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Future of Interventional Cardiology. How bright?

Discussion in 'Cardiology' started by LebronManning, Jan 28, 2019.

  1. LebronManning

    LebronManning Probationary Status

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    Obviously Interventional Cards is one of the most promising and dynamic fields going forward, but just curious to hear some insight about how much this field with evolve?

    Will IC proliferate into Neuro IR (ESN)? See Oschner in New Orleans as this has already been started. ICs doing carotid stenting has already proliferated but its quite amazing to see that they are doing cerebrovascular interventions now too.

    Will TAVR soon be done without needing CTS in the room? Will interventionalists learn to do a surgical cutdown?

    Double impella like contraptions and/or directed stem cell therapy for HF?
     
  2. Phospholipid

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    Obviously Interventional Cards is one of the most promising and dynamic fields going forward, but just curious to hear some insight about how much this field with evolve? A Lot

    Will IC proliferate into Neuro IR (ESN)? Maybe See Oschner in New Orleans as this has already been started. ICs doing carotid stenting has already proliferated but its quite amazing to see that they are doing cerebrovascular interventions now too.

    Will TAVR soon be done without needing CTS in the room? Possibly Will interventionalists learn to do a surgical cutdown? Possibly

    Double impella like contraptions and/or directed stem cell therapy for HF? Sure
     
  3. yyy103

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    TAVR is routinely done without CTS in the room now. That would not be considered a new development whatsoever.

    The issue with stroke intervention is purely territorial with Neuro IRs not wanting what they perceive as a hostile takeover from Interventional Cardiology. This will likely soon be overcome by the sheer need for proceduralists. There simply aren't anywhere near enough Neuro IRs to provide adequate acute stroke intervention cover; there isn't even a fraction. There will be a minimum amount of training required for ICs to be able to offer this service, but the number of proceduralists is significant and the networks for emergency care are in place from STEMI. The technical aspect of acute stroke intervention is not challenging at all, particularly for physician who are adept at catheter-based interventions already.
     
  4. IMreshopeful

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    TAVR rarely requires any cutdown from transfemoral access unless something goes horribly wrong. CTS can help bail out disasters but it’s quite rare and TAVR is done routinely without CTS. It’s nice to have them close by but otherwise they are superfluous.

    I’m aware of Oschner IC teaching mechanical thrombectomy. I think Neuro IR will continue to have the monopoly on it but sure IC could breach it a bit. Especially with the need for more stroke intervention with the positive trials im sure IC folks will dabble in it. I personally have zero desire personally to engage in it and take acute stroke call on top of STEMI call but I’m sure someone is interested.

    Double Impella is done sure. Impella trials have been somewhat disappointing as longer term MCS but there is a role. Plenty of IC docs doing ECMO too.
     
  5. alphakingdom

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    when I visited oschner in October and talked with the program, they were slowly moving away from stoke call compared to the old golden days.

    IC is bright, but the light is also fading too. PCI becomes less valuable and more restricted with new research. The only intervention growing is mitral clip today. TAVR is coming up there. Structural interventional is growing (places now have 2 year sub-fellowship programs to meet this demand)

    50 years in the future, we will have nanotech medicine break down atherosclerosis. Whats IC go to do then...
     
  6. OP
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    LebronManning

    LebronManning Probationary Status

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    Revert to practicing cardiology medicine. I guess that's whats most beautiful about interventional medicine fields compared to surgical. Highly protected from drastic medication advances eliminating procedures because they can also practice the medicine.
     
  7. IMreshopeful

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    I mean I won’t be working 50 years from now hopefully haha and can take advantage of that nanotechnology

    I think for the foreseeable future PCI has a role. It hasn’t changed a whole lot in the past ten years
     
  8. IMreshopeful

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    Yeah agree, I’d just go back to doing clinical cardiology
     
  9. OP
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    LebronManning

    LebronManning Probationary Status

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    @IMreshopeful

    You are an IC, correct?

    I'm curious, would it be possible to have a truly comprehensive IC practice? I'm talking a doc that does PCI, TAVR, MitraClip, Peripheral disease, carotid stenting, IABP, Impella, and ECMO? Im sure learning all that would require a 2 yr IC fellowship but would that broad a practice be feasible? I'm thinking outside academic centers but still at larger tertiary referral centers.
     
  10. IMDoc607

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    Yes it is possible.
     
  11. badasshairday

    badasshairday Vascular and Interventional Radiology
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    No. Very doubtful they will do neuroIR work. Completely different anatomy and disease management for acute stroke. Oschner was doing things like angioplasty intracranial many many moons ago.. not anymore.
     
  12. IMreshopeful

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    I mean I’m only a rising IC fellow - but Yes it is; however structural jobs are much more sparse now than they used to be. Plenty of coronary work
     
  13. IMreshopeful

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    Oschner still does them I think
    Y’all can keep that though. I don’t want to work nearby the brain
     

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