Intraluminal coronary thrombus aspiration in patients with STEMI. Prof. Andre...Chaichuk Sergiy
Intraluminal coronary thrombus aspiration in patients with STEMI was studied in randomized trials. Results showed thrombus aspiration before stenting improved myocardial perfusion scores and ST-segment resolution compared to conventional PCI alone. Meta-analyses found manual thrombus aspiration reduced distal embolization and improved angiographic and electrocardiographic outcomes, while its effect on mortality is unclear. Larger randomized trials are still needed to definitively establish the benefits of routine thrombus aspiration in STEMI.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
The principles of the initiative „Stent for Life” in Poland: advantages and d...Chaichuk Sergiy
This document discusses the principles of the "Stent for Life" initiative in Poland, including its advantages and difficulties in implementation. It provides background on the epidemiology of acute coronary syndrome (ACS) in Poland and summarizes data on trends in percutaneous coronary intervention (PCI) for ACS from 2002-2011. It also describes the development of primary PCI networks across Poland and analyzes factors influencing first medical contact to balloon times. Both the advantages of improved access to timely PCI for ACS patients nationwide, and the logistical/quality control difficulties in further optimizing the initiative are highlighted.
Intraluminal coronary thrombus aspiration in patients with STEMI. Prof. Andre...Chaichuk Sergiy
Intraluminal coronary thrombus aspiration in patients with STEMI was studied in randomized trials. Results showed thrombus aspiration before stenting improved myocardial perfusion scores and ST-segment resolution compared to conventional PCI alone. Meta-analyses found manual thrombus aspiration reduced distal embolization and improved angiographic and electrocardiographic outcomes, while its effect on mortality is unclear. Larger randomized trials are still needed to definitively establish the benefits of routine thrombus aspiration in STEMI.
The effective national primary angioplasty network. Petr WidimskýChaichuk Sergiy
The document discusses lessons learned from effective primary angioplasty networks in 5 European countries. It finds that regional networks covering 500,000-1,000,000 people, 24/7 primary PCI services, and bypassing nearest hospitals to limit delays are optimal. Direct transport to the cath lab without going through the emergency room can achieve under 90 minute door-to-balloon times in most patients.
The principles of the initiative „Stent for Life” in Poland: advantages and d...Chaichuk Sergiy
This document discusses the principles of the "Stent for Life" initiative in Poland, including its advantages and difficulties in implementation. It provides background on the epidemiology of acute coronary syndrome (ACS) in Poland and summarizes data on trends in percutaneous coronary intervention (PCI) for ACS from 2002-2011. It also describes the development of primary PCI networks across Poland and analyzes factors influencing first medical contact to balloon times. Both the advantages of improved access to timely PCI for ACS patients nationwide, and the logistical/quality control difficulties in further optimizing the initiative are highlighted.
Local drug delivery with balloons eluting a liquid paclitaxel formulation. Yo...Chaichuk Sergiy
Local drug delivery with balloons eluting a liquid paclitaxel formulation
Paclitaxel is a lipophilic drug that is active at low concentrations and remains in cells after short exposure by binding to microtubules. Animal and cellular studies show paclitaxel inhibits smooth muscle cell proliferation after brief exposure. A catheter using porous balloons delivered paclitaxel locally in rabbit arteries, preventing neointimal thickening. Further animal studies using drug-coated and eluting balloons found local paclitaxel reduced restenosis. Initial human trials showed local paclitaxel delivery with eluting balloons was feasible and safe for treating in-stent restenosis, with low
Primary PCI is the preferred treatment for STEMI, achieving success rates of around 90% compared to 50% for thrombolysis. While thrombolysis has mortality rates of 7-10% in trials and 10-17% in registries, primary PCI has lower mortality rates of 5% in trials and 5-9% in registries. The PRAGUE studies showed lower combined endpoints of death, re-infarction and stroke for primary PCI compared to thrombolysis. Guidelines now recommend primary PCI as the default reperfusion strategy for STEMI when it can be performed in a timely manner.
This document describes renal ablation as a new approach for treating resistant hypertension. It begins by providing epidemiological data on hypertension, noting that only half of treated hypertensive patients achieve blood pressure control. It then discusses the role of the kidneys and renal sympathetic nerves in hypertension, and how ablation of these nerves using a catheter-based radiofrequency approach was found to significantly reduce renal norepinephrine levels in preclinical studies. The document outlines the clinical trial program evaluating renal denervation and presents baseline characteristics of patients in the Symplicity HTN-1 study, the first clinical trial to evaluate this approach.
Eluting balloons, the mechanism of action, indications for use Ivan. G. HorvathChaichuk Sergiy
1) Eluting balloons deliver antiproliferative drugs locally via a balloon catheter to prevent restenosis without the need for a permanent stent.
2) Early studies showed eluting balloons significantly reduced late lumen loss and restenosis compared to uncoated balloons in treating small vessel disease and in-stent restenosis.
3) Subsequent randomized trials found eluting balloons were non-inferior and in some cases superior to drug-eluting stents in preventing restenosis, with fewer risks of stent thrombosis and need for long-term dual antiplatelet therapy.
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
Local drug delivery with balloons eluting a liquid paclitaxel formulation. Yo...Chaichuk Sergiy
Local drug delivery with balloons eluting a liquid paclitaxel formulation
Paclitaxel is a lipophilic drug that is active at low concentrations and remains in cells after short exposure by binding to microtubules. Animal and cellular studies show paclitaxel inhibits smooth muscle cell proliferation after brief exposure. A catheter using porous balloons delivered paclitaxel locally in rabbit arteries, preventing neointimal thickening. Further animal studies using drug-coated and eluting balloons found local paclitaxel reduced restenosis. Initial human trials showed local paclitaxel delivery with eluting balloons was feasible and safe for treating in-stent restenosis, with low
Primary PCI is the preferred treatment for STEMI, achieving success rates of around 90% compared to 50% for thrombolysis. While thrombolysis has mortality rates of 7-10% in trials and 10-17% in registries, primary PCI has lower mortality rates of 5% in trials and 5-9% in registries. The PRAGUE studies showed lower combined endpoints of death, re-infarction and stroke for primary PCI compared to thrombolysis. Guidelines now recommend primary PCI as the default reperfusion strategy for STEMI when it can be performed in a timely manner.
This document describes renal ablation as a new approach for treating resistant hypertension. It begins by providing epidemiological data on hypertension, noting that only half of treated hypertensive patients achieve blood pressure control. It then discusses the role of the kidneys and renal sympathetic nerves in hypertension, and how ablation of these nerves using a catheter-based radiofrequency approach was found to significantly reduce renal norepinephrine levels in preclinical studies. The document outlines the clinical trial program evaluating renal denervation and presents baseline characteristics of patients in the Symplicity HTN-1 study, the first clinical trial to evaluate this approach.
Eluting balloons, the mechanism of action, indications for use Ivan. G. HorvathChaichuk Sergiy
1) Eluting balloons deliver antiproliferative drugs locally via a balloon catheter to prevent restenosis without the need for a permanent stent.
2) Early studies showed eluting balloons significantly reduced late lumen loss and restenosis compared to uncoated balloons in treating small vessel disease and in-stent restenosis.
3) Subsequent randomized trials found eluting balloons were non-inferior and in some cases superior to drug-eluting stents in preventing restenosis, with fewer risks of stent thrombosis and need for long-term dual antiplatelet therapy.
Структура «Реперфузионной Сети» Чешской Республики. Первичное стентирование д...Chaichuk Sergiy
The document proposes new certification requirements for interventional cardiologists in the Czech Republic based on European models. It recommends interventional cardiology become a certified subspecialty after completing cardiology training. The proposed requirements include 1 year of full-time interventional cardiology training, courses, publications, and a final board exam. Accredited centers must have experienced trainers, cath labs, ICU, and imaging. Up to 100 experienced interventional cardiologists could be initially certified without the exam to start the program.
This randomized trial compared percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease over 5 years. At 5 years, the cumulative rate of major adverse cardiac and cerebrovascular events was not significantly different between PCI and CABG. However, ischemia-driven revascularization was significantly higher with PCI. Mortality and rates of myocardial infarction were similar with both treatments. PCI may be considered an alternative to CABG for select left main coronary artery disease patients when performed at high-volume centers.
Длительность двойной антитромбоцитарной терапии у NSTEMI пациентов. Совреме...
Обзор основных проблем интервенционной кардиологии. 2012 год. Ю.Н.Соколов
1.
2.
3.
4. SyntaxScore 0-22 – низкая оценка риска (среди сложных пациентов)
Кумулятивныесобытия
месяцы наблюдения
Смерть
ЦВО
ИМ
Смерть,
ЦВО или
ИМ
Повтор.
реваскул.
АКШ Р АКШ (n=104)
ПКВ (n=118)
5. SyntaxScore 23-32 – промеж. оценка риска (среди сложных пациентов)
Кумулятивныесобытия
месяцы наблюдения
АКШ (n=92)
ПКВ (n=103)
Смерть
ЦВО
ИМ
Смерть,
ЦВО или
ИМ
Повтор.
реваскул.
АКШ Р
6. SyntaxScore 0-32 – низкая + промеж. оценка риска
Смерть
ЦВО
ИМ
Смерть,
ЦВО или
ИМ
Повтор.
реваскул.
АКШ Р
Кумулятивныесобытия
месяцы наблюдения
АКШ (n=196)
ПКВ (n=221)
7. SyntaxScore ≥ 32 – высокая оценка риска (среди сложных пациентов)
Смерть
ЦВО
ИМ
Смерть,
ЦВО или
ИМ
Повтор.
реваскул.
АКШ Р
Кумулятивныесобытия
месяцы наблюдения
АКШ (n=149)
ПКВ (n=135)
8.
9.
10.
11.
12. Группа РДН (n=49) Контроль (n=51)
р<0,0001
мм Hg
систол. диастол.
систол. диастол.
- 84% РДН пациентов имели снижение
сист. АД ≥10 ммHg
- и только у 10% сист. АД не снижалось
n=106
13. систол. АД
† р<0,0001 между группами сравнения
систол. АД
диастол. АД
† † р=0,002 между группами сравнения
† † † р=0, 005 между группами сравнения
диастол. АД
Группа контроля
n=106
17. «… улучшить своевременную доставку и обеспечить доступ
пациентам к жизнеспасающим процедурам первичным ПКВ, тем
самым снизить смертность у пациентов с ОКС …»