Coronary Artery Bypass Graft Surgery in Patients Receiving Antiplatelet Therapy: Can We “Fine-Tune” the Balance of Safety and Efficacy?
- Mon, 1/30/12 - 12:46pm
- 0 Comments
- 195 reads
Oral dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, most often clopidogrel, has been demonstrated to reduce the composite risk of ischemic morbidity and mortality across a wide range of patient groups including those with acute coronary syndromes (ACS) and post-percutaneous coronary intervention (PCI).1-3
Incomplete Stent Apposition… Do We Still Need to be Convinced?
- Wed, 1/4/12 - 4:48pm
- 0 Comments
- 610 reads
One of the cornerstones of contemporary stent implantation during percutaneous coronary revascularization is the need for adequate stent expansion with apposition of stent struts to the vessel wall. In most cases, this is achieved with high-pressure dilatation using a non-compliant balloon, so called post-dilatation. The value of adequate stent expansion and stent strut apposition is related to both reductions in repeat revascularization from restenosis and in-stent thrombosis.1-5
Embolic ProtectionDevices in Saphenous Vein Graft Interventions: Is There Still a Role?
- Wed, 1/4/12 - 3:30pm
- 0 Comments
- 480 reads
Saphenous vein grafts (SVG) are commonly used conduits for coronary bypass, with a graft failure rate of up to 45% per patient and 29% per graft on angiographic follow-up at 18 months.1 Atherosclerotic plaques in SVGs tend to be bulky, friable, lipid-rich, and less calcified compared to atherosclerosis in native arteries. Percutaneous intervention in SVGs carries an early as well as late increase in the risk of major adverse cardiac events, resulting from distal microembolization, vasospasm of the distal vascular bed, and microvascular plugging.2
Percutaneous Coronary Intervention in the Very Elderly: Do Nonagenarians Have the Most to Gain or the Most to Lose?
- Thu, 12/1/11 - 3:22pm
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- 582 reads
The elderly are often poorly represented in major clinical trials of percutaneous coronary intervention (PCI).1 An exact definition for “elderly” varies; for instance, the 2002 ACC/AHA practice guideline for the management of acute coronary syndromes considered patients ≥75 as a special “at-risk” group.2 Many clinical trials exclude patients over 75.
The SYNTAX Score: Usefulness, Limitations, and Future Directions
- Thu, 12/1/11 - 1:31pm
- 0 Comments
- 1401 reads
In 2009, the landmark Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial sought to establish whether coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) was the standard of care for patients with three-vessel or left main coronary artery disease.1
Utility of Adenosine Sequelae in Primer Balloon Aortic Valvuloplasty
- Tue, 10/25/11 - 11:37am
- 0 Comments
- 723 reads
Aortic stenosis is an insidious disease with a long latency period.1 Severe symptomatic aortic stenosis is associated with poor outcomes unless an aortic valve replacement procedure is performed.1 In the real world, 30% of patients with severe symptomatic aortic stenosis do not undergo surgical aortic valve replacement because of advanced age, left ventricular dysfunction, or the presence of multiple comorbid conditions.2
Stent Evaluation by Coronary Computed Tomographic Angiography and Expert Consensus Documents
- Tue, 10/25/11 - 10:47am
- 0 Comments
- 985 reads
As coronary computed tomographic angiography (CCTA) has rapidly evolved, its extension to more complex scenarios has kept pace. Stent evaluation has intrinsic technical difficulties. However, since left main disease, in particular, is not reliably addressed by myocardial perfusion imaging, the potential importance of alternate technologies such as CCTA is increased. The paper by Veselka et al in the current issue of the Journal of Invasive Cardiology1 evaluated the accuracy of CCTA to detect left main in-stent restenosis (ISR) in 34 patients, 3 (8.8%) with intravascular-ultrasound documented ISR.
Preventing Contrast-Induced Nephropathy in Patients Undergoing Primary PCI
- Mon, 10/24/11 - 12:41pm
- 0 Comments
- 2076 reads
Contrast-induced nephropathy (CIN) continues to be one of the most common major adverse side effect of cardiac catheterization, and is associated with short- and long-term morbidity and mortality.1,2 This is particularly true in the population presenting with acute ST-elevation myocardial infarction (STEMI). A recent study evaluating the epidemiology of CIN in over 8000 patients undergoing PCI found that CIN occurred in 12% of STEMI, which was significantly higher compared with patients undergoing non-emergent catheterization (9.2% in unstable angina and NSTEMI patients and 4.5% undergoing elective PCI).
What is High-Risk PCI, and How Do You Safely Perform It?
- Thu, 9/29/11 - 2:11pm
- 0 Comments
- 2022 reads
You can liken performance of high-risk percutaneous coronary intervention (PCI) to attempting to repair a damaged car engine while it is turned on. Moreover, that car is trying to slowly drive away from a steep cliff with the ocean crashing at its base. If you can’t repair the engine, the car will stall and will slide backward and over the cliff into the ocean. Although slightly melodramatic, this analogy does summarize the consequences of failure after high-risk PCI.
Catheter Ablation of Atrial Fibrillation: Do the Newer Tools Help?
- Thu, 9/29/11 - 12:01pm
- 0 Comments
- 1326 reads
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia, increasing in occurrence with age. Based on recent epidemiology, it is estimated to affect 6.1 million Americans, and this number is likely to increase to 15.9 million by 2050.1 Partly because of the limitations of antiarrhythmic medications, catheter ablation has come into common use for clinical treatment of atrial fibrillation.
