What we have observed in cardiovascular medicine is what I would term a “treatment paradox” both for bypass surgery and for percutaneous revascularization. Specifically, as disease burden and complexity increase, ironically, both among surgeons and as interventional cardiologists, we perform less revascularization.

Use of a large lumen supportive guide, modification of certain techniques, and careful planning will allow successful management of LM disease via the radial approach in select cases.

In hospitals with certified Primary Stroke Center or Comprehensive Stroke Center designations, the cardiac cath lab staff, by following the established protocols, can rapidly and effectively treat their cardiac patients who develop peri-procedure strokes.

I think physicians make a great effort to communicate with each other, but it takes a great deal of effort. It is better to have a structure that facilitates that kind of care.