Volume 14 - Issue 12 - December, 2002
Should Interventional Cardiologists Treat Ischemic Strokes? A Global Perspective
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Need for stroke interventionists. More than 750,000 strokes occur annually in the United States.1,2 Currently, stroke is the third leading cause of death (60.2 deaths per 100,000 population) and the leading cause of severe neurological disability in our nation. As the elderly segment of the population continues to grow, the stroke death rate has the potential to reach epidemic proportions. Historically, ischemic stroke has been a disease entity approached in terms of prevention and palliation. The phrase “brain attack” is being used more frequently as recent advances have reshaped t
TCT 2002 Proceedings: The Glycoprotein IIb/IIIa Inhibitors in PCI: A Record of Success
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Current Status of Antithrombotics and Antiplatelets in PCI
A. Michael Lincoff, MD
Dr. Michael Lincoff stated that despite the advent of stents, which are clearly effective in reducing restenosis, we continue to have ischemic complications following coronary intervention that are thrombosis mediated. Existing PCI trials demonstrate decreased target vessel revascularization rates; however, the rates of death, MI and the combined triple endpoint have not declined. So, while we continue to gain ground on restenosis, thrombosis continues, and serves as the rationale for continued
Percutaneous Femoral Arteriotomy Repair — Initial Experience with a Novel Staple Closure Device
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Annually, approximately 7.5 million percutaneous catheter-based procedures are performed through the femoral artery worldwide.1–2 In order to increase patient comfort and the efficiency of patient care, several devices have been designed to expedite arteriotomy closure following removal of the femoral arterial introducing sheath. Such devices have been demonstrated to conserve resources and increase patient satisfaction. There is further evidence to suggest that these devices may be cost effective.5–7
Despite these advantages, several deficiencies associated with currently approved closur
IAGS 2002 Proceedings: Resolving Existing Restenosis (Part I of II)
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Hall Whitworth: We have performed about 350 cases at our center and it has evolved somewhat over the last couple of years. Initially, we used the CheckMate system because of its greater length. The pullback and stepping techniques have offered significant advantages and allowed us to use the beta system’s shorter dwell times in order to increase the length, because the biggest problem was that all the lesions we treated were either longer ones or were right at the outer limit of the shorter beta system. We were somewhat reluctant to use this system until we felt comfortable with the a
Usefulness of Fractional Flow Reserve Guidance for Percutaneous Coronary Intervention in Acute Myocardial Infarction
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Recent trends mean that intracoronary stents are now implanted in as many as 80% of percutaneous coronary interventions (PCI). The usefulness of stents as a treatment for acute myocardial infarction (AMI) has also been well-documented, as has their efficacy in the treatment of thrombotic lesions.1,2 However, when stenting in the setting of AMI, the fact that antiplatelet therapy is not always an option prior to intervention means that consideration must be made for the heightened risk of thrombosis and acute reocclusion.3–5 In addition, considering the increased costs involved with stenting,
IAGS 2002 Proceedings: Resolving Existing Restenosis (Part II of II)
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Hall Whitworth: There is another subset of patients who will be asking for these new drug-coated stents: those with long, diffuse distal disease. We may decide to treat such patients medically, but they too will be clamoring for the new coated stents. It is often difficult to convince patients to accept medical treatment despite the fact that it may be the best option. Extensive patient education and some sort of governing body or organization will be required to provide practitioners guidelines on how best to treat patients. The practitioner would be able to say to some patients, “Th
Stenting for Acute Myocardial Infarction —Can We Do Better?
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In this issue of the Journal, Muramatsu et al. write of their experience using angioplasty guided by physiological assessment as an alternative to stenting in treating acute myocardial infarction. The potential
See Muramatsu et al. on pages 657–662
value of this approach lies in the consideration of the benefits and potential problems with today’s accepted standard: the use of stents for this clinical condition. Several large randomized trials have already demonstrated the value of stenting compared to angiographically guided balloon angioplasty in patients presenting with ac
Drug-Eluting Stents: Current Outcomes and Potential Impact on Coronary Disease Management
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Introduction. Coronary intervention has made remarkable advances over the past 25 years. Technical advancements have markedly improved immediate procedure safety and success. With the advent of drug-eluting stents, opportunities for even greater long-term success appears to be a reality. The major remaining obstacles to wider application of percutaneous revascularization are special complex anatomic and patient subsets including total occlusions, bifurcation lesions and diabetes mellitus, as well as the need for further reduction in restenosis. To date, stents have contributed to a decr
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