Advances in interventional cardiology Minh Vo
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Advances in interventional cardiology Minh Vo

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  • 1844, French physiologist Bernard coined the term "cardiac catherization" and used catheters to record intracardiac pressures in animals
  • 1929 in Germany, first documented cardiac catheterization (in humans) performed by Dr.Werner Forssman: in a small hosp near Berlin, a young surgical resident named Werner Forssman against the wishes of his chief, conducted an experiment on himself. he anesthetized his own elbow, inserted a catheter in his antecubital vein with the catheter dangling from his arm...proceeded to a basement x-ray room where he documented the catheter's position in his right atrium proving that is is safe. (the belief at that time that any entry into the heart would be fatal) He was immediately fired...con't to experiment on himself until all of his veins with 17 cutdowns were used up then he experimented with catheterization in dogs. Discouraged by his lack of acceptance in cardiology, he switched to urology and eventually became a country dr. He never retured to cardio research but was awarded a Nobel prize in 1956
  • 1958, while conducting an imaging procedure in which dye was to be injected into Ao valve of a pt with Ao valve disease, Dr.Mason Sones a pediatric cardiologist at the Cleveland clinic discovered that the catheter had accidentally entered the pts RCA and before it could be removed, 30cc of dye was released...he expected VF but realized that the coronaries could tolerate dye...he went on to perfect the angio technique
  • Coronary angioplasty first introduced by Andreas Gruentzig in 1977...used to reduce severity of coronary stenosis and diminish or eliminate objective and subjective manifestations of cardiac ischemia. Data have shown that PTCA is better than medical treatments in reducing symptoms In Nov 1977, at AHA conference, Gruentzig presented his first human case of PTCA...after he showed his coronary cine, audience stood up and gave him a standing ovation...People then began to visit him in Zurich but it became very crowded and he wasn't looked very favorable by his bosses...he then began to have courses, 5 in Switzerland before he came to US (Atlanta and became Director of Interventional Cardiology at Emory University)
  • 44 y.o male; only risk factor is smoking history. Called EMS from home d/t severe c/p and initial EKG by EMS -> transmitted to cardiologist: acute anterolateral STEMI -> VFIB arrest -> 1min CPR -> defib X1 -> cath lab. (contact time-to-balloon time < 1hr)

Advances in interventional cardiology Minh Vo Advances in interventional cardiology Minh Vo Presentation Transcript

  • Advances in interventional cardiology Minh Vo University of Manitoba April 30, 2009
  • Claude Bernard (1813-1878)
  • Werner Forssman (1904-1979)
  • Mason Sones (1919-1985)
  • Andreas Gruentzig (1939-1985)
  • 1987 - first report of stents used in humans
  • 2003 – approval for drug-eluting stents
  • Vascular access
  •  
  •  
  • Complications post percutaneous coronary intervention
    • death 0.1%
    • stroke 0.05%
    • MI 0.05%
    • emergent CABG 0.1%
    • VF 0.5%
    • contrast agent reaction 0.23%
    • hematoma 1-3%
    • retroperitoneal hematoma
    • pseudo-aneurysm 1-3%
    • AV fistulas (<0.4%)
    • neuropathy
    • arterial thrombosis
    • distal emboli
    • infection 0.2%
    Major complications are rare (<1%) Minor complications are uncommon 1-3%
  • Taking care of patients after percutaneous coronary intervention in-stent restenosis (BMS 20% vs. DES 5%) (highest incidence 6-9 months) in-stent thrombosis (~1%) (highest incidence within 1yr) platforms anti-platelet therapy
  • Anti-platelet therapy in patients with intracoronary stents
    • BMS (bare metal stents):
      • ASA 162-325mg for 1month then 75-162mg daily indefinitely
      • plavix 75mg for at least 1 month (minimum of 2 weeks if bleeding risk 1,2 ) and preferably up to 1 year
    • DES (drug-eluting stents) :
      • ASA 162-325mg for 3 months after SES* (Cypher) and for 6 months after PES* (Taxus) then 75-162mg daily indefinitely
      • plavix 75mg for at least 1 year
    * SES indicates sirolimus eluting stents. PES indicates paclitaxel eluting stents
  • Conclusions
    • Continuing advances in interventional cardiology
    • Procedure is very safe
    • Dual antiplatelet therapy extremely important
  •