Interventional Cardiologist

[Bevo 13658]

@Fat Bastard or anyone else, who are the best interventional cardiologists in Texas. Non-relative has stenosis of the internal jugular and was told that nothing can be done. I was curious on who would be the best to address the issue. Unfortunately, this is the type of patient people don't like to see - self-diagnoses a multitude of things and pesters. But, I'm curious at the very least.

 

 

[Fat Bastard 625]

We more commonly see thrombosis (clots) in veins than stenosis (tightening). Usually when the internal jugular (IJ) goes down it’s from previous instrumentation from a cath or central venous line. It’s usually chronic and nothing needs to be done. If it’s known acute and, say, occurred during a recent hospitalization, we give Eliquis/Xarelto/or Coumadin based on what the patient can afford. 
 

I’d suggest making sure it’s the IJ that’s affected and not carotid artery (or subclavian artery) stenosis - which is treated much differently.   
 

And, if the patient is adamant about seeing a cardiologist, it would help to know what city they’re located in. I can give tons of recs in Houston, some in Dallas/Austin/El Paso. Don’t know many in San Antonio or other cities. 
 

Hope that helps. 

[Fat Bastard 625]

I should add that venous thrombectomy is a booming field and there tons of new devices on the market (Inari, Penumbra, AlphaVac, Jeti, etc). I’ve never used any of those for an IJ clot (only for DVT/PE) and know, without a shadow of a doubt, it has never been done for IJ thrombosis at my institution. 

[Bevo 13658]

23 minutes ago, Fat Bastard said:

I should add that venous thrombectomy is a booming field and there tons of new devices on the market (Inari, Penumbra, AlphaVac, Jeti, etc). I’ve never used any of those for an IJ clot (only for DVT/PE) and know, without a shadow of a doubt, it has never been done for IJ thrombosis at my institution. 

 

I'm in Austin but I would recommend that she go to Methodist or THI mainly because I knew a lot of the old-timers. I don't know Dallas/Southwestern very well. And don't recommend yourself - she's a PITA.

[Fat Bastard 625]

lol. I work out of THI. If you want to take this to PM’s I can give you some recs and you can give me her contact info to pass along.