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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE On Demand Web ArchiveNon-Accredited Target Audience: Physicians, nurses, and technologists. This activity is supported by an educational grant from Terumo Medical Corporation. |
Review
Current Perspectives on Carotid Revascularization Among Patients Who Need Cardiac Surgery
ABSTRACT: Carotid stenosis is often present in patients who need cardiac surgery and is predictive of post-operative stroke. A strategy of combined carotid endarterectomy and cardiac surgery had been adopted in the past. Staged carotid artery stenting prior to cardiac surgery is a less invasive alternative and seems to be associated with a lower incidence of stroke and myocardial infarction as compared to the combined surgical approach. This article provides a systemic review of the management of patients with concomitant carotid and cardiac disease requiring cardiac surgical
The Balance Between Anti-ischemic Efficacy and Bleeding Risk of Antithrombotic Therapy in Percutaneous Coronary Intervention: A
ABSTRACT: Background. The development of newer and more potent antithrombotic agents and strategies has markedly reduced cardiovascular mortality and ischemic complications in patients with acute coronary syndromes and those undergoing percutaneous coronary intervention (PCI). With every approach to reduce coronary thrombosis, however, there is an accompanying risk of increasing bleeding complications elsewhere. Conversely, reducing bleeding complications may increase coronary thrombotic (ischemic) events. This is the Yin-Yang principle of antithrombotic therapy and st
The Relationship Between Bleeding and Adverse Outcomes in ACS and PCI: Pharmacologic and Nonpharmacologic Modification of Risk
ABSTRACT: Antithrombotic therapy, including antiplatelet and antithrombin agents, effectively reduces the risk of ischemic events in patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI). Unfortunately, these agents intrinsically increase the risk of bleeding complications, which in turn are associated with adverse outcomes, particularly mortality. Accordingly, there is great value in improving the understanding of bleeding complications, including the definitions employed, severity and types of bleeding, as well as the patient characteristi
Virtual Histology Imaging in Acute Coronary Syndromes: Useful or Just a Research Tool?
ABSTRACT: Acute coronary syndromes (ACS) frequently cause considerable morbidity and mortality with a high risk of further events within the following year, despite the use of percutaneous coronary intervention (PCI). Numerous studies have described the concept of acute, partial or complete thrombotic occlusion of the coronary artery, which occurs at the site of a friable atherosclerotic plaque with a lipid-rich necrotic core and a ruptured overlying thin fibrous cap (“culprit lesion”). Moreover, this process appears independent of the severity of the underlying stenosis
Unresolved Issues Associated with Early Initiation of Antiplatelet Therapy in Acute Coronary Syndromes
ABSTRACT: Early initiation of antiplatelet therapy in addition to aspirin is critical for all patients with acute coronary syndrome (ACS) due to improved short- and long-term outcomes. Thus, evidence-based practice guidelines for ACS management recommend early and intensive initiation of antiplatelet therapy with aspirin, clopidogrel, and/or glycoprotein (GP) IIb/IIIa inhibitors. Despite the comprehensive nature of current guidelines, several important clinical issues concerning the optimal initiation of antiplatelet therapy remain. This review addresses four of these clinical issues: When sho
Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory (Full title below)
Avoiding Intelligence Failures in the Cardiac Catheterization Laboratory: Strategies for the Safe and Rational Use of Dalteparin or Enoxaparin during Percutaneous Coronary Intervention
ABSTRACT: Low-molecular-weight heparin (LMWH) has been a mainstay for the management of acute coronary syndromes (ACS) for almost a decade. However, several recent developments have seriously threatened the prominence of this drug class: (i) the adoption of an early invasive strategy, frequently leading to percutaneous coronary intervention (PCI) where the dosing and monitoring of LMWH is unfamiliar
Use of Drug-Eluting versus Bare-Metal Stents in ST-Segment Elevation Myocardial Infarction
From the Los Angeles County Hospital/University of Southern California Medical Center, Department of Cardiovascular Medicine, Los Angeles, California.
The authors report no conflicts of interest regarding the content herein.
Manuscript submitted February 10, 2009, provisional acceptance given March 23, 2009, and final version accepted March 24, 2009.
Address for correspondence: Leonardo Clavijo, MD, 1510 San Pablo Street, Suite #322, Los Angeles, CA 90033. E-mail: lclavijo@usc.edu
ABSTRACT: The development of drug-eluting stents (DES) is one of
Inferior Vena Cava Filter Migration: Updated Review and Case Presentation
ABSTRACT: We report a case of inferior vena cava filter migration to the right ventricle resulting in ventricular tachycardia and elevated troponin. The patient was taken to the cardiac catheterization laboratory and under fluoroscopy the filter was found to be in the right ventricle. Later in the day the filter was removed surgically with the aid of cardiopulmonary bypass. This case, as well as the other 27 reported cases of filter migration, were reviewed. It was noticed that newer retrievable filters made of nitinol, phynox and elgioly have a significantly higher percentage
Anaphylactoid Reactions to Radiocontrast Agents: Prevention and Treatment in the Cardiac Catheterization Laboratory
ABSTRACT: The use of iodinated contrast agents for angiography dates back to the 1920s.1 The initial prototype has undergone modifications to reduce the toxicity and discomfort associated with the early contrast molecules. More importantly, these changes have dramatically decreased the rate and risk for severe adverse reactions such as hypersensitivity and anaphylaxis. With over 15 million contrast-requiring procedures performed annually in the United States,2 it is important to understand the risk factors, pathogenesis, diagnosis, prevention and treatment of contrast-induced anaphylactoid rea
Post-Traumatic Ventricular Septal Defects — Review of the Literature and a Novel Technique for Percutaneous Closure
ABSTRACT: Post-traumatic ventricular septal defect (VSD) is infrequent, with clinical sequelae ranging from imminent death to complete spontaneous resolution. The most appropriate management strategy is unclear. Careful observation has been advocated in the management of these patients. We demonstrate this concept by reporting two different approaches in two patients with traumatic injuries to the chest and review the English-language literature of both spontaneous and percutaneous closure of these lesions. In our case of percutaneous closure, we report a novel technique involving a transsepta
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Press Release
— Bethlehem, Pennsylvania – Invatec received 510(k) clearance from the U.S. Food and Drug Administration (FDA) in October to market its Mo.Ma Ultra Proximal Cerebral Protection Device for use during carotid artery stenting (CAS). The device effectively reduces and captures debris released during the stenting procedure to prevent it from traveling to the brain, where it has the potential to cause a stroke.
CME Showcase
 The Use of Remote Robotic Navigation in Complex Arrhythmias Complimentary Accredited Web Archive This activity is designed for electrophysiologists and EP allied professionals. Diagnosing Coronary Artery Disease: Advanced Cardiovascular Imaging Solutions  New Standards of Care for CRMD Antibiotic Protection Complimentary CME Accredited Webcast Dates: November 18, 2008 Time: 6:00 pm ET November 19, 2008 Time: 3:00 pm ET This activity is sponsored by the North American Center for Continuing Medical Education. |
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