Coronary stent thrombosis
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This document discusses coronary stent thrombosis, a serious complication of percutaneous coronary intervention (PCI). It outlines risk factors and prevention strategies. Key points include: - Stent thrombosis is a nightmare for cardiologists and can have various causes, including patient factors, lesion characteristics, technical issues, and non-adherence to dual antiplatelet therapy. - Prevention through optimal stent deployment, complete coverage of the lesion, and adherence to prolonged dual antiplatelet therapy are critical to minimizing the risk of stent thrombosis. - Intravascular imaging can help identify issues like incomplete stent expansion or apposition that may lead to thrombosis. - Large clinical trials have demonstrated the efficacy of newer antiplatelet regimens like
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Stent Thrombosis
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
Left main stenting
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
3. While CABG remains the standard of care for many patients, randomized trials found PCI with DES to have non-inferior outcomes to CABG at 1-2 years for death, MI, and stroke in selected patients with low complexity lesions. Rates
Coronary artery dissection
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Coronary Calcium Modification
Coronary artery calcification (CAC) results in reduced vascular compliance, abnormal vasomotor responses, and impaired myocardial perfusion.
The presence of CAC is associated with worse outcomes in the general population and in patients undergoing revascularization
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No reflow and slow flow phenomenon during pci
This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
Left main pci
This document discusses left main coronary artery (LMCA) percutaneous coronary intervention (PCI). Key points:
1. LMCA disease can be treated with balloon angioplasty or stenting. Drug-eluting stents have reduced restenosis rates compared to bare-metal stents.
2. Assessment of LMCA lesions includes angiography as well as intravascular ultrasound (IVUS) and fractional flow reserve (FFR) to determine significance. An IVUS minimum luminal area <4.5mm2 or FFR<0.80 indicate a significant stenosis.
3. Techniques for stenting LMCA lesions depend on location and involve strategies like single crossover stenting or provisional two
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No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
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Stent Thrombosis
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
Left main stenting
1. Significant unprotected left main coronary artery (ULMCA) disease occurs in 5–7% of patients undergoing CAG and is treated medically has a 3-year mortality rate of 50%.
2. Studies have shown PCI with drug-eluting stents for ULMCA disease can achieve low rates of death, MI, and TLR at 12 months compared to bare-metal stents which had high rates of restenosis and mortality.
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Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction characterized by a non-traumatic separation of the coronary arterial wall. It most commonly affects younger women and the left anterior descending artery. SCAD results from an intimal tear or bleeding of vasa vasorum that leads to the formation of a false lumen filled with blood. This can cause the artery to narrow and restrict blood flow. SCAD is increasingly recognized and can be caused by conditions affecting connective tissue or hormonal factors during pregnancy. Angiography is used to diagnose SCAD but findings may be subtle, with long diffuse narrowing being most common. Management involves conservative treatment but revascularization may be needed for ongoing ischemia
Coronary Calcium Modification
Coronary artery calcification (CAC) results in reduced vascular compliance, abnormal vasomotor responses, and impaired myocardial perfusion.
The presence of CAC is associated with worse outcomes in the general population and in patients undergoing revascularization
Two recognized types of CAC are
Atherosclerotic (Intimal)
Medial artery calcification
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No-reflow phenomenon refers to the inability to perfuse the myocardium after opening a previously occluded coronary artery. It results from endothelial damage, platelet and fibrin embolization, vasospasm, and tissue edema overwhelming the coronary microcirculation. Risk factors include thrombus presence, cardiogenic shock, increased reperfusion time, and hyperglycemia. Diagnosis involves contrast staining in the coronary artery and residual chest pain after angioplasty. Treatment aims to prevent no-reflow through optimal blood sugar control, statin use, anticoagulation, and intracoronary nitrates. Pharmacological therapies like adenosine, statins, and calcium inhibitors may also help. Measurement of treatment outcome can be
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This document discusses strategies and prevention of slow flow and no-reflow phenomenon during percutaneous coronary intervention (PCI). It defines no-reflow as inadequate myocardial perfusion through a coronary artery without mechanical obstruction. No-reflow occurs in 8-11% of primary PCIs and is associated with worse clinical outcomes. The pathophysiology involves distal embolization, ischemic injury, reperfusion injury, and individual patient susceptibility. Preventing no-reflow requires reducing thrombus burden, ischemia time, reperfusion injury through anti-inflammatory drugs, and addressing risk factors like diabetes.
Left main pci
This document discusses left main coronary artery (LMCA) percutaneous coronary intervention (PCI). Key points:
1. LMCA disease can be treated with balloon angioplasty or stenting. Drug-eluting stents have reduced restenosis rates compared to bare-metal stents.
2. Assessment of LMCA lesions includes angiography as well as intravascular ultrasound (IVUS) and fractional flow reserve (FFR) to determine significance. An IVUS minimum luminal area <4.5mm2 or FFR<0.80 indicate a significant stenosis.
3. Techniques for stenting LMCA lesions depend on location and involve strategies like single crossover stenting or provisional two
Management of no reflow
No-reflow occurs when there is a lack of reperfusion to the myocardium after successful coronary recanalization and is defined as inadequate perfusion without angiographic evidence of vessel obstruction. It occurs in 0.6-3.2% of PCI cases and is associated with increased risk of LV dysfunction, remodeling, arrhythmias, heart failure and cardiac rupture. Diagnosis is typically done using myocardial contrast echocardiography or cardiac MRI. Treatment focuses on improving perfusion and includes vasodilators like adenosine, antithrombotics, mechanical strategies like thrombectomy, and preventing no-reflow through measures like pre-conditioning.
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The document discusses in-stent restenosis (ISR), defined as the re-narrowing of a stented coronary artery due to neointimal tissue proliferation. ISR rates range from 3-20% with drug-eluting stents and 16-44% with bare-metal stents, usually occurring 3-20 months after stent placement. Predictors of ISR include patient characteristics like diabetes, lesion characteristics like length, and procedural characteristics like stent undersizing. The main mechanism is neointimal tissue proliferation due to arterial wall damage during stenting. ISR treatment involves revascularization like balloon angioplasty or additional stenting.
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2. Contemporary DES like cobalt-chromium everolimus-eluting stents (CoCr-EES) showed very low risks of stent thrombosis. However, BVS was associated with a significantly higher risk of device thrombosis compared to CoCr-EES and other DES.
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- Restenosis can be focal or diffuse and is classified based on its severity and treatment approach. Higher grades of restenosis are associated with poorer outcomes.
- Factors contributing to in-stent restenosis include patient and lesion characteristics, stent design and materials, drug effects, inflammation, neoatherosclerosis, low wall shear stress areas, and potential thrombus formation.
- Earlier and more rapid neoatherosclerosis may occur inside drug-eluting stents compared to bare-metal stents,
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Stent design aspects and coronary artery disease were discussed. Coronary artery disease is a leading cause of death worldwide. Historical developments in treatments including balloon angioplasty, bare metal stents, and drug-eluting stents were covered. Mechanisms of in-stent restenosis and approaches to prevent it such as mechanical techniques, drug coatings, and biodegradable stents were described. Clinical measures for evaluating restenosis outcomes were defined.
Coronary stent
This document summarizes coronary stents, including their purpose, types, history, procedure for placement, and future advancements. Stents are small mesh devices that are placed in arteries to keep them open and improve blood flow after balloon angioplasty. There are bare metal stents and drug-eluting stents, which combat re-narrowing after placement. The first coronary stent was placed in 1986, and drug-eluting stents were introduced in 2001 to further reduce re-narrowing. Placement involves threading a catheter through an artery to the blockage and expanding a balloon and stent to open the artery. Future advancements include bioresorbable polymers that dissolve after artery healing is complete.
The story of coronary stent
A stent is a small, expandable tube. During a procedure called angioplasty, the stent is inserted into a coronary artery and expanded using a small balloon. A stent is used to open a narrowed or clotted artery.
AHA: BASKET-PROVE
This study aimed to compare 1st and 2nd generation drug-eluting stents (DES) to bare-metal stents (BMS) in large vessel stenting. The BASKET-PROVE trial randomized over 2,300 patients to receive either a 1st generation sirolimus-eluting stent (SES), a 2nd generation everolimus-eluting stent (EES), or a BMS. The primary endpoint was a composite of cardiac death and myocardial infarction up to 2 years. The study found that both DES were superior to BMS in reducing the risk of the primary endpoint and repeat revascularization, with no significant differences between the DES. Late safety concerns about DES were not confirmed. The
26.09.13 how to choose your bride among three sisters
1. The document discusses how to choose a bride among three sisters.
2. It notes that choosing a bride is a delicate matter that requires considering compatibility, personality, family background, and health of each sister.
3. The best approach is to carefully evaluate each sister individually based on these factors and choose the one who is most suitable and with whom you can have a happy marriage.
Isicam, high bleeding risk pci,2016,isman
The document summarizes a case study of a high bleeding risk patient who required urgent PCI prior to orthopedic surgery. The patient had multiple vessel disease including chronic total occlusions. The interventional cardiologist performed complex PCI using dual guidewires and drug-coated stents, which allowed for a shortened dual antiplatelet therapy duration of 1 month prior to surgery. The case highlights the importance of an individualized approach for high bleeding risk PCI patients, including consideration of drug-coated stents to balance risks of bleeding and restenosis.
Novedades en intervencionismo coronario
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Novedades en intervencionismo coronario
Juan Miguel Ruiz Nodar (Hosp. General de Alicante)
Bare Metal Stents
Bare Metal Stents: Will Their Lower Thrombosis Advantage over DES Vanish Against the CoCr-Everolimus Eluting Stents? Armando Tellez, SOLACI Congress 2012, Mexico.
Updates on Stent Design
This document discusses stent design and the features of an innovative new stent called EluNIR. It summarizes:
1) EluNIR has a unique design with wide "W" struts that provide excellent radial strength and narrow "Z" struts that provide flexibility and conformability.
2) The optimal scaffolding area of EluNIR provides uniform support and drug elution while preventing tissue prolapse.
3) EluNIR's flexible closed cell configuration and narrow strut width of 40/72 microns allows it to maintain natural vessel curvature after implantation and facilitate stent apposition and deliverability.
Anticoagulation in pci
1) Dr. Pahlajani discusses anticoagulation strategies for complex percutaneous coronary interventions (PCI) that require dual antiplatelet therapy (DAPT) and oral anticoagulation (OAC).
2) Studies have shown that major bleeding during acute coronary syndromes (ACS) is associated with significantly higher in-hospital mortality. Blood transfusions for non-ST elevation myocardial infarction (NSTEMI) patients are also linked to higher 30-day mortality.
3) When selecting anticoagulation and antiplatelet regimens, it is important to balance preventing ischemic events with avoiding major bleeding which can negate the benefits of antithrombotic therapy. Strategies discussed include
Novedades en farmacología en intervencionismo
XXVII Reunión anual de la sección de Hemodinámica y Cardiología Intervencionista
16 y 17 de junio de 2016 León
http://secardiologia.es/xxvii-reunion-anual-de-la-seccion-de-hemodinamica-y-cardiologia-intervencionista
Novedades en farmacología en intervencionismo
Antonio Fernández Ortiz (Hosp. Clínico San Carlos. Madrid)
Update Status of the Enduring Drug Eluting Stents
Update Status of the Enduring Drug Eluting StentsSociedad Latinoamericana de Cardiología Intervencionista
This document discusses the evolution of drug-eluting stent (DES) technology, including DES systems that use bioabsorbable polymers. Several bioabsorbable polymer DES systems are described, including the BioMatrix DES which uses a biodegradable polylactic acid polymer coating to deliver biolimus, and data is presented showing low late lumen loss and low rates of restenosis. Other bioabsorbable polymer DES discussed include the Synergy DES, DESyne, Inspiron, Orbus DES, and Biomine DES. The document highlights advantages of bioabsorbable polymer DES systems over durable polymer DES, as bioabsorbable polymers avoid long-term inflammation and delays in re-endManagement bei ACI und Stent-Patienten:
welche Plättchenhemmer und wann absetzen
Management bei ACI und Stent-Patienten:
welche Plättchenhemmer und wann absetzen
In stent restenosis
In-Stent Restenosis occurs when a blockage redevelops inside a stent placed in a coronary artery. The rate of restenosis is lower with drug-eluting stents (DES) compared to bare-metal stents or balloon angioplasty alone. For treatment of in-stent restenosis, repeat stenting with DES has shown success, though DES for prior DES restenosis remains controversial due to the risk of developing multiple layers of stent struts. Drug-coated balloons are an alternative to repeat stenting and have been shown to be effective for both bare-metal and drug-eluting stent in-stent restenosis. Ongoing randomized clinical trials are further evaluating
Coronary Stent Design- Part B
This document discusses the design of drug-eluting stents (DES). It outlines the key components of a DES including the platform (materials, design), drug, drug-eluting matrix, and fabrication techniques. The platform discusses factors like strength, deliverability, and hemodynamics. Drug options and targeted drugs are presented. Drug-eluting matrices can be durable polymers, degradable polymers, or porous ceramics. Fabrication involves laser cutting, coating, crimping, and packaging. Risks of DES like hypersensitivity, restenosis, and thrombosis are also reviewed.
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Coronary Stent thrombosis,comparisons between stents.Bioreabsorbable vascular...
Coronary Stent thrombosis,comparisons between stents.Bioreabsorbable vascular...
26.09.13 how to choose your bride among three sisters
26.09.13 how to choose your bride among three sisters
Management bei ACI und Stent-Patienten:
welche Plättchenhemmer und wann absetzen
Management bei ACI und Stent-Patienten:
welche Plättchenhemmer und wann absetzen
Similar to Coronary stent thrombosis
Titan S.V Final Ici
1) The document discusses revascularization options for patients with small vessel coronary artery disease less than 2.5mm in diameter.
2) It finds that drug-eluting stents (DES) and bio-active stents significantly reduce long-term restenosis rates compared to bare metal stents (BMS) in small vessels.
3) The bio-active stent (Titan) performed similarly to DES with low restenosis and target-lesion revascularization rates, suggesting it may be an alternative option for patients who cannot tolerate long-term anti-platelet therapy required by DES.
Problem associated with drug eluting stent
This ppt will tell us about the problem which a cardiologist has to face after implantation of Drug eluting stent in a patient of coronary artery diseases. Although there are lots of problem but i am going to describe only three major problem.
Lecture 04. Pulmonary embolism 2.ppt
Deep vein thrombosis and pulmonary embolism are serious conditions that can be fatal if not properly treated. This document discusses the etiology, diagnosis, treatment and prevention of venous thromboembolism. It notes that venous thromboembolism affects millions of people worldwide each year and carries high economic costs. Diagnosis involves assessment of clinical probability followed by D-dimer and ultrasound testing. Treatment involves anticoagulation medications like low molecular weight heparins or novel oral anticoagulants. Catheter-directed thrombolysis may be considered in some cases to help restore blood flow.
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSIC
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSICPROFESSOR DR. MD. TOUFIQUR RAHMAN
The document discusses left main revascularization and provides information on left main stenosis, coronary revascularization options including PCI vs CABG, ESC guidelines on CABG vs PCI for left main disease, and conditions where CABG may be preferable to PCI for left main stenosis. It also includes summaries of clinical trials comparing outcomes of PCI and CABG for left main disease and considerations for left main PCI.Primary Percutaneus coronary intervention
Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.
primarypci-130928132211-phpapp01 (1).pdf
Primary PCI involves performing percutaneous coronary intervention (PCI) on the culprit artery in patients presenting with ST-elevation myocardial infarction (STEMI). It aims to open the blocked artery as quickly as possible, preferably within 90 minutes of arrival, to restore blood flow and reduce damage to heart muscle. The key advantages of primary PCI over thrombolysis are higher rates of successful artery opening and lower risks of bleeding. Optimal outcomes require a coordinated system with rapid diagnosis, transfer, and treatment at experienced heart attack centers capable of performing 24/7 PCI.
While thrombolysis can be used when PCI is not immediately available, primary PCI is preferred when it can be performed promptly by an experienced operator, as it leads to better flow
Coronary flow for the critically ill by Dr Pranesh Jogia
The intent of this presentation is to provide an update of coronary assessment and management for the adult intensivist. Discussion points will include:
1. An assessment of coronary severity, using established methods, in particular fractional flow reserve (FFR),
2. Which stent- highlight the evolution of the stent to the current generation and what is evolving,
3. How to keep the stent open with current concepts of antiplatelet therapy and how this impacts the critically ill patient
4. What to consider if the ECG is abnormal, but the coronaries are not flow limiting obstruction- an occasional dilemma in the critically ill patient and finally
5. Discussion around a contemporary study regarding cardiogenic shock and coronary ischemia.
Chevalier B
This document discusses TRI (transradial intervention) in patients with chronic kidney disease (CKD). It notes that CKD patients have accelerated atherosclerosis and are at high risk for coronary artery disease. While PCI can help treat CAD, CKD patients face higher risks of bleeding complications and renal impairment from the procedures. The document recommends hydration, low-osmolar contrast agents, and limiting contrast load when performing PCI in CKD patients to protect kidney function. It argues that TRI may reduce bleeding risks compared to transfemoral approaches but must be used cautiously in end-stage renal disease to avoid compromising existing or future arteriovenous fistulas needed for hemodialysis access.
Guidelines in the management of carotid stenosis
This document provides an overview of guidelines for the management of carotid stenosis. It discusses:
1) Stroke is a major cause of death, with many caused by carotid artery disease. The risk of stroke is directly related to the degree of stenosis.
2) Natural history studies show that the risk of stroke is highest in the first year after symptoms and then declines over time. The risk is higher for more severe stenosis.
3) Early trials demonstrated the benefits of carotid endarterectomy (CEA) in reducing stroke risks compared to medical management alone for symptomatic and some asymptomatic patients.
4) Later trials evaluated carotid angioplasty and stenting (CAS) as an alternative to CEA but
Management of Carotid Artery Stenosis - Evidence and guidelines
Current Management of Carotid artery stenosis.
Comparison of Endarterectomy vs. Stenting.
Evidence review. Discussion of present guidelines.
How should recently symptomatic patients be treated urgent cea or cas
Recent symptomatic patients with carotid artery stenosis can be treated with either urgent carotid endarterectomy (CEA) or carotid artery stenting (CAS). While early studies found CEA to have better outcomes, more recent trials like CREST showed comparable rates of stroke and death between CEA and CAS. For recently symptomatic patients specifically, CEA may still be preferred to CAS due to concerns about stabilizing carotid plaque after stenting. Operator experience also impacts outcomes, so treatment should be individualized based on each patient's clinical situation.
Bifurcation lesions
Coronary bifurcation lesions are challenging to treat percutaneously and account for approximately 15% of PCIs. Interventions on bifurcations have lower success rates and higher complication rates than other lesions. The optimal strategy for treating bifurcations, whether provisional stenting of the main vessel with treatment of the side branch only if needed versus systematic two-stent techniques, is still debated. Several randomized trials have compared different approaches but longer-term data is still needed. Dedicated bifurcation stents may improve outcomes but need low profiles, ease of use, and cost effectiveness.
Health beat
Drug Eluting Stents (DES) are coated with anti-proliferative drugs like sirolimus or paclitaxel to prevent re-stenosis. First generation DES like sirolimus-eluting stents provided better outcomes than bare metal stents by reducing re-stenosis rates from 25% to 7%. Second generation DES like zotarolimus and everolimus-eluting stents were developed to further reduce re-stenosis and prevent endothelial cell inhibition. Angioplasty and stenting successfully treats coronary artery narrowing in over 70% of patients.
Dimitri Karmpaliotis - CTO PCI in Post-CABG Patients
1) Over 100,000 CABG operations are performed annually in the US, with 10,000 re-do CABG procedures each year. Hundreds of thousands of post-CABG patients have occluded/degenerated grafts causing symptoms that are often under-treated.
2) CTO PCI in post-CABG patients is more technically challenging due to diffuse disease, calcified vessels, distortion of anatomy from vessel tenting, and progression of native vessel disease.
3) Technical success rates for CTO PCI in post-CABG patients have improved in recent years to over 80% due to improved techniques like retrograde recanalization, but it remains a difficult subset of patients with
Journal club drug eluting balloon for cad
This document discusses treatment options for in-stent restenosis (ISR) in a patient with a past history of percutaneous coronary intervention. It summarizes the findings of several studies comparing drug-eluting balloons (DEBs) and drug-eluting stents (DES) for treating ISR. The studies found that DES were superior to DEBs for reducing repeat revascularization, while safety outcomes like death and heart attack were similar. However, DEBs may be preferred over DES in certain high risk cases, like those with multiple stent layers or who are at high risk of bleeding complications from long-term dual antiplatelet therapy. Additional research with longer follow-ups is still needed to further compare DEBs
Journal review 27 04-2020 1
1) The document describes a randomized controlled trial called ISCHEMIA-CKD that compared an invasive strategy (PCI or CABG) to a conservative strategy in patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia.
2) The trial found that an initial invasive strategy did not result in a lower rate of death or nonfatal myocardial infarction compared to an initial conservative strategy.
3) Limitations of the trial included exclusion of very symptomatic patients and lower than expected event rates, reducing the power to detect differences between strategies.
Pacchioni A - AIMRADIAL 2014 - Cerebral microembolism
Pacchioni A - AIMRADIAL 2014 - Cerebral microembolismInternational Chair on Interventional Cardiology and Transradial Approach
This document compares the risk of microembolization during diagnostic coronary angiography between single catheter and double catheter strategies. In the first study, a left radial approach was found to have a lower rate of microembolization than a right radial approach, likely due to less catheter manipulation and exchanges. Independent predictors of high microembolization included a greater number of catheters used. A second study found that using a single "Tiger" catheter halved the rate of microembolization compared to using a double catheter "Judkins" strategy, mainly by reducing catheter exchanges. Minimizing catheter exchanges may help reduce the risk of air embolism and microembolization during coronary angiography procedures.Carotid artery stenosis
This document summarizes the treatment options for carotid artery stenosis, specifically carotid endarterectomy (CEA) versus carotid artery stenting (CAS). CEA has been shown to be superior to medical management alone in reducing stroke risk and is the gold standard treatment. CAS may be preferable for high-risk patients with conditions making CEA difficult, but is associated with a higher risk of perioperative stroke. The choice between CEA and CAS depends on patient characteristics, disease factors, and operator experience. While CAS can be performed less invasively, current evidence shows CEA remains the standard treatment for standard-risk patients.
Taquicardia Ventricular relacionada à Cicatriz - por Dr. André D´Avila
Taquicardia Ventricular relacionada à Cicatriz - por Dr. André D´AvilaClínica Ritmo - Arritmia e Marcapasso
Aula sobre Taquicardia Ventricular relacionada à Cicatriz, ministrada pelo Dr. André D´Avila (CRM/SC 4797), no I Simpósio Catarinense de Arritmia Cardíaca, realizado em Julho de 2017, em Florianópolis - SC.
O evento, promovido pela Clínica Ritmo, clínica especializada no tratamento de Arritmias e Implante de Marcapasso, teve como objetivo abordar todas as formas de arritmias cardíacas e as possibilidades de tratamentos, com temas trazidos a partir de casos reais tratados pelos especialistas da Clínica Ritmo nos últimos cinco anos.
Para saber mais sobre os procedimentos, acesse: http://www.clinicaritmo.com.br/Ptca vs cabg
PTCA and CABG are two revascularization procedures used to treat coronary artery disease. PTCA involves using a balloon to open blocked arteries, while CABG uses grafts to bypass blocked arteries. PTCA has a higher risk of restenosis but is less invasive, while CABG has better long-term outcomes for multi-vessel disease but is more invasive. Factors like the number of blocked vessels, presence of diabetes, and left ventricular function help determine which procedure is most appropriate for a given patient. Guidelines provide direction on when PTCA or CABG is generally recommended based on a patient's specific condition.
Similar to Coronary stent thrombosis (20)
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSIC
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSIC
Coronary flow for the critically ill by Dr Pranesh Jogia
Coronary flow for the critically ill by Dr Pranesh Jogia
Management of Carotid Artery Stenosis - Evidence and guidelines
Management of Carotid Artery Stenosis - Evidence and guidelines
How should recently symptomatic patients be treated urgent cea or cas
How should recently symptomatic patients be treated urgent cea or cas
Dimitri Karmpaliotis - CTO PCI in Post-CABG Patients
Dimitri Karmpaliotis - CTO PCI in Post-CABG Patients
Pacchioni A - AIMRADIAL 2014 - Cerebral microembolism
Pacchioni A - AIMRADIAL 2014 - Cerebral microembolism
Taquicardia Ventricular relacionada à Cicatriz - por Dr. André D´Avila
Taquicardia Ventricular relacionada à Cicatriz - por Dr. André D´Avila
More from Ramachandra Barik
Willens's syndrome.pptx
A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
MISPLACED ECG LEADS.pptx
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
- The sites of origin for supraventricular tachycardia (SVT) and ventricular arrhythmias.
- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
Intra aortic balloon pump
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
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Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
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3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
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3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
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5. ECG in Medical Practice by ABM Abdullah, 4th edition
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Coronary stent thrombosis
- 1. Coronary Stent Thrombosis Nightmare for cardiologist
- 2. Let see how it looks!
- 3. Get involved to prevent Understanding • Serious complication of PCI. • DES=BMS for early and late ST • Frequently in first-generation DES • Risk factors-Modifiable(Most) • Address • Patient • Lesion • Stent • DAPT Prevention is better • a good technical result; and effective DAPT • are critical in minimizing the risk of ST.
- 4. Stent Paradox ! Cardiologist invites thrombus Thrombus there But not cardiologist That’s a deathly nightmare
- 5. Tetrad of ST Patient Stent Medication Lesion Lesion Lesion
- 6. Definition of Stent Thrombosis According to the Valve Academic Research Consortium Level of certainty Time temporal Definite Angiographic or pathological confirmation of partial or total thrombotic occlusion within the peri-stent region AND at least 1 of the following additional criteria: Acute ischemic symptoms Ischemic electrocardiogram changes Elevated cardiac biomarkers Early Acute (<24 h) Subacute (24 h to 30 days Probably Any unexplained death <30 days of stent implantation Any myocardial infarction related to documented acute ischemia in the territory of the implanted stent without angiographic confirmation of stent thrombosis and in the absence of any other obvious cause Late 31 days to 1 yr Possible Any unexplained death beyond 30 days Very late More than 1 yr
- 7. ORACLE Profile Early Late Patient Malignancy, heart failure, peripheral artery disease, diabetes mellitus, acute coronary syndromes, nonadherence to dual-antiplatelet therapy, genetic polymorphisms, thrombocytosis End-stage renal disease, smoking, STEMI, nonadherence to dual-antiplatelet therapy (unknown for very late ST) Lesion Bifurcation lesion, LAD, vessel size, lesion length, thrombus, saphenous vein grafts LAD, incomplete endothelialization, delayed healing, previous brachytherapy, vein graft stenting Procedure Stent undersizing, stent underexpansion, stent malapposition, dissection, no pre-procedural thienopyridine administration, bivalirudin as anticoagulant in STEMI patients, stent length DES (compared with BMS), permanent polymer DES (compared with bioresorbable polymer DES), overlapping DES Postprocedure Discontinuation of antiplatelet therapy Discontinuation of antiplatelet therapy (unknown for very late ST), late acquired stent malapposition
- 8. INTRAVASCULAR IMAGING • Expansion • Apposition • Stent fracture • Dissection • Malposition • Thrombus • Neo-atherosclerosis • New plaque rupture • Negative remodelling at the stent edge
- 9. Factors used for risk score • NSTE MI • STEMI • Current smoking • Insulin-treated diabetes mellitus • History of PCI • Platelet count • Pre-PCI Heparin • Aneurysm or ulceration • TIMI flow grade (Base) • Final TIMI flow • No. of vessels treated
- 10. Who is culprit? Cardiologist put stent, thrombus caused death
- 11. PLATO IS SOVERIGN AND TICA IS KING RCT YEAR F/U Comparison Definite of probably ST p bleeding p TRITON 2K7 15M CLOPI VS PASU 24.4/1.1 0.001 1.8 (111/6716) 2.4 (146/6741) 0.03 PLATO 2K9 12M CLOPI VS TICA 2.9/2.2 0.009 7.7 (638/9186) 7.9 (657/9235) .57 CHAMPION 2K9 48H CLOPI VS CANGRE 0.3/02 0.34 0.3 (14/4365) 0.4 (19/4374) 0.39 CHAMPION FOENIX 2K9 48H CLOPI VS CANGRE 1.4/0.8 0.01 0.1 (5/5527) 0.1 (5/5529) 0.99 CURRENT -OASIS 7 2K10 1M CLOPI VS 2XCLOPI 2.3/1.8 0.001 0.7 (60/8703) 1.0 (80/8560) 0.074
- 12. Learning curve • From 2004 to 2014 ST related death dropped from 50% to 1% • BMS changed to DES in 2005 • 1ST generation banned • 2ND AND 3RD generation replaced 1st generation DES • ARC came in 2008
- 13. TECHNIQUE • Newer generation stent(OK) • Expansion[No residue] • Apposition [full length] • Dissections[No residual-IVUS] • Provisional stenting[Preferred] • Crush and Culotte[Discourage]
- 14. DAPT compliance • Do not stop at all • Never stop during 1st month • If stopped ,expect ST in 7 days
- 15. DAPT INTERRUPTION Hurry Should be postponed as long as possible Aspirin should be continued. No Hurry • Postpone the procedure until 1 year after stent implantation • Guideline recommended period of 6 to 12 months
- 16. Subha Diwali 2014 • Light for ST is not enough what is given here,You have to light it for yourself from today[23-10-2014]