Podcasts about Thrombolysis

Send us a textThis recording features audio versions of June 2025 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Comparison of Bypass Surgery versus Endovascular Interventions for Peripheral Artery Disease through Systematic Review and Meta-Analysis of Randomized Controlled Trials ReadThe Incidence and Consequences of Endovascular Technical Failure in Patients with Chronic Limb-Threatening Ischemia: Results from the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb-Threatening Ischemia (BEST-CLI) Trial ReadComparative Radiologic Response Assessment after Transarterial Chemoembolization, Percutaneous Ablation, and Multimodal Treatment: Radiologic-Pathologic Correlation in 81 Tumors ReadBreast Cancer Recurrence after Cryoablation in Patients Who Are Poor Surgical Candidates or Who Refuse Surgery ReadKetamine/Midazolam versus Fentanyl/Midazolam Sedation for Interventional Radiology Procedures: A Prospective Registry ReadPortal and Hepatic Vein Embolization versus Portal Venous Embolization Alone in Cirrhotic and Noncirrhotic Swine: A Pilot Study ReadAssessment of Catheter-Directed Thrombolysis and Histotripsy Treatment for Deep Vein Thrombosis ReadExpanding Global IR Outreach to Address Postpartum Hemorrhage in Kenya Using Geospatial Analytic Mapping ReadJVIR and SIR thank all those who helped record this episode. To sign up to help with future episodes, please contact our outreach coordinator at millennie.chen.jvir@gmail.com.  Host and audio Editor:Sonya Choe, University of California Riverside School of MedicineOutreach coordinator:Millennie Chen, University of California Riverside School of MedicineAbstract readers:Marc Attalla, University of California Riverside School of MedicineAgnes Manish, Loma Linda University School of MedicineClare Necas, Western University of Health Sciences, College of Osteopathic MedicineGavin Shu, University of California San Francisco School of MedicineMark Oliinik, Loma Linda University School of MedicineAbhisri Ramesh, George Washington School of Medicine and Health SciencesAndrew Sasser, University of Miami Miller School of Medicine Sakeena Siddiq, Western University of Health Sciences, College of Osteopathic MedicineSIR thanks BD for its generous support of the Kinked Wire.Read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.Support the show

On Episode 50 of the Stroke Alert Podcast, host Dr. Negar Asdaghi highlights two articles from the March 2025 issue of Stroke: “Impact of Subarachnoid Hemorrhage on Human Glymphatic Function: A Time-Evolution Magnetic Resonance Imaging Study” and “Thrombolysis for Ischemic Stroke Beyond the 4.5-Hour Window: A Meta-Analysis of Randomized Clinical Trials.” She also interviews Drs. Mayank Goyal and Michael Hill about the ESCAPE-MeVO trial, presented in February at the International Stroke Conference. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20250314.838310

Three recent trials investigated the effectiveness of endovascular treatment (EVT) in ischemic stroke. The OPENS-2 trial (Lancet 2025) found that normobaric hyperoxia combined with EVT improved 90-day functional outcomes for large-vessel occlusion stroke without increasing adverse events. The DISTAL trial (NEJM 2025) reported no significant benefit of EVT over medical therapy for medium/distal vessel occlusions and noted a higher risk of hemorrhage. Similarly, the ESCAPE-MeVO trial (NEJM 2025) found no improvement with EVT in medium-vessel occlusion stroke, alongside increased mortality and intracranial hemorrhage. Collectively, these findings suggest that EVT's benefits depend on vessel size and may be enhanced with adjunctive treatments like hyperoxia in specific cases.

Welcome back Rounds Table Listeners!We are back today with a solo episode with Dr. Mike Fralick!This week, he will discuss a paper exploring the role of intravenous thrombolytic therapy in patients with minor ischemic stroke and intracranial vessel occlusion. Here we go!Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion (TEMPO-2): a randomised, open-label, phase 3 superiority trial (0:00 – 6:18).And for the Good Stuff:Trial Files (6:18 – 7:59).Questions? Comments? Feedback? We'd love to hear from you! @roundstable @InternAtWork @MedicinePodsDo you ever feel like you can't get ahead of charting? Freed AI has an AI driven scribe for you! You can try Freed for free right now by going to getfreed.ai. Listeners can use the INTERN50 code for $50 off their first month!

PEERLESS: Large-Bore Mechanical Thrombectomy vs Catheter-directed Thrombolysis for Treatment of Intermediate-Risk Pulmonary Embolism

This recording features audio versions of January 2025 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Effectiveness of Track Cauterization in Reduction of Adverse Events for Lung Microwave Ablation ReadSelective Lymphatic Duct Embolization for Treatment of Thoracic Lymphatic Flow Disorders in Children: Technical Aspects and Comparison with Thoracic Duct Embolization ReadA Comparison of Postprocedural Hemoglobin in Catheter-Directed Thrombolysis versus Large-Bore Aspiration Thrombectomy for Acute Pulmonary Embolism ReadClinical Outcomes following Invasive Treatment of Femoropopliteal Artery Disease: A Retrospective Single-Center Cohort Study ReadOutcomes of Endovascular Treatment for Infectious Thoracic Aortic Diseases ReadThe Influence of Preablation Embolization Particle Size on the Size of the Microwave Ablation Zone in a Porcine Orthotopic Renal Tumor Model ReadJVIR and SIR thank all those who helped record this episode. To sign up to help with future episodes, please contact our outreach coordinator at millennie.chen.jvir@gmail.com.  Host:Manbir Singh Sandhu, University of California Riverside School of MedicineAudio editor:Manbir Singh Sandhu, University of California Riverside School of MedicineOutreach coordinator:Millennie Chen, University of California Riverside School of MedicineAbstract readers:Maximillion Hayama, Duke University School of MedicineSonya Choe, University of California Riverside School of MedicineSiddak Dhaliwal, University of Missouri School of MedicineAkumbir Singh Grewal, St. George's University School of MedicineBryan Torres, University of California Riverside School of MedicineJason Hoang, The Ohio State College of MedicineSIR thanks BD for its generous support of the Kinked Wire.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show

Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged. Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.Today's guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue. Key ReferenceTenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]GuestsDr Duncan Austin PhD FRACP MRCP (Cabrini Health) Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne) Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland). ProductionProduced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort Out' by Walt Adams and ‘the Appalachian Trail' by Hunter Quinn. Image produced and copyrighted by RACP.Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.  Please visit the Pomegranate Health web page for a transcript and supporting references.Login to MyCPD to record listening and reading as a prefilled learning activity. Subscribe to new episode email alerts or search for ‘Pomegranate Health' in Apple Podcasts, Spotify,Castbox or any podcasting app.

Dr. Dan Ackerman and Dr. Silja Räty discuss the outcomes of patients with basilar artery occlusion treated with intravenous thrombolysis (IVT) only and compares IVT with endovascular thrombectomy.  Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209249 

Dr. Dan Ackerman talks with Dr. Silja Räty about the outcomes of patients with basilar artery occlusion treated with intravenous thrombolysis (IVT) only and compares IVT with endovascular thrombectomy. Read the related article in Neurology. This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information. Disclosures can be found at Neurology.org.

N Engl J Med 2013;369:999-1010Background: Adding P2Y12 inhibitors to aspirin improves outcomes in patients with acute coronary syndrome. Yet, debate persisted regarding the optimal timing for administering these drugs in patients undergoing percutaneous coronary intervention (PCI). The ATLANTIC trial showed that pre-hospital administration of ticagrelor did not improve outcomes compared to in-hospital administration, in patients with ST elevation myocardial infarction.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The ACCOAST trial sought to test the hypothesis that administering the P2Y12 inhibitor, prasugrel, 2-48 hours before angiography in non-ST elevation myocardial infarction patients is superior to administering it during PCI.Patients: Patients were enrolled if they had non-ST elevation myocardial infarction. Patients were scheduled to undergo angiography with possible PCI within 2-48 hours after randomization. Patients were excluded if they had cardiogenic shock, refractory ventricular arrhythmias, prior hemorrhagic or ischemic stroke or TIA, history of intracranial neoplasms, history of intracranial AV malformations or aneurysm, surgery within 4 weeks, active bleeding or history of bleeding diathesis or had high risk of bleeding based on the judgement of the investigator.Baseline characteristics: The average age of patients was 64 years with 72% being men. The average weight was 82 kg. About 20% had diabetes, 45% had hyperlipidemia, 62% had hypertension and 33% were current smokers. Creatinine clearance was ≤ 30 ml/min in 3% of the patients and GRACE score was < 140 in 77% of them. Beta-blockers were given in 84% of the patients, statins in 90%, angiotensin-receptor blockers in 13% and ACE inhibitors in 70%.After randomization, 68.7% of the patients underwent PCI while 25.1% were treated medically. CABG within 7 days was performed in 6.2% of the patients.Procedures: Patients were randomized 1:1 to receive pretreatment with prasugrel or matching placebo (control group). Those in the pretreatment group received a 30 mg loading dose of prasugrel before coronary angiography with an additional 30 mg if angiography confirmed the need for PCI. Patients in the control group received placebo before coronary angiography and a 60 mg loading dose of prasugrel in patients undergoing PCI. Only the initial 30 mg loading dose of prasugrel or placebo were administered, if a decision, after coronary angiography, was made to pursue CABG or medical therapy.Endpoints: The primary efficacy end point was a composite endpoint of death from cardiovascular causes, myocardial infarction, stroke, urgent revascularization, or the need for rescue therapy with glycoprotein IIb/IIIa inhibitors. Follow up for the primary endpoint was 7 days post randomization. Secondary endpoints included death from any cause, stent thrombosis and a composite endpoint of death from cardiovascular causes, myocardial infarction, or stroke.Safety end points were major or minor bleeding according to Thrombolysis in Myocardial Infarction (TIMI) criteria.Statistical analysis was performed on the intention-to-treat principle. To achieve 80% power with two-sided alpha of 0.05 for detecting 24% relative risk reduction in the pretreatment compared to the control group, 400 patients with the primary outcome and approximately 4,100 enrolled patients would be needed.Results: The trial randomized 2,037 patients to the pre-treatment group and 1,996 to the control group. The median time from the initial loading dose to PCI was 4.3 hours.The incidence of the composite primary end point was similar between both treatment groups (10.0% in the pre-treatment group vs 9.8% in the control group, HR: 1.02, 95% CI: 0.84 – 1.25; p= 0.81). There was no significant difference between both treatment groups in any of the components of the primary end point, death from any cause, or stent thrombosis. Results were similar for patients who underwent PCI (about two thirds of study participants).There were more major bleeding events at 7 days in the pretreatment group (2.6% vs 1.4%, HR: 1.90, 95%: 1.19 – 3.02; p= 0.006). Major bleeding events not related to CABG were also higher in the pre-treatment group (1.3% vs 0.5%; p= 0.003). In the PCI cohort, 12 patients in the pre-treatment group had life-threatening bleeding compared to 2 in the control group. Most bleedings in this cohort were access site bleeding, pericardial bleeding and retroperitoneal bleeding.Subgroup analysis for the primary efficacy endpoint did not identify any subgroup who would benefit from pre-treatment with prasugrel.Conclusion: In patients with non-ST elevation myocardial infarction undergoing coronary angiography within 48 hours of admission, pre-treatment with prasugrel did not improve ischemic events and resulted in more major bleeding.The results of this trial led to the recommendation that prasugrel should be used after coronary anatomy is defined and PCI is chosen as the treatment strategy. This approach will reduce the risk of bleeding complications without increasing the risk of ischemic events.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

N Engl J Med 2012;367:1297-1309Background: In patients with acute coronary syndrome, clinical guidelines recommend early angiography particularly in those deemed moderate to high risk. However, a proportion of patients do not undergo revascularization, and these patients have poorer outcomes compared to those who do undergo revascularization.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The TRITON-TIMI 38 trial demonstrated that prasugrel, when compared to clopidogrel, reduces ischemic events in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). Notably, in the TRITON-TIMI 38 trial, 99% of the patients underwent PCI at the time of randomization.Expanding upon the findings of TRITON-TIMI 38, the TRILOGY ACS trial sought to test the hypothesis that aspirin plus prasugrel is superior to aspirin plus clopidogrel in patients with acute coronary syndrome, without ST segment elevation, who are managed medically without revascularization.Patients: Patients were enrolled if they had unstable angina or non-ST elevation myocardial infarction and were treated medically without revascularization, within 10 days of the index event. Patients with non-ST elevation myocardial infarction had elevated cardiac biomarkers. Patients with unstable angina had ST-segment depression of more than 1 mm in two or more electrocardiographic leads and negative cardiac biomarkers. Patients had to have one of the following: age of 60 years or older, diabetes mellitus, prior myocardial infarction or prior revascularization with either PCI or coronary-artery bypass grafting (CABG). Main exclusion criteria were history of stroke or TIA (this group had net harm with prasugrel in TRITON-TIMI 38), renal failure requiring dialysis and patients taking oral anticoagulants.Baseline characteristics: The trial enrolled 9,326 patients at 966 sites in 52 countries. The average age of patients was 66 years, with 78% were below 75 years old, and 61% were men. About 70% of the patients had non-ST elevation myocardial infraction as their index event. The average GRACE score was 122. About 82% had hypertension, 59% had hyperlipidemia, 38% had diabetes, 43% had prior myocardial infarction and 20% were current or recent smokers. The majority of patients were stable, with 88% classified as Killip class I.Angiography before randomization was performed in 41% of the patients. Medications at randomization included beta-blockers in 78% of the patients, ACEi or ARB in 75%, statins in 83% and proton pump inhibitors in 25%.Procedures: The trial was conducted as double-blind double-dummy study. Patients who underwent randomization within 72 hours after the first medical contact received a loading dose of 30mg of prasugrel followed by 10mg daily. The maintenance dose of prasugrel was 5mg daily for patients aged 75 years or older or patients who weighed less than 60 kg. Patients who underwent randomization after 72 hours of the first medical contact received open label clopidogrel before randomization and the maintenance study drug after randomization. Clopidogrel was given as a loading dose of 300mg followed by a maintenance dose of 75mg daily. Aspirin was given in all patients and the recommended dose was 100mg per day or less. Study drugs were given for a minimum of 6 months and a maximum of 30 months.Endpoints: The primary efficacy endpoint was a composite of death from cardiovascular causes, nonfatal myocardial infarction or nonfatal stroke among patients < 75 years old. Safety endpoints were bleeding not related to CABG based on Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) criteria for severe or life-threatening bleeding and Thrombolysis in Myocardial Infarction (TIMI) criteria for major bleeding, and neoplasms.Analysis was performed based on the intention-to-treat principle. The trial was event-driven. To ensure 90% power to detect 22% relative risk reduction of prasugrel over clopidogrel with a two-sided alpha of 5%, a total of 688 patients,

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.                                                  >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.                                                                                  Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome back to "Ditch the Labcoat," where today we debunked heart health myths with the remarkable Dr. Michael Ward. Did you know stress can literally break your heart? Dr. Ward broke down the realities of Takatsubo cardiomyopathy, stressed the importance of timely intervention in heart attacks, and shared his insights on the Mediterranean diet for cardiac wellness. Plus, we got a glimpse into the high-stakes world of interventional cardiology—straight from the operation room. Stay heart-smart and catch the full episode for a deep dive into the art and science of keeping your ticker ticking! Remember, a healthy heart is a healthy start. Don't miss it!00:00:03 Understanding Takotsubo Cardiomyopathy and Broken Heart Syndrome with Dr. Michael WardDr. Mark Bonta discusses Takotsubo cardiomyopathy, also known as broken heart syndrome, with Dr. Michael Ward. They explore how the condition is often triggered by emotional stress, such as the loss of a loved one, leading to acute heart failure.00:01:03 Discussion on the Heart as a Muscle and Cardiac ConditionsDr. Michael Ward discusses the heart as a muscle that pumps and the various cardiac conditions patients may face, such as heart attacks, heart failure, and heart rhythm problems. The conversation emphasizes the importance of understanding the basic function of the heart for better management of cardiac health.00:02:26 Discussion with Dr. Michael Ward on Interventional Cardiology and Hypertrophic CardiomyopathyDr. Michael Ward is an expert in interventional cardiology who helps people prevent and recover from heart-related issues. He also focuses on hypertrophic cardiomyopathy, a genetic condition affecting the heart. With a background in both medicine and research, he is a valuable asset at Western University in London, Ontario.00:03:50 Interview with Dr Michael Ward, Interventional CardiologistDr. Michael Ward, an interventional cardiologist with both an MD and a PhD, discusses his background in cell-based gene therapy and his interest in cardiovascular medicine. He shares insights on heart health, the importance of vacations for mental health, and his balanced lifestyle.00:07:18 Insight into the Fascinating Aspects of the Heart from an Interventional Cardiology PerspectiveDr Mark Bonta, an interventional cardiologist, shares his perspective on the intricate nature of the heart, highlighting how it responds to various stimuli and stressors. He emphasizes the role of the cardiovascular system in determining life and death outcomes and the potential for improving quality of life through cardiology interventions.00:11:14 Discussion on Interventional CardiologyDr. Mark Bonta discusses their work in interventional cardiology, including responding to emergencies like heart attacks and performing procedures in the catheterization laboratory. They describe the challenges faced by patients with heart conditions and the range of cases they handle.00:13:26 Understanding Cardiovascular System with Dr. Michael WardDr. Michael Ward talks about atherosclerosis as the accumulation of plaque in the arteries, which can lead to heart issues like angina and heart attacks. The discussion also touches on the difference between chronic accumulation of plaque and acute blockages causing heart attacks.00:18:01 Understanding Acute Heart Attacks and Plaque Ruptures in ArteriesAcute heart attacks can occur when plaque ruptures inside an artery, leading to a clot that blocks the artery and causes the heart attack. Platelets play a crucial role in responding to the rupture and forming clots to heal the affected area.00:19:44 Importance of Timely Intervention in Heart AttacksDuring a conversation between Dr. Mark Bonta and Dr. Michael Ward Interventional Cardiology, they discussed the critical importance of timely intervention in heart attacks. Dr. Bonta mentioned that when a heart attack occurs, time is of the essence as the muscle of the heart is deprived of blood flow. Historically, patients were given aspirin and blood thinners but no interventional procedures were done immediately.00:21:20 Advanced Cardiac Care Protocols in CanadaIn Canada, there are advanced protocols in place for managing ST-elevation myocardial infarction (STEMI) cases, including direct ambulance transportation to hospitals with cath labs. Time is crucial in treating cardiac emergencies to minimize heart muscle damage.00:23:51 Patient Experience in the Cath Lab: What to ExpectThe patient experience in the cath lab involves inserting a needle with a wire into their arteries, either through the wrists or groin. Patients may not feel much during the procedure, but there might be some sensations of discomfort or awareness of the procedure taking place.00:26:56 Understanding the Process of Opening Blocked Heart VesselsIn the conversation between Dr Mark Bonta and Dr Michael Ward Interventional Cardiology, they discuss the process of opening blocked heart vessels during angioplasty procedures. They talk about using topical lidocaine for anesthesia and how temporary discomfort may be felt when the blockage is being opened up. Dr Ward explains that a stent is not a rigid pipe but a meshwork that is placed in the living system of the coronary artery.00:29:41 Understanding Interventional Cardiology and StentingInterventional cardiology involves using contrast dye and x-ray cameras to map arteries and identify blockages. Stents are used to provide support and prevent arteries from narrowing, improving blood flow to the heart muscle. The decision to place a stent is based on the degree of blockage and the impact on blood flow.00:34:10 Discussion on Heart Health Interventions and Medical ManagementThe conversation between Dr. Mark Bonta and Dr. Michael Ward Interventional Cardiology delves into the topic of heart health interventions and the importance of medical management in cardiac care. They discuss the limitations of interventions like stents in treating moderate blockages and emphasize the significance of lifestyle changes and medications in preventing heart attacks and strokes.00:38:32 Preventing Cardiovascular Disease Through Exercise and MedicationsDr. Mark ...

Editor's Summary by Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for the March 5, 2024, issue.

Commentary by Dr. Candice Silversides

With support from our colleagues at Thrombolex, learn more about how to incorporate pharmaco-mechanical thrombolysis into your practice

With support from our colleagues at Thrombolex, this session provides an overview of pharmaco-mechanical thrombolysis and what the data tell us

CardioNerds co-founder Dr. Dan Ambinder joins CardioNerds join Dr. Pooja Prasad, Dr. Khoa Nguyen and expert Dr. Abigail Khan (Assistant Professor of Medicine, Division of Cardiovascular Medicine, School of Medicine) from Oregon Health & Science University and discuss a case of mechanical valve thrombosis. Audio editing by CardioNerds Academy Intern, student doctor Adriana Mares.  A 23-year-old pregnant woman with a mechanical aortic valve presented to the maternal cardiac clinic for a follow-up visit. On physical exam, a loud grade three crescendo-decrescendo murmur was audible and transthoracic echocardiography revealed severely elevated gradients across the aortic valve.  Fluoroscopy confirmed an immobile leaflet disk. Thrombolysis was successfully performed using a low dose ultra-slow infusion of thrombolytic therapy, leading to normal valve function eight days later. Treatment options for mechanical aortic valve thrombosis include slow-infusion, low-dose thrombolytic therapy or emergency surgery. In addition to discussing diagnosis and management of mechanical valve thrombosis, we highlight the importance of preventing valve thrombosis during the hypercoagulable state of pregnancy with careful pre-conception counseling and a detailed anticoagulation plan. See this case published in European Heart Journal - Case Reports. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - mechanical valve thrombosis The hypercoagulable state of pregnancy presents a risk for women with mechanical heart valves with contemporary data estimating the rate of valve thrombosis during pregnancy at around 5%. Thrombolytic therapy is a (relatively) safe alternative to surgery and should be considered first line for treatment of prosthetic valve thrombosis in all patients, especially in pregnant women. Pre-conception counselling and meticulous anticoagulation management for patients with mechanical heart valves are key aspects of their care. The evaluation for prosthetic valve thrombosis in pregnant persons requires a review of anti-coagulation history and careful choice of diagnostic testing to confirm the diagnosis and minimize risks to the parent and the baby. Multi-disciplinary care with close collaboration between cardiology and obstetrics is critical when caring for pregnant persons with cardiac disease. Show Notes - mechanical valve thrombosis How can we counsel and inform women with heart disease who are contemplating pregnancy? Use the Modified World Health Organization classification of maternal cardiovascular risk to counsel patients on their maternal cardiac event rate and recommended follow-up visits and location of delivery (local or expert care) if pregnancy is pursued. To learn about normal pregnancy cardiovascular physiology and pregnancy risk stratification in persons with cardiovascular disease, enjoy CardioNerds Episode #111. Cardio-Obstetrics: Normal Pregnancy Physiology with Dr. Garima Sharma. Adapted from the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy What is the differential diagnosis for a new murmur in a pregnant person who has undergone heart valve replacement? Normal physiology - elevated flow from hyperdynamic state and/or expansion of blood volume in pregnancy. Pathologic - increased left ventricular outflow tract flow from turbulence of flow due to pannus ingrowth, new paravalvular leak, or obstructive mechanical disk motion from vegetation or thrombus. What are diagnostic modalities for the evaluation of suspected prosthetic valve thrombosis? The 2020 ACC/AHA guidelines gave a class I recommendation for evaluation of susp...

We welcome another fantastic returning guest in the form of Dr Paul Sellors, consultant in stroke medicine at North Bristol Hospital NHS Trust. Sam and Paul discuss tricky cases in Stroke medicine including stroke mimics, the modified Rankin score, the NIHSS, thrombolysis and thrombectomy! Plenty to unpack in this episode so sit back and enjoy!Paul was so generous with his time, we have had to make this into another double header episode! Next episode you will get the end of this pre-recorded episode where we discuss mechanical thrombectomy but also an update on the new National Clinical Guidelines for Stroke published in 2023. 03:00 Basic stroke nomenclature and physiology11:00 Thrombolysis and stroke assessment22:20 Seizure activity and stroke28:00 Contraindications to thrombolysis38:00 Calling the Stroke Consultant42:00 Digression: BP control in stroke47:30 Digression: Glucose control in stroke50:00 Wake-up strokes> > Sign up for Pastest HERE! <

The July 2023 replay of past episodes showcases five interviews on social determinants of health in neurology. The episode begins with an interview with Dr. Heather Leeper on the links between pain and depression with unemployment due to CNS cancer. The episode continues with an interview with Dr. Wyatt Bensken on racial and ethnic difference in antiseizure medication prescription. The next interview is with Dr. Scott Mendelson on race-ethnic disparities in stroke thrombolysis. The fourth interview is with Dr. Vikas Kotagal on neighborhood socioeconomic factors in people with various movement disorders. The final episode is with Dr. Daniel Di Luca on racial and ethnic differences in quality of life among people with Parkinson's disease.   Related Podcast Links: Links Between Pain & Depression with Unemployment Due to CNS Cancer:  https://directory.libsyn.com/episode/index/id/26356875 Racial and Ethnic Differences in Antiseizure Medications Among People with Epilepsy on Medicaid: https://directory.libsyn.com/episode/index/id/25916646 Race-Ethnic Disparities in Stroke Thrombolysis: https://directory.libsyn.com/episode/index/id/23377391 Social Determinants of Health in Patients with Movement Disorders: https://directory.libsyn.com/episode/index/id/26531040 Racial and Ethnic Differences in Quality of Life in Parkinson Disease: https://directory.libsyn.com/episode/index/id/27196008 Related Article Links: Association of Employment Status With Symptom Burden and Health-Related Quality of Life in People Living With Primary CNS Tumors: https://n.neurology.org/content/100/16/e1723 Racial and Ethnic Differences in Antiseizure Medications Among People With Epilepsy on Medicaid: A Case of Potential Inequities: https://cp.neurology.org/content/13/1/e200101  Race-Ethnic Disparities in Rates of Declination of Thrombolysis for Stroke: https://n.neurology.org/content/98/16/e1596 Neighborhood Social Determinants of Health in Patients Seen in Neurology Movement Disorders Clinics: https://cp.neurology.org/content/13/2/e200142 Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence: https://n.neurology.org/content/100/21/e2170   Visit NPUb.org/Podcast for associated article links

Contributor: Aaron Lessen, MD Educational Pearls: What is thrombolysis? Thrombolysis is performed by administration of a medication that promotes the body's natural ability to break up clots. These medications include Alteplase (tPA) and Tenecteplase (TNK). The main side effect of using such an agent is bleeding which typically occurs at puncture sites but can also occur internally. However, an unusual side effect of thrombolytic agents, which occurs in about 1-5% of cases, is angioedema. What is angioedema? Angioedema is a medical condition that causes swelling beneath the surface of the skin, typically in the face, lips, and throat (orolingual angioedema). Fluid leaks from blood vessels and accumulates in the deeper layers of the skin. How are these two connected? The mechanism by which angioedema occurs after thrombolysis is not well understood, but it is likely connected to how tPA can increase levels of bradykinin and histamine. Swelling can appear suddenly but can also occur up to 24 hours after thrombolysis, and may last for a few hours or several days. In some cases, angioedema can affect the airways, leading to difficulty breathing. What can be done? If this side effect occurs the provider can stop the medication or infusion and treat the patient with anti-histamines, steroids, epinephrine, and airway monitoring. Medications such as Berinert or Icatibant, typically used in hereditary angioedema or ACE-i-induced angioedema, can also be used but have limited evidence for their efficacy. Fun fact tPA-related angioedema is about 4 times more likely in patients on ACE inhibitors. This is likely related to how ACE inhibitors also increase bradykinin and histamine in a patient's body. References Zhu A, Rajendram P, Tseng E, Coutts SB, Yu AYX. Alteplase or tenecteplase for thrombolysis in ischemic stroke: An illustrated review. Res Pract Thromb Haemost. 2022 Sep 20;6(6):e12795. doi: 10.1002/rth2.12795. PMID: 36186106; PMCID: PMC9487449. Pahs L, Droege C, Kneale H, Pancioli A. A Novel Approach to the Treatment of Orolingual Angioedema After Tissue Plasminogen Activator Administration. Ann Emerg Med. 2016 Sep;68(3):345-8. doi: 10.1016/j.annemergmed.2016.02.019. Epub 2016 May 10. PMID: 27174372. Burd M, McPheeters C, Scherrer LA. Orolingual Angioedema After Tissue Plasminogen Activator Administration in Patients Taking Angiotensin-Converting Enzyme Inhibitors. Adv Emerg Nurs J. 2019 Jul/Sep;41(3):204-214. doi: 10.1097/TME.0000000000000250. PMID: 31356244. Sczepanski M, Bozyk P. Institutional Incidence of Severe tPA-Induced Angioedema in Ischemic Cerebral Vascular Accidents. Crit Care Res Pract. 2018 Sep 27;2018:9360918. doi: 10.1155/2018/9360918. PMID: 30363665; PMCID: PMC6180929. Summarized by Jeffrey Olson, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS1

Tenecteplase in Acute Ischemic Stroke  Special Guest: Salia Farrokh, PharmD, BCCCP, FNCS 07:45 – Alteplase history and comparison 14:20 – Thrombolysis guidelines in AIS 19:15 – Tips for reading stroke literature 21:00 – Tenecteplase literature review  39:45 – Tenecteplase research-in-progress 42:30 – Thrombolytic-induced ICH management 46:25 – Arguments for and against Tenecteplase 51:30 – Advice when switching thrombolytics 58:20 – Ultimate take-aways Reference List: https://pharmacytodose.files.wordpress.com/2023/04/tenecteplase-in-acute-ischemic-stroke-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

The First Principles of Acute Coronary Syndromes that can get you through your Internal Medicine placements: What are they? What are the ECG changes? How do you ask about the risk factors? === Other Links === Check out our new website 1pm.wiki for the Notion document, free Anki flashcards, and podcast episodes. Check out our Instagram: https://www.instagram.com/firstprinciplesofmedicine/ Recorded 6 September 2022 Co-hosts: JT Yeung, Jason D'Silva, Adian Izwan & Daniel Bontempo feat. Jayanth Cheyyur. Produced by Evangelyn Sim, JT Yeung & Adian Izwan. If you have any ideas or feedback, comment on this Notion document, or shoot us an email at hello@1pm.wiki *** We're really excited to be collaborating with Becky from Becky's notes, a UK based resource, to produce an infographic on ACS for our visual learners out there. Becky's notes brings together all the key topics medical students need to know in a readily available place, reviewed by specialists in the field. These visually striking notes are a refreshing change from all the boring textbooks. You can check her out on instagram at @beckysnotes01 and get her books at https://linktr.ee/Beckysnotes === Timestamps === (00:51) What is atherosclerosis? (01:56) Modifiable & non-modifiable risk factors (03:02) Troponins (06:15) Layers of the heart (08:36) What is ACS? (11:05) Taking a history of a suspected ACS (15:45) ACS differentials (17:09) Investigations (20:15) Management (22:53) PCI vs Thrombolysis (24:47) Long term management (27:01) Complications

Bradyarrhythmia during AF screening, thrombolysis in stroke, NP vs MD care, and the most biased paper this year — on LAAO — are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Screening with ILR - Ade Adamson Tweet https://twitter.com/AdeAdamson/status/1625878856820482048?s=20 - The Rapid Rise in Cutaneous Melanoma Diagnoses https://www.nejm.org/doi/full/10.1056/NEJMsb2019760 - Loop Trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01698-6/fulltext - Prevalence and Prognostic Significance of Bradyarrhythmias in Patients Screened for Atrial Fibrillation vs Usual Care https://jamanetwork.com/journals/jamacardiology/fullarticle/2801362 II. Thrombolysis in Mild Stroke Thrombolysis Not Necessary in Mild Nondisabling Stroke: ARAMIS https://www.medscape.com/viewarticle/988381 - PRISMS Trial https://jamanetwork.com/journals/jama/fullarticle/2687354 - Risk of selection bias assessment in the NINDS rt-PA stroke study https://pubmed.ncbi.nlm.nih.gov/35705913/ - Tissue Plasminogen Activator for Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/NEJM199512143332401 - Effects of alteplase for acute stroke; Hacke et al meta-analysis https://journals.sagepub.com/doi/10.1177/1747493017744464 - Methodological survey of missing outcome data in an alteplase for ischemic stroke meta-analysis https://onlinelibrary.wiley.com/doi/full/10.1111/ane.13656 - ECASS; Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke https://www.nejm.org/doi/full/10.1056/nejmoa0804656 - Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances https://pubmed.ncbi.nlm.nih.gov/32430395/ III. NP vs MD Care This Doc Still Supports NP/PA Led Care ... With Caveats https://www.medscape.com/viewarticle/967073 - The Productivity of Professions: Evidence from the Emergency Department https://www.nber.org/papers/w30608 - Independent Nurse Practitioners and Physician Assistants: A Doc's View https://www.medscape.com/viewarticle/924047 IV. LAAO vs OAC - Comparative Effectiveness of Left Atrial Appendage Occlusio Versus Oral Anticoagulation by Sex https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062765 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this week's podcast, Neurology Today's editor-in-chief discusses the report on outcomes of IV thrombolysis for large vessel occlusions; the discovery of a new brain layer in the subarachnoid space; and the impact of mindfulness and exercise on cognition.

Dr. David J. Seiffge discusses his paper, "Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants". Show references: https://jamanetwork.com/journals/jamaneurology/fullarticle/2799622 This episode is brought to you by Mass General Brigham Department of Neurology, please visit us at www.massgeneralbrigham.org.  

Dr. Dan Ackerman talks with Dr. David Seiffge, about the use of oral anticoagulants on ischemic stroke. Read the full article in JAMA Neurology. This episode is brought to you by Mass General Brigham Department of Neurology, please visit us at www.massgeneralbrigham.org.

In this week's episode, we'll discuss involvement of IL-13 and IL-4 signaling in fibrotic progression of myelofibrosis; next, we review results on a novel agent using vWF-dependent mechanisms to lyse pathological thrombi in acute ischemic stroke. Finally, we'll shed new light on findings that implicate the GARP-TGF-beta-1 pathway in the loss of natural killer cell cytotoxicity in relapsed AML.

Pulmonary embolism, coffee, when DOACs don't work, lipoprotein (a), and the marginal benefits of current CV therapy are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Pulmonary Embolism - Positive Data on Thrombectomy Catheter That Avoids Thrombolytics in Acute PE https://www.medscape.com/viewarticle/981322 - Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism https://eurointervention.pcronline.com/article/acute-outcomes-for-the-full-us-cohort-of-the-flash-mechanical-thrombectomy-registry-in-pulmonary-embolism - PEERLESS Study https://clinicaltrials.gov/ct2/show/NCT05111613 - Ultrasound-facilitated, Catheter-directed, Thrombolysis in Intermediate-high Risk Pulmonary Embolism (HI-PEITHO) https://clinicaltrials.gov/ct2/show/NCT04790370 - A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary Embolism: The FLARE Study https://doi.org/10.1016/j.jcin.2018.12.022 II. Coffee Again - Coffee Linked to Reduced Cardiovascular Disease and Mortality https://www.medscape.com/viewarticle/981518 Enough With the Coffee Research and Other Distractions https://www.medscape.com/viewarticle/883709 - The impact of coffee subtypes on incident cardiovascular disease, arrhythmias, and mortality: long-term outcomes from the UK Biobank https://doi.org/10.1093/eurjpc/zwac189 III. DOAC and Mechanical Valves - PROACT Xa Trial of Apixaban With On-X Heart Valve Stopped https://www.medscape.com/viewarticle/981644 - Artivion Follows Recommendation to Stop PROACT Xa Clinical Trial https://investors.artivion.com/news-releases/news-release-details/artivion-follows-recommendation-stop-proact-xa-clinical-trial - PROACT Xa - A Trial to Determine if Participants With an On-X Aortic Valve Can be Maintained Safely on Apixaban https://clinicaltrials.gov/ct2/show/NCT04142658 - Dabigatran versus Warfarin in Patients with Mechanical Heart Valves https://www.nejm.org/doi/full/10.1056/nejmoa1300615 IV. Lipoprotein(a) - Aspirin Primary Prevention Benefit in Those With Raised Lp(a)? https://www.medscape.com/viewarticle/981602 - Aspirin for Primary Prevention of Cardiovascular Events in Relation to Lipoprotein(a) Genotypes https://www.jacc.org/doi/full/10.1016/j.jacc.2022.07.027 - A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women https://www.nejm.org/doi/full/10.1056/nejmoa050613 - Effect of Aspirin on Disability-free Survival in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1800722 - Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 - Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1803955 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact: news@medscape.net

The pathophysiology of ARDS is complex and remains incompletely understood.  However, it is clear that ARDS is not simply a disease of the alveoli. Understanding the pathological basis of ARDS will assist in the development of new therapies for this potentially fatal disease. One such avenue is the role of thrombolysis.  Professor Anders Aneman and Dr Lucy Coupland are leaders of a new program of research looking at this potential intervention.See omnystudio.com/listener for privacy information.

This episode is a rapid fire review of litigation issues surrounding the provision of (or lack of provision of) tPA for stroke. Guests: Latha Ganti, MD, MS, MBA Professor of Emergency Medicine & Neurology ,University of Central Florida College of Medicine Joshua N. Goldstein MD, PhD Professor of Emergency Medicine, Harvard Medical School Host: Jason Woods MD References: Chernyshev OY, Martin-Schild S, Albright KC, Barreto A, Misra V, Acosta I, Grotta JC, Savitz SI. Safety of tPA in stroke mimics and neuroimaging-negative cerebral ischemia. Neurology. 2010 Apr 27;74(17):1340-5. doi: 10.1212/WNL.0b013e3181dad5a6. Epub 2010 Mar 24. PMID: 20335564; PMCID: PMC2875935. Gebel JM, Sila CA, Sloan MA, Granger CB, Mahaffey KW, Weisenberger J, Green CL, White HD, Gore JM, Weaver WD, Califf RM, Topol EJ. Thrombolysis-related intracranial hemorrhage: a radiographic analysis of 244 cases from the GUSTO-1 trial with clinical correlation. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. Stroke. 1998 Mar;29(3):563-9. doi: 10.1161/01.str.29.3.563. PMID: 9506593. Kass J et al. CONTINUUM (MINNEAP MINN) 2020;26(2, CEREBROvascular disease): 499-505  

Guest: Adam Oostema, MD MS FACEP (Associate Professor of EM, Michigan State University College of Human Medicine) Host: Jason Woods MD Select References: National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7. doi: 10.1056/NEJM199512143332401. PMID: 7477192. Saver JL, Gornbein J, Starkman S. Graphic reanalysis of the two NINDS-tPA trials confirms substantial treatment benefit. Stroke. 2010 Oct;41(10):2381-90. doi: 10.1161/STROKEAHA.110.583807. Epub 2010 Sep 9. PMID: 20829518; PMCID: PMC2949055. Kwiatkowski TG et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999 Jun 10;340(23):1781-7. doi: 10.1056/NEJM199906103402302. PMID: 10362821. Ingall TJ et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004 Oct;35(10):2418-24. doi: 10.1161/01.STR.0000140891.70547.56. Epub 2004 Sep 2. PMID: 15345796. Emberson J et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014 Nov 29;384(9958):1929-35. doi: 10.1016/S0140-6736(14)60584-5. Epub 2014 Aug 5. PMID: 25106063; PMCID: PMC4441266. Hacke W et al. ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. doi: 10.1056/NEJMoa0804656. PMID: 18815396. Alper BS et al. Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances. BMJ Evid Based Med. 2020 Oct;25(5):168-171. doi: 10.1136/bmjebm-2020-111386. Epub 2020 May 19. PMID: 32430395; PMCID: PMC7548536. Powers WJ et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec;50(12):e344-e418. doi: 10.1161/STR.0000000000000211. Epub 2019 Oct 30. Erratum in: Stroke. 2019 Dec;50(12):e440-e441. PMID: 31662037.

Drs. B.J. Hicks and Andy Southerland talk with Dr. Scott Mendelson about racial and ethnic disparities in the rates of declination of thrombolysis in patients with acute ischemic stroke. Read the full article in Neurology.

Dr. Scott Mendelson discusses racial and ethnic disparities in the rates of declination of thrombolysis in patients with acute ischemic stroke.  Show references: https://n.neurology.org/content/early/2022/02/28/WNL.0000000000200138

Commentary by Dr. Valentin Fuster

In the latest podcast, we discuss the joint expedited recommendations from the European Stroke Organisation (ESO) and the European Society for Minimally Invasive Neurological Therapy (ESMINT) on indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischemic stroke and anterior circulation large vessel occlusion. JNIS Editor-in-Chief, Dr. Felipe C. Albuquerque, interviews Dr. Guillaume Turc, Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université de Paris, and co-chair of the module working group. Paper available here: https://jnis.bmj.com/content/14/3/209. Please subscribe to the JNIS Podcast via all podcast platforms, including Apple Podcasts, Google Podcasts, Stitcher and Spotify, to get the latest episodes. Also, please consider leaving us a review or a comment on the JNIS Podcast iTunes page: https://podcasts.apple.com/gb/podcast/jnis-podcast/id942473767. Thank you for listening!

Dr. Benjamin M. Scirica is a cardiovascular medicine specialist and associate professor of medicine at Harvard Medical School (HMS). He is the director of quality initiatives at Brigham and Women's Hospital's (BWH) Cardiovascular Division and a senior investigator at the Thrombolysis and Myocardial Infarction (TIMI) Study Group, where he is director of the Electrocardiography Core Laboratory.Dr. Scirica received his medical degree from HMS. He completed an internal medicine residency and a cardiovascular disease fellowship at BWH. He also completed a research fellowship in cardiovascular disease with the TIMI Study Group at BWH and received a master's degree in public health from Harvard School of Public Health. Dr. Scirica is board certified in cardiovascular disease.His clinical and research interests include assessing novel therapeutic agents and developing electrocardiography and cardiac biomarkers. As director of quality initiatives at the Cardiovascular Division at BWH, he leads projects to improve delivery of care and inter-disciplinary communications. At the TIMI Study Group, Dr. Scirica's research focuses on improving risk stratification and cardiovascular disease treatment. He has authored over 100 peer-reviewed publications.We hope you enjoy this episode where we discuss disruptive innovations, change implementation, and teambuilding. Welcome to leading the rounds. Questions We Asked: Tell us about your NEJM article “Disruptive and Sustaining Innovation in Telemedicine: A Strategic Roadmap”?How do we build sustainable systems to use innovative technology? Have we been able to effectively evaluate telemedicine as a healthcare media? What is your company CardioCompass? What have you learned about leading diverse interprofessional teams? What are your favorite books? Quotes & Ideas: Disruption theory by Clay ChristensenThe Innovator's Dilemma Cardiocompass In order to create an innovation, you need to release a minimum viable produce and then refine and improve it based on feedback and inefficiencies“What's the job that needs to be done” As a leader, “think out loud and let people into your thought process.”“It's almost impossible to over communicate, especially virtually.” Book Suggestions: Books about Abraham Lincoln 

Show notes available at podcast.rnrrounds.ca

Pulmonary Embolisms can pop up out of nowhere.  This episode breaks down the pathophysiology of PE and what interventions are needed to stop the PE spiral of death.

In this episode of REBEL Cast, Anand Swaminathan and I sit down to discuss the utility of thrombolysis prior to Endovascular therapy for LVO acute ischemic stroke.  The discussion is broken up into two potential scenarios: Not all facilities are comprehensive stroke centers In comprehensive stroke center, time from door to groin puncture will be ... Read more The post REBEL Cast Ep 105: Thrombolysis Before Endovascular Therapy for LVO Acute Ischemic Stroke appeared first on REBEL EM - Emergency Medicine Blog.

In this podcast, Brian G. DeRubertis, MD, answers our questions about his session at the 2021 VEITHsymposium, which highlighted 2 large clinical trials on the more-aggressive strategies of thrombus removal for patients with deep vein thrombosis. More at: www.consultant360.com

On this month's episode, Dr. Lauren Koffman interviews Drs. Victor Urrutia and Roland Faigle on their recent article, “Low-Intensity Monitoring After Stroke Thrombolysis During the COVID-19 Pandemic.” NCS offers free CE credits for the NCS Podcast Series episodes. Listen to any of the posted episodes, complete a five question survey, and claim your credits here! Credits are available for physicians, pharmacists, nurses, and non-physicians. The NCS Podcast is the official podcast of the Neurocritical Care Society. Our senior producer is Bonnie Rossow. Our host is Fawaz Almufti, and our production staff includes Tareq Saad Almaghrabi, Andrew Bauerschmidt, Leonid Groysman, Atul Kalanuria, Lauren Koffman, Kassi Kronfeld, Holly Ledyard, Lindsay Marchetti, Alexandra Reynolds, Lucia Rivera Lara, Jon Rosenberg, Jason Siegel, Zachary Threlkeld, Teddy Youn, and Chris Zammit. Our administrative staff includes Bonnie Rossow. Music by Mohan Kottapally.

Dr. Andy Southerland talks with Dr. Jyri Virta about the use of thrombolysis for acute ischemic stroke in patients with unruptured intracranial aneurysms.

About Dr. Anthony Comerota (Host)Dr. Comerota is a board-certified vascular surgeon. He joined Inova as the Medical Director of the Eastern Region Heart and Vascular Institute, with over 36 years of clinical experience. Dr. Comerota served as a faculty member at Temple University Health Sciences Center where he became Chief of Vascular Surgery, Professor of Surgery, Program Director of General and Vascular Surgery, President of the Medical Staff and President of the Medical Alumni Association. He also served as Director of the Jobst Vascular Institute, ProMedica Toledo Hospital from 2002 - 2015 and Executive Director of Research, ProMedica Health System and Jobst Vascular Institute from 2015 to January 2017. Dr. Comerota has been a major contributor to the development of some of the newest forms of treatment for vascular disease and has been the principal investigator of seven major national trials and a co-investigator of numerous others. Dr. Comerota has a special interest in acute and chronic venous thromboembolic disease, complex deep venous reconstruction, and carotid artery disease. He became interested in venous thromboembolic disease because it is a serious and common vascular disorder.About Dr. Riyaz Bashir (Guest)While maintaining his full medical and academic responsibilities at the Temple University and Temple University Hospital System, Dr. Bashir serves in an ex-officio Chief Medical Consultant role for Thrombolex.Dr. Bashir shares the product design creation responsibilities with Mr. Green. Dr. Bashir is a Professor of Medicine at Temple University School of Medicine and is the inventor of the Bashir Endovascular Catheter. His specialties include: carotid artery and peripheral vascular diseases, coronary and endovascular interventions (including carotid stenting and gene and stem cell therapy).He attended medical school at the University of Kashmir, Government Medical College, Srinagar, India. His training includes a fellowship, interventional cardiology, Mayo Clinic; fellowship, vascular medicine and endovascular intervention, Tufts University School of Medicine, St. Elizabeth's Medical Center; fellowship, cardiovascular medicine, Tufts University School of Medicine, St. Elizabeth's Medical Center; residency, internal medicine, University of Kashmir, S.M.H.S. Hospital and Nassau University Medical Center, SUNY at Stony Brook.His certifications include: interventional cardiology, vascular technology, endovascular interventions, vascular medicine, cardiovascular disease, and internal medicine.About the Bashir Endovascular CatheterThe BASHIR™ Endovascular Catheter is a device intended for the localized infusion of physician specified fluids, including thrombolytics, into the peripheral vasculature.The distal infusion segment of the device is 12.50 cm long and consists of an expandable basket with mini-infusion catheters, each with multiple infusion holes.It is used for the delivery of the physician-specified fluids at multiple cross-sectional points of the target vessel location.The infusion basket can be expanded using the red actuator located on the handle at the proximal end of the device.After expansion, the mini-infusion catheters may be returned to their original closed positions by depressing the white button on the actuator and advancing the actuator toward the distal end of the device. BASHIR™ Endovascular Catheters are for use only by trained physicians in strict accordance with the FDA-cleared IFU. Read more.Dr. Steve Elias bids adieu -- VEIN Magazine thanks him for 12 wonderful episodes of the VEIN Magazine Podcast. Be sure to listen to his new show -- The Venous Edge Podcast 

FDA 连续批准2个CGRP受体拮抗剂治疗急性偏头痛NEJM 中国41家三甲医院参加的DIRECT-MT研究NEJM 连续发表2种脊髓侧索硬化症在研新疗法瑞美吉泮（rimegepant）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。例如，偏头痛发作时血清中CGRP水平升高。瑞美吉泮（rimegepant）是一种新型的口服、小分子血管舒张剂-CGRP受体拮抗剂。2020年2月，FDA批准瑞美吉泮用于治疗偏头痛急性发作。《随机对照研究：瑞美吉泮治疗急性偏头痛的3期临床研究》Lancet，2020年8月 (1)在这项双盲、随机、安慰剂对照、多中心的第三期试验中，纳入偏头痛病史≥1年的、偏头痛患者1466人，被随机分配接受瑞美吉泮口腔崩解片75mg 和安慰剂治疗。给药后2小时，瑞美吉泮口腔崩解片在止痛方面优于安慰剂（21%对11%，p

The role of thrombolysis in submassive PE remains controversial to date. In this podcast, Dr Chacko & I dive deeper to explore the current evidence on this topic.

This week on The Rounds Table Kieran Quinn and Mike Fralick are back with another rapid fire episode: just the salient points from four articles instead of two, this time examining important cardiovascular studies. The risk of subsequent stroke after minor stroke or TIA is as high as 15% within 90 days. Mike covers the ... The post Summer Replay – Cardiovascular Rapid Fire: MRI-Guided Thrombolysis, Recurrent Stroke Prevention, and E-Cigs & Smoking Cessation appeared first on Healthy Debate.

This week on The Rounds Table Kieran Quinn and Mike Fralick are back with another rapid fire episode: just the salient points from four articles instead of two, this time examining important cardiovascular studies. The risk of subsequent stroke after minor stroke or TIA is as high as 15% within 90 days. Mike covers the ...The post Summer Replay – Cardiovascular Rapid Fire: MRI-Guided Thrombolysis, Recurrent Stroke Prevention, and E-Cigs & Smoking Cessation appeared first on Healthy Debate.

This week on The Rounds Table Kieran Quinn and Mike Fralick are back with another rapid fire episode: just the salient points from four articles instead of two, this time examining important cardiovascular studies. The risk of subsequent stroke after minor stroke or TIA is as high as 15% within 90 days. Mike covers the ...The post Cardiovascular Rapid Fire: MRI-Guided Thrombolysis, Recurrent Stroke Prevention, and E-Cigs & Smoking Cessation appeared first on Healthy Debate.

This week on The Rounds Table Kieran Quinn and Mike Fralick are back with another rapid fire episode: just the salient points from four articles instead of two, this time examining important cardiovascular studies. The risk of subsequent stroke after minor stroke or TIA is as high as 15% within 90 days. Mike covers the ... The post Cardiovascular Rapid Fire: MRI-Guided Thrombolysis, Recurrent Stroke Prevention, and E-Cigs & Smoking Cessation appeared first on Healthy Debate.

In this episode on Whistler's Update in Emergency Medicine Conference 2014 Highlights we have... Chapter 1 with David Carr on his approach to Shock, including the RUSH protocol, followed by a discussion on Thrombolysis for Submassive Pulmonary Embolism.... Then in Chapter 2 Lisa Thurgur presents a series of Toxicology Cases packed with pearls, pitfalls and surprises and reviews the use of Lipid Emulsion Therapy in toxicology....Finally in Chapter 3 Joel Yaphe reviews the most important articles from 2013 including the Targeted Temperature Managment post-arrest paper, the use of Tranexamic Acid for epistaxis, return to play concussion guidelines and clinical decision rules for subarachnoid hemorrhage. Another Whistler's Update in Emergency Medicine Conference to remember....... The post Episode 44 – Whistler Update in Emergency Medicine Conference 2014 appeared first on Emergency Medicine Cases.