Nav Sharma

@ClevelandClinic Interventional Cardiologist/vascular interventionist by way of @Columbiamed Endo VM & @weillcornell IC/structural fellow.

[Nav Sharma @nsharmaMD]

Groundbreaking CREST-2 Results: CAS Role in Asymptomatic Carotid Stenosis Evolving!

Thrilled by today's NEJM publication of CREST-2—two RCTs with 2,485 patients showing intensive medical management (IMM) alone yields excellent outcomes, but revascularization adds targeted value.

In the stenting arm (n=1,245), IMM + TCAS cut 4-year primary events (stroke/MI/periprocedural death) to 2.8% vs. 6.0% with IMM alone (HR 0.45; P=0.02)—a clear win for TCAS!

The endarterectomy arm (n=1,240) was closer: 3.7% vs. 5.3% (HR 0.70; P=0.24), no significant edge for CEA, highlighting periprocedural risks.

Paradigm shift: Prioritize TCAS + IMM for high-risk cases to slash strokes—modern meds are powerful, but selective intervention saves lives! Why the uptick in events for CEA between 3-4 years? Thoughts on guideline updates? #CREST2 #StrokePrevention #CarotidStenting #CAS #EmbolicProtection #CAS

[NEJM @NEJM]

Presented at #SVIN25:

CREST-2: In high-grade asymptomatic carotid stenosis, addition of stenting to medical therapy led to a lower risk of stroke over a 4-year period. Endarterectomy did not lead to a significant benefit. Full results: https://t.co/ojge1CjqiU

Editorial: Managing Asymptomatic Carotid Stenosis https://t.co/D9LH89Edyk

@svinsociety

[Fawaz Al-Mufti, MD, FSVIN @almuftifawaz]

Verdict is out!!!!! #CREST2 RESULTS FAVORING CAS!!!

Absolute risk difference = 3.2% (95% Cl, 0.6 to 5.9; P=0.016) Relative risk = 2.13 (95% Cl, 1.15 to 4.39)

Happening now at #SVIN25
@svinsociety
@MThrombectomy

[Nav Sharma @nsharmaMD]

@sudarshanballa Why the surgical replacement then? Excellent teaching point on the imaging btw

[Lea Alhilali, MD @teachplaygrub]

1/The 90s called & wants its carotid imaging back!

It’s been 30 years--why are you still just quoting NASCET?

Do you feel vulnerable when it comes to identifying plaque vulnerability?

Here’s a thread to help you identify high risk plaques with carotid plaque imaging

[Nav Sharma @nsharmaMD]

@BrianLi_MD Fantastic case Brian. Truly innovative and inspiring work!!

[Brian Li @BrianLi_MD]

Excited to share our new case report on the initial experience with TD-ADR in North America using HD-IVUS! Check out the step-by-step guide complete with diagrams and IVUS video from the case.

🔗 https://t.co/vgh7tbERAY

https://t.co/vWTU4aTA6a

#TDADR #Cardiology #BostonScientific #IVUS #CTO #PCI #CaseReport #CTOPCI #medtwitter #cardiotwitter

@PCRonline @SCAI @TCTMD @JACCJournals @ACCinTouch @SCC_CCS @ACCI_CAIC @mmamas1973 @Laserrman @OpolskiMP @LAzzaliniMD @mirvatalasnag @nsharmaMD @drrahulpsharma @wfearonmd @docjohnnyg @RinfretStephane @hwijeysundera @realarainmd @DrBIqbal @evandrofilhobr @SKuramitsu0511 @jl35wilsonMD @TWilsonMD @GilbertTangMD

[Nav Sharma @nsharmaMD]

Two big VM updates in one day. CMS updates on CAS and FDA update on PTX.

https://t.co/HoiXos7nJd

https://t.co/FtdyoykiWY

[Carl Nasman @CarlNasman]

“It’s just summer.” 🙄 https://t.co/f03z18cMTX

[Nav Sharma @nsharmaMD]

@FadiSaab17 @_MCLIN_ @CLI_Global @MacAnsari @AnahitaDua @JVargheseMD @kmadass @JayMathewsMD @LessneVIR @anishthomasmd @HadyLichaaMD @dandu_n Take another filter past the fractured wire, might be able to catch it in the basket on the way back.

[Nav Sharma @nsharmaMD]

Right foot: reviewer 1
Left foot: reviewer 2
#ICmemes

[Diego Jolodenco 🇮🇱🎗️⭐️⭐️⭐️ @DiegoJolo]

- El equipo de Silvina Batakis ya está analizando la profundidad de la crisis.

El equipo de Silvina Batakis:

[Nav Sharma @nsharmaMD]

@fabioccarvalho @RadialFirstBot @BotPci 3 D Right guides are quite useful in such take off. Makes the intervention smoother. Nice result btw.

[Nav Sharma @nsharmaMD]

@Darcy_ID_doc There is alphavac now that doesn’t require VV ECMO. Regardless if the PFO is that big a concern, the aortic arch vessels can be protected with a filter, although the likelihood of embo is rare bc the VV ECMO filters the veg out before returning the blood. Hope it held

[JACC Journals @JACCJournals]

Does dissection occur at different diameters based on aortic location? See more on this important question on type A aortic dissection in #JACC: https://t.co/4OUgrC96Jo

#CardioTwitter @MarkELindsay @keaglemd

[Nav Sharma @nsharmaMD]

@AvrahamCooperMD @KinturSanghvi Can be retrieved with lasso technique w endovascular approach. Always a god reminder for RHC to assess fluid status before venous stents, having fluids on and ultilizing ivus.

[Nav Sharma @nsharmaMD]

@RogueRad The Desi dad in me says…just NBA ref, how come not NBA PLAYER?!?!?

[Nav Sharma @nsharmaMD]

@dr_benoy_n_shah Depends on the clinical scenario, if the patient is symptomatic would consider @LargeBoreOG angiovac.

[Nav Sharma @nsharmaMD]

@RobertAvramMD Would remove these sheaths with the dilator in. How did it perform going in?

[Nav Sharma @nsharmaMD]

Wordle 281 4/6
@nytimes good test!
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[LA McKeown @lamckeown1]

“The primary utility of IVUS appears to be accurate vessel sizing with the benefit of this being in cases treated with DCB." @Flinders @EricSecemskyMD https://t.co/k7s8IUKPkh

[European Society of Cardiology Journals @ESC_Journals]

Have you done trans-coronary pacing via Rota Wire to overcome bradycardia during rotational atherectomy? Read more here: https://t.co/ngvKl62QRW @EHJCREiC @aayshacader @TJ_Yeo @ANazmiCalik @FarhanaAra @cfcamm @KardiologieHH #RadialFirst