned strategy was followed in 99.6% of the patients. The median follow-up time was 4.8 years.FFR was 0.8 or less in 392 (47.3%) of non-culprit vessels assessed, and PCI was performed in 369 (94.1%) of these vessels. In total, PCI was performed in 18.8% of the total non-culprit vessels. The average number of stents during the index hospitalization was 1 in the culprit-only PCI group and 2 in the complete revascularization group.The primary composite outcome was not significantly different between both treatment groups (19.0% with complete-revascularization vs 20.4% with culprit-only PCI, HR: 0.93, 95% CI: 0.74 - 1.17; p= 0.53). There were also no significant differences in composite endpoint of death from any cause or myocardial infarction (16.5% with complete revascularization vs 15.3% with culprit-only PCI) or unplanned revascularization (9.2% with complete revascularization vs 11.7% with culprit-only PCI).Stent thrombosis and stent restenosis were significantly more frequent in the complete revascularization arm (2.5% vs 0.9%, HR: 2.80, 95% CI: 1.18 – 6.67) and (4.2% vs 2.3%, HR: 1.84, 95% CI: 1.03 – 3.28), respectively.Baseline risk or coronary anatomy did not significantly affect subgroup interactions for the primary outcome.Conclusion: In patients with STEMI or high risk NSTEMI, FFR-guided complete revascularization compared to culprit-only PCI, did not improve the outcomes of death from any cause, myocardial infarction, or unplanned revascularization, over a median follow up time of 4.8 years. Complete revascularization resulted in more stent thrombosis and stent restenosis.The study lost some statistical power by stopping early, resulting in a final power of 74%. We disagree with the authors' decision to halt the trial prematurely based on the findings of the COMPLETE trial. COMPLETE was the first large trial to demonstrate a benefit in hard outcomes when revascularizing stable plaques, and its results warrant further confirmation. Furthermore, COMPLETE used different strategy as FFR was not required.Note to readers: Power measures the study's ability to avoid a Type II error (false negative) and it equals 1 - β with β being the probability of a Type II error. In other words, power represents the probability of correctly rejecting the null hypothesis (H₀) when the alternative hypothesis (H₁) is true. Most clinical trials aim for 80% or 90% power. For example, a study with 80% power has a 20% risk of failing to detect a real effect.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Pants Illustrated: https://www.instagram.com/pants.illustrated?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==Andy's appearance on "Unconventional Pathways" https://open.spotify.com/episode/13Vvnv8E0ws4mHOQV1JTLS?si=QbBr7oIySE-ESOYeruvScgAndy's appearance on Pitch Bleak on Youtube: https://youtu.be/grK7kSL_T2g?si=sVX-s1mhXx9ZhQDfThere's never been a better time to order Gustav & Henri from Andy and Pete's very own online shop.You can support the pod by chipping in to our patreon here (thank you!)Join the other TITTT scholars on the TITTT discord server hereHey, why not listen to Al's meditation/comedy podcast ShusherDon't forget TITTT Merch is now available on Red Bubble. Head over here and grab yourselves some material objectsYou can find us on twitter at @twointankAndy Matthews: @stupidoldandyAlasdair Tremblay-Birchall: @alasdairtb and instaAnd you can find us on the Facebook right here Hosted on Acast. See acast.com/privacy for more information.

Study finds the thyroid gland needs higher vitamin D levels to function optimallyWhat are your thoughts on encapsulated organ meat supplements?  Are they bioavailable?How much water should you drink per day?  Do other beverages count towards the total?I recently had a cardiac cath procedure resulting in no stent!  Phew!

In this podcast, Dr. Valentin Fuster introduces a detailed review on managing coronary stent under-expansion, a critical issue that increases risks like restenosis and myocardial infarction. The discussion highlights the causes, challenges, and treatment strategies for under-expanded stents, emphasizing the importance of intravascular imaging and individualized approaches to optimize patient outcomes.

In this podcast, Dr. Valentin Fuster discusses the Target for NA trial, which compares biodegradable polymer stents to second-generation drug-eluting stents for coronary intervention. While the results showed the biodegradable stents were non-inferior in preventing target lesion failure, questions remain regarding their real-world performance and procedural handling in clinical practice.

Hey Girl! Today's episode dives into my recent healing journey from an Iliac Stent Placement to treat my PeVD (Pelvic Venous Disorder or Pelvic Congestion Syndrome) and more about what I have been working on during my recovery to help you succeed in reaching your health and wellness goals this year! Are you a busy mom or woman  who is tired of peeing your pants when you sneeze, cough, jump or run? Maybe you're postpartum and wanting to restore your pelvic floor and core so you can feel strong and confident in your body, but not sure which exercises are “safe” and which might make your problems worse? How are you supposed to exercise and heal  if you have no time or energy?

Boyle's father in-law is in hospital and it is chaos.

Hey Friend, For those that haven't been following along, I have been struggling with symptoms of Pelvic Venous Disorder or PeVD or better known as, Pelvic Congestion Syndrome, for the last year.  It all started with an ovarian cyst like pain, but I later learned that my “menstrual cramps” I was feeling on and off throughout the month, not just during my menses, was also due to these enlarged veins.  The heaviness and cramping was starting to get so uncomfortable that standing or sitting for too long was painful, and even exercise started to become painful.  Thankfully sex was never painful, but painful intercourse or dyspareunia, especially pain or cramping with and after arousal or orgasm, is a very common symptom of PeVD.  I was not a typical presentation for this diagnosis, so it surprised me when I found out from an ultrasound.  So I share my story so that others with pelvic pain, constipation, heaviness, sharp abdominal pain, low back pain or pain with sitting, standing, or exercising, can start to become aware of this diagnosis and advocate for yourself.  As many gynecologists do not believe this condition is a cause of pain…. And I can tell you… it most definitely IS!   After two procedures using coil embolization and sclerotherapy to close off the dysfunctional varicose veins in my pelvis, it was identified that a compression of my Iliac vein was pretty severe and needed to be treated with a stent.  I am two weeks postop and recovery has been a journey.  Many things I was not expecting, so again, I wanted to share with the World so that maybe you can feel more prepared and aware of the treatment options out there for you! Thanks for following along on my health journey and sending all the love and supporting messages, it has meant a lot!  As always, if you are experiencing any pelvic floor/women's health issue like urinary incontinence/leaking, pelvic pain, pain with sex, urgency, heaviness/prolapse or any other back/hip/joint pain let's get you booked for a virtual coaching session or in person physical therapy session for a more individualized plan and one-on-one instructions so you can feel confident in your body and start healing today!!    Make Sure to reach out to> PTDes@balancedmomtality.com  AND/OR Join my FREE Facebook community for ACCOUNTABILITY and a safe and supportive place to share and support each other!> https://www.facebook.com/groups/1696216757461633/    Join my VIP Insider group and receive my Newsletter full of great tips and tricks and upcoming resources! > https://newsletter.balancedmomtality.com/   Follow and get tips/tricks on:  Facebook> @thebalancedmomtality Instagram> @the_balanced_momtality   Learn > www.balancedmomtality.com

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A Note from James:Imagine you are dying or you're about to die. Let's say you were hit by a car, you're bleeding out, you're on the way to the hospital but you just have this sense that you're not going to live, and you see visions of someone you knew in the past, maybe a mother or a father, and they're saying, "Don't worry, we're here for you." Come down this light at the end of a tunnel. Does that change your experience of life if you then survive? Well, we're going to hear from Sebastian Junger, who wrote "In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife." And if you don't know who Sebastian is, he's written many books about being a war reporter, his experiences in war zones, and other intense situations. But this is perhaps his most intense book that I've read, where he's not talking about deaths on the battlefield or in a war zone, but his own experience of dying and what happened to him during that experience. It really makes you think. And I've been thinking about it a lot for personal reasons this past week. I hope everybody enjoys it. If you do, please retweet it, share it with your friends, and subscribe to the podcast so all the good little algorithms work for me. Thanks so much, and here is Sebastian.Episode Description:In this compelling episode, James Altucher converses with Sebastian Junger, acclaimed author and war reporter, about his harrowing near-death experience and his exploration of the afterlife in his latest book, "In My Time of Dying." Junger shares the profound and mystifying moments he faced at the brink of death, challenging his atheistic beliefs and scientific understanding. This episode isn't just about a personal encounter with mortality but dives into the larger implications of consciousness, the mysteries of the human mind, and what it means to truly live after facing death.What You'll Learn:The profound impact of near-death experiences on one's worldview and beliefs.The intersection of scientific rationalism and mystical experiences.Insights into the psychological and emotional aftermath of surviving a near-death experience.Theories about consciousness and the potential for an afterlife from both scientific and experiential perspectives.Practical lessons on living a more appreciative and meaningful life after a brush with death.Chapters:00:01:30 - Introduction: Sebastian Junger's Near-Death Experience00:04:41 - The Moment of Crisis: Abdominal Hemorrhage and Medical Intervention00:09:00 - Encountering the Void and Seeing His Father00:14:22 - The Medical Miracle: Innovative Interventional Radiology00:24:26 - Rational Explanations vs. Mystical Experiences00:31:30 - Unexplained Phenomena: Quantum Mechanics and Consciousness00:41:29 - Personal and Philosophical Reflections on Life and Death00:52:30 - The Aftermath: Dealing with Anxiety and Fear00:56:35 - Finding Meaning and Appreciation in Life Post-Trauma01:02:15 - Writing About the Experience: Structuring the Narrative01:05:28 - Final Thoughts and TakeawaysAdditional Resources:Sebastian Junger's Official WebsiteIn My Time of Dying: How I Came Face to Face with the Idea of an AfterlifeTribe: On Homecoming and Belonging by Sebastian JungerWar by Sebastian JungerQuantum Enigma: Physics Encounters Consciousness by Bruce Rosenblum and Fred KuttnerBiocentrism: How Life and Consciousness are the Keys to Understanding the True Nature of the Universe by Robert Lanza ------------What do YOU think of the show? Head to JamesAltucherShow.com/listeners and fill out a short survey that will help us better tailor the podcast to our audience!Are you interested in getting direct answers from James about your question on a podcast? Go to JamesAltucherShow.com/AskAltucher and send in your questions to be answered on the air!------------Visit Notepd.com to read our idea lists & sign up to create your own!My new book, Skip the Line, is out! Make sure you get a copy wherever books are sold!Join the You Should Run for President 2.0 Facebook Group, where we discuss why you should run for President.I write about all my podcasts! Check out the full post and learn what I learned at jamesaltuchershow.com------------Thank you so much for listening! If you like this episode, please rate, review, and subscribe to “The James Altucher Show” wherever you get your podcasts: Apple PodcastsiHeart RadioSpotifyFollow me on social media:YouTubeTwitterFacebookLinkedIn