INTERVENTIONAL TECHNIQUES IN CHRONIC TOTAL OCCLUSIONS
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Chronic total occlusion pci
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
Chronic Total Occlusions: The Road Less Traveled
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Choice And Use Of Appropriate Guidewire in PCI
COMPONENTS OF A GUIDE WIRE, WORKHORSE WIRE
WIRES FOR DIFFERENT OCCASIONS, TRACKABILITY
KNOW YOUR WIRE, CLASSIFICATION, PROPERTIES OF AN IDEAL WIRE
Retrograde cto interv.
The document discusses strategies for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). It describes:
1. The antegrade approach is the most commonly used, with success rates of 60-80%. Tapered guidewires are first-choice to probe microchannels.
2. A four-wire strategy is recommended, starting with a polymer-coated wire and progressing to stiffer wires if needed.
3. Advanced techniques like parallel wiring or antegrade dissection and reentry may be used if initial wiring fails.
Lmca dissection
1. A 59-year-old man underwent a scheduled PCI of the LCx that resulted in a catheter-induced dissection of the left main coronary artery (LMCA).
2. Emergency stenting of the LMCA, LAD and LCx arteries was performed to restore blood flow, along with supportive care including activation of surgical and ECMO teams.
3. The patient recovered well with conservative management of a limited intramural hematoma in the ascending aorta, and was discharged four days later on antiplatelet therapy.
Chronic total occlusion
A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.
CORONARY ARTERY PERFORATION DURING PCI
This document discusses coronary artery perforation during percutaneous coronary intervention (PCI). Some key points:
- Coronary perforation can occur during or after PCI and is defined as extravasation of contrast or blood from the coronary artery. Proximal or mid vessel perforations are more severe while distal perforations often have a benign course.
- Perforations are classified based on their severity. Treatment depends on the severity and location of the perforation. Conservative measures often suffice for minor perforations while techniques like prolonged balloon inflation or stenting may be needed for more severe perforations to stop bleeding.
- Factors like the use of atherectomy or laser devices, complex lesions, small vessels, and guide
Coronary artery dissection and perforation
Coronary artery dissection and perforation are serious potential complications of percutaneous coronary intervention (PCI) that can be life-threatening. Up to 30% of conventional balloon angioplasties result in angiographically significant coronary artery dissection. Perforation occurs in 0.3-0.6% of all PCI cases. The development of devices to remove or ablate tissue has increased the risk of these complications. Types C through F dissections according to the NHLBI classification portend significant morbidity and mortality if untreated, as they can lead to total coronary occlusion without blood flow. Acute vessel closure was the most feared complication before stents but now occurs in less than 1% of elective PCI due to stenting
Recommended
Chronic total occlusion pci
Coronary CTO is characterized by heavy atherosclerotic plaque burden within the artery, resulting in complete (or nearly complete) occlusion of the vessel. Although the duration of the occlusion is difficult to determine on clinical grounds, a total occlusion must be present for at least 3 months to be considered a true CTO. Patients with CTO typically have collateralization of the distal vessel on coronary angiography, but these collaterals may not provide sufficient blood flow to the myocardial bed, resulting in ischemia and anginal symptoms. CTO is clinically distinct from acute coronary occlusion, which occurs in the setting of ST-segment–elevation myocardial infarction, or subacute coronary occlusion, discovered with delayed presentation after ST-segment–elevation myocardial infarction. Clinical features and treatment considerations of these entities differ considerably from CTO.
Among patients who have a clinical indication for coronary angiography, the incidence of CTO has been reported to be as high as 15% to 30%. Patients with CTO are referred for angiography because of anginal symptoms or significant ischemia on noninvasive ischemia testing. Patients who are symptomatic will have stable exertional angina resulting from a limitation of collateral vessel flow to meet myocardial oxygen demand with stress. Of patients referred for PCI in clinical trials of CTO PCI, only 10% to 15% of patients are asymptomatic. It is likewise uncommon for patients with CTO to present with an acute coronary syndrome caused by the CTO itself.
Chronic Total Occlusions: The Road Less Traveled
By M. Nicholas Burke, MD. The use of pioneering percutaneous treatments for chronic total occlusions: indications, limitations, outcomes and current research.
Choice And Use Of Appropriate Guidewire in PCI
COMPONENTS OF A GUIDE WIRE, WORKHORSE WIRE
WIRES FOR DIFFERENT OCCASIONS, TRACKABILITY
KNOW YOUR WIRE, CLASSIFICATION, PROPERTIES OF AN IDEAL WIRE
Retrograde cto interv.
The document discusses strategies for percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). It describes:
1. The antegrade approach is the most commonly used, with success rates of 60-80%. Tapered guidewires are first-choice to probe microchannels.
2. A four-wire strategy is recommended, starting with a polymer-coated wire and progressing to stiffer wires if needed.
3. Advanced techniques like parallel wiring or antegrade dissection and reentry may be used if initial wiring fails.
Lmca dissection
1. A 59-year-old man underwent a scheduled PCI of the LCx that resulted in a catheter-induced dissection of the left main coronary artery (LMCA).
2. Emergency stenting of the LMCA, LAD and LCx arteries was performed to restore blood flow, along with supportive care including activation of surgical and ECMO teams.
3. The patient recovered well with conservative management of a limited intramural hematoma in the ascending aorta, and was discharged four days later on antiplatelet therapy.
Chronic total occlusion
A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.
CORONARY ARTERY PERFORATION DURING PCI
This document discusses coronary artery perforation during percutaneous coronary intervention (PCI). Some key points:
- Coronary perforation can occur during or after PCI and is defined as extravasation of contrast or blood from the coronary artery. Proximal or mid vessel perforations are more severe while distal perforations often have a benign course.
- Perforations are classified based on their severity. Treatment depends on the severity and location of the perforation. Conservative measures often suffice for minor perforations while techniques like prolonged balloon inflation or stenting may be needed for more severe perforations to stop bleeding.
- Factors like the use of atherectomy or laser devices, complex lesions, small vessels, and guide
Coronary artery dissection and perforation
Coronary artery dissection and perforation are serious potential complications of percutaneous coronary intervention (PCI) that can be life-threatening. Up to 30% of conventional balloon angioplasties result in angiographically significant coronary artery dissection. Perforation occurs in 0.3-0.6% of all PCI cases. The development of devices to remove or ablate tissue has increased the risk of these complications. Types C through F dissections according to the NHLBI classification portend significant morbidity and mortality if untreated, as they can lead to total coronary occlusion without blood flow. Acute vessel closure was the most feared complication before stents but now occurs in less than 1% of elective PCI due to stenting
Chronic total occlusion-PTCA
This document discusses strategies and techniques for managing chronic total occlusions (CTO). It provides details on the histopathology of CTOs and explains why recanalizing them can provide clinical benefits like relieving angina and improving left ventricular function. It describes various CTO management techniques including pre-procedure planning, guide catheter selection, and use of specialized CTO guidewires. Predictors of procedural success and failure are also reviewed.
CTO
This document discusses techniques for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention. It describes the distal cap penetration technique using a reverse controlled antegrade and retrograde subintimal tracking (CART) approach. Key aspects of CTO wiring are discussed, including wire features needed for penetration, pushability, steerability, and shaping memory. Retrograde strategies and hardware options are presented, including parallel wiring, the star technique, and snaring. The document shares experience from over 300 CTO cases with a high success rate and low complications.
Spontaneous coronary artery dissection—A review
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
Coronary perforation
This document discusses the treatment of coronary perforations that can occur during percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). It describes 5 types of coronary perforations and provides guidance on how to treat each type. For minor perforations (Type I), careful observation is sufficient. For more significant perforations (Types II-III), prolonged balloon inflation at the perforation site is recommended, along with reversing anticoagulation if needed. For life-threatening bleeding (Type IV), measures may include pericardiocentesis, prolonged balloon inflation, and deployment of a covered stent. Surgery is needed for some unresponsive perforations (Type II-III).
How to manage coronary dissections and intramural hematomas 2015
- Intramural hematoma (IMH) appears on imaging as a crescent-shaped accumulation of blood within the vessel wall. IVUS can clearly identify IMH but OCT may worsen dissections.
- The management of IMH is not well-defined but approaches include cutting balloons, stenting spiral dissections under IVUS guidance, and initially conservative management for stabilized spontaneous coronary artery dissection patients.
- Case examples demonstrate identifying IMH by IVUS and treating with cutting balloons or stenting under IVUS guidance for optimal results. IMH appears similar to dissection and requires precision treatment to prevent complications.
PCI procedure complication
This document discusses complications that can occur during percutaneous coronary intervention (PCI) procedures. It notes that while PCI has over a 90% success rate, complications still occur in 1-5% of cases. It identifies several factors that can increase the risk of complications, such as advanced age, urgent procedures, and comorbidities like heart failure or diabetes. The document categorizes types of potential complications and discusses some in more depth, such as vascular access complications, dissections, and perforations. It also examines angiographic and technical factors that can influence complications, as well as indications for emergency cardiac surgery following PCI.
PCI complications
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
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.
Choosing catheters & guidewires
The document discusses materials useful to have in stock for vascular surgery cases, including 3 types of guide wires, 4 diagnostic catheters, sheaths, balloons and stents, and peripheral stent grafts. It provides details on the types and uses of guide wires, catheters, sheaths, and other tools. Key catheters mentioned are Headhunter, Cobra, Motarjeme and Simmons. It recommends having 3 types of guide wires and answers questions about the most useful catheters and number of guide wire types needed.
Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
Arrythmia ratheesh
This document defines and describes various types of arrhythmias. It begins by defining arrhythmia as any change from the normal sequence of electrical impulses in the heart. Various cardiac and non-cardiac conditions can cause arrhythmias. The document then describes several specific types of arrhythmias in detail, including sinus bradycardia, sick sinus syndrome, sinus tachycardia, premature atrial contractions, atrial flutter, atrial fibrillation, junctional tachycardia, paroxysmal supraventricular tachycardia, premature ventricular contractions, ventricular fibrillation, pulseless electrical activity, asystole, and various types of heart block. Treatment options are provided for each type
Left Main Coronary Artery Disease- Management Strategy
1) Left main coronary artery disease has traditionally been treated with coronary artery bypass grafting (CABG), which is considered the gold standard.
2) Recent studies comparing percutaneous coronary intervention (PCI) using drug-eluting stents to CABG have shown no significant differences in mortality or major adverse cardiac events between the two treatments.
3) PCI may be preferable to CABG for patients with isolated left main or left main plus single vessel disease, while CABG remains the standard treatment for more complex multi-vessel disease.
Pulmonary arterial hypertension
The document discusses pulmonary arterial hypertension (PAH), defining it as a sustained elevation of pulmonary arterial pressure. It describes the types of PAH and the histological findings seen. There is an imbalance of vasoactive mediators like prostacyclin and thromboxane A2 as well as endothelin-1, nitric oxide, serotonin, and vascular endothelial growth factor in PAH patients. Clinical signs include breathlessness and physical exam findings of right heart strain. Diagnostic testing involves echocardiogram, chest imaging, pulmonary function tests, and right heart catheterization.
Strategies of handling side branch during pci
This document summarizes strategies for handling side branches during percutaneous coronary interventions (PCI) involving coronary bifurcations. It discusses:
1. Bifurcation lesions account for 15-20% of PCIs and have lower success rates and higher restenosis than other PCIs.
2. Classification systems for bifurcation lesions including the Medina and Duke classifications.
3. Techniques for stenting bifurcation lesions including provisional stenting, T-stenting, crush techniques, and double stenting.
4. Randomized trials have found that provisional stenting is generally as effective as more complex double stenting techniques for treating bifurcation lesions.
Navin`s rota ppt
This document provides information about rotablation, a technique used to treat calcified coronary lesions. It discusses the indications and contraindications for rotablation, important trials that have evaluated it, tips for performing the procedure, complications like slow-flow and perforation, and comparisons of using rotablation with bare-metal stents versus drug-eluting stents. Key points include that rotablation works via differential cutting with diamond-coated burrs, it is useful for treating heavily calcified or difficult lesions, and optimal techniques aim to minimize platelet activation and potential complications.
Complication and management of rotablation
This document discusses complications that can occur during rotational atherectomy and their management. It notes that complications include bradycardia, slow or no blood flow, dissection, perforation, side branch occlusion, hypotension, and device failures. Proper guidewire placement and limiting ablation times can prevent many complications. Slow or no flow is managed with vasodilators, fluids, and pacing. Dissections may require stenting. Device failures like burr entrapment require vigorous vasodilation. Being prepared to address complications promptly is key to achieving success during this procedure.
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The Worst
This document describes a case of a 59-year-old male patient who presented with exertional angina and dyspnea. Coronary angiography revealed a mid-LAD CTO. Attempts at antegrade recanalization failed. Retrograde recanalization through septal collateral channels resulted in a septal perforation. Coils were implanted but the patient developed cardiac tamponade requiring pericardiocentesis. The perforation persisted and additional coils were implanted, but tamponade recurred requiring emergency cardiac surgery. The perforation was successfully treated with coils and surgery, and the patient was discharged after one week and had an uneventful recovery.
08:15 Lombardi - Learning Antegrade Dissection and Re-entry
1. The document discusses techniques for learning antegrade dissection and re-entry (ADR) for chronic total occlusion percutaneous coronary intervention (CTO PCI), including using new devices like the Stingray balloon.
2. It presents an algorithm for provisional and hybrid approaches to CTO PCI incorporating techniques like antegrade and retrograde wiring, dissection, and re-entry.
3. The key to success is acquiring a variety of hybrid skills through teachable and reproducible methods in order to have multiple strategies for challenging cases.
Artis Ka Inins - CTO PCI retrograde case. Stucked retrograde wire
4th European Live Summit on Retrograde CTO Revascularization - May 8–9, 2015, in Zurich, Switzerland
Saturday 1415 – Saghatelyan - Patient with porcelain aorta
A 46-year-old man with risk factors of hypertension, hyperlipidemia, and history of chest radiation therapy was referred for PCI of an occluded right coronary artery (RCA). Coronary angiography revealed a heavily calcified proximal RCA occlusion near the origin along with a calcified aorta. The cardiologist attempted a retrograde approach using septal collaterals but had difficulty advancing the guidewire. An anchoring balloon in a side branch provided support to advance the wire through the collaterals. Reverse controlled antegrade and retrograde subintimal tracking (CART) was used to recanalize the occlusion. Stents were placed with difficulty due to heavy calcification. The procedure was successful but
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ESTADO DEL ARTE: TERAPIA ENDOVASCULAR BASADA EN CATETERES PARA EL EVENTO CER...
ESTADO DEL ARTE: TERAPIA ENDOVASCULAR BASADA EN CATETERES PARA EL EVENTO CER...Dr. Jose L. Assad-Morell
Actualización de los Estudios de Trombectomía Mecánica para la Recanalización de las Oclusiones de las Grandes Arterias Cerebrales en el Evento Cerebral Vascular Isquémico Agudo. La Revisión termina el 26 de Agosto, 2012 .-More Related Content
Viewers also liked
Chronic total occlusion-PTCA
This document discusses strategies and techniques for managing chronic total occlusions (CTO). It provides details on the histopathology of CTOs and explains why recanalizing them can provide clinical benefits like relieving angina and improving left ventricular function. It describes various CTO management techniques including pre-procedure planning, guide catheter selection, and use of specialized CTO guidewires. Predictors of procedural success and failure are also reviewed.
CTO
This document discusses techniques for crossing chronic total occlusions (CTOs) during percutaneous coronary intervention. It describes the distal cap penetration technique using a reverse controlled antegrade and retrograde subintimal tracking (CART) approach. Key aspects of CTO wiring are discussed, including wire features needed for penetration, pushability, steerability, and shaping memory. Retrograde strategies and hardware options are presented, including parallel wiring, the star technique, and snaring. The document shares experience from over 300 CTO cases with a high success rate and low complications.
Spontaneous coronary artery dissection—A review
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
Coronary perforation
This document discusses the treatment of coronary perforations that can occur during percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). It describes 5 types of coronary perforations and provides guidance on how to treat each type. For minor perforations (Type I), careful observation is sufficient. For more significant perforations (Types II-III), prolonged balloon inflation at the perforation site is recommended, along with reversing anticoagulation if needed. For life-threatening bleeding (Type IV), measures may include pericardiocentesis, prolonged balloon inflation, and deployment of a covered stent. Surgery is needed for some unresponsive perforations (Type II-III).
How to manage coronary dissections and intramural hematomas 2015
- Intramural hematoma (IMH) appears on imaging as a crescent-shaped accumulation of blood within the vessel wall. IVUS can clearly identify IMH but OCT may worsen dissections.
- The management of IMH is not well-defined but approaches include cutting balloons, stenting spiral dissections under IVUS guidance, and initially conservative management for stabilized spontaneous coronary artery dissection patients.
- Case examples demonstrate identifying IMH by IVUS and treating with cutting balloons or stenting under IVUS guidance for optimal results. IMH appears similar to dissection and requires precision treatment to prevent complications.
PCI procedure complication
This document discusses complications that can occur during percutaneous coronary intervention (PCI) procedures. It notes that while PCI has over a 90% success rate, complications still occur in 1-5% of cases. It identifies several factors that can increase the risk of complications, such as advanced age, urgent procedures, and comorbidities like heart failure or diabetes. The document categorizes types of potential complications and discusses some in more depth, such as vascular access complications, dissections, and perforations. It also examines angiographic and technical factors that can influence complications, as well as indications for emergency cardiac surgery following PCI.
PCI complications
This document discusses complications that can occur during percutaneous coronary intervention (PCI), specifically contrast-induced nephropathy and coronary perforation. It defines contrast-induced nephropathy as acute kidney injury occurring after administration of radiocontrast media. Coronary perforation is defined as extravasation of contrast or blood from the coronary artery during or after PCI. The document discusses risk factors, prevention, diagnosis and management of these complications.
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.
Choosing catheters & guidewires
The document discusses materials useful to have in stock for vascular surgery cases, including 3 types of guide wires, 4 diagnostic catheters, sheaths, balloons and stents, and peripheral stent grafts. It provides details on the types and uses of guide wires, catheters, sheaths, and other tools. Key catheters mentioned are Headhunter, Cobra, Motarjeme and Simmons. It recommends having 3 types of guide wires and answers questions about the most useful catheters and number of guide wire types needed.
Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
Arrythmia ratheesh
This document defines and describes various types of arrhythmias. It begins by defining arrhythmia as any change from the normal sequence of electrical impulses in the heart. Various cardiac and non-cardiac conditions can cause arrhythmias. The document then describes several specific types of arrhythmias in detail, including sinus bradycardia, sick sinus syndrome, sinus tachycardia, premature atrial contractions, atrial flutter, atrial fibrillation, junctional tachycardia, paroxysmal supraventricular tachycardia, premature ventricular contractions, ventricular fibrillation, pulseless electrical activity, asystole, and various types of heart block. Treatment options are provided for each type
Left Main Coronary Artery Disease- Management Strategy
1) Left main coronary artery disease has traditionally been treated with coronary artery bypass grafting (CABG), which is considered the gold standard.
2) Recent studies comparing percutaneous coronary intervention (PCI) using drug-eluting stents to CABG have shown no significant differences in mortality or major adverse cardiac events between the two treatments.
3) PCI may be preferable to CABG for patients with isolated left main or left main plus single vessel disease, while CABG remains the standard treatment for more complex multi-vessel disease.
Pulmonary arterial hypertension
The document discusses pulmonary arterial hypertension (PAH), defining it as a sustained elevation of pulmonary arterial pressure. It describes the types of PAH and the histological findings seen. There is an imbalance of vasoactive mediators like prostacyclin and thromboxane A2 as well as endothelin-1, nitric oxide, serotonin, and vascular endothelial growth factor in PAH patients. Clinical signs include breathlessness and physical exam findings of right heart strain. Diagnostic testing involves echocardiogram, chest imaging, pulmonary function tests, and right heart catheterization.
Strategies of handling side branch during pci
This document summarizes strategies for handling side branches during percutaneous coronary interventions (PCI) involving coronary bifurcations. It discusses:
1. Bifurcation lesions account for 15-20% of PCIs and have lower success rates and higher restenosis than other PCIs.
2. Classification systems for bifurcation lesions including the Medina and Duke classifications.
3. Techniques for stenting bifurcation lesions including provisional stenting, T-stenting, crush techniques, and double stenting.
4. Randomized trials have found that provisional stenting is generally as effective as more complex double stenting techniques for treating bifurcation lesions.
Navin`s rota ppt
This document provides information about rotablation, a technique used to treat calcified coronary lesions. It discusses the indications and contraindications for rotablation, important trials that have evaluated it, tips for performing the procedure, complications like slow-flow and perforation, and comparisons of using rotablation with bare-metal stents versus drug-eluting stents. Key points include that rotablation works via differential cutting with diamond-coated burrs, it is useful for treating heavily calcified or difficult lesions, and optimal techniques aim to minimize platelet activation and potential complications.
Complication and management of rotablation
This document discusses complications that can occur during rotational atherectomy and their management. It notes that complications include bradycardia, slow or no blood flow, dissection, perforation, side branch occlusion, hypotension, and device failures. Proper guidewire placement and limiting ablation times can prevent many complications. Slow or no flow is managed with vasodilators, fluids, and pacing. Dissections may require stenting. Device failures like burr entrapment require vigorous vasodilation. Being prepared to address complications promptly is key to achieving success during this procedure.
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The Worst
This document describes a case of a 59-year-old male patient who presented with exertional angina and dyspnea. Coronary angiography revealed a mid-LAD CTO. Attempts at antegrade recanalization failed. Retrograde recanalization through septal collateral channels resulted in a septal perforation. Coils were implanted but the patient developed cardiac tamponade requiring pericardiocentesis. The perforation persisted and additional coils were implanted, but tamponade recurred requiring emergency cardiac surgery. The perforation was successfully treated with coils and surgery, and the patient was discharged after one week and had an uneventful recovery.
08:15 Lombardi - Learning Antegrade Dissection and Re-entry
1. The document discusses techniques for learning antegrade dissection and re-entry (ADR) for chronic total occlusion percutaneous coronary intervention (CTO PCI), including using new devices like the Stingray balloon.
2. It presents an algorithm for provisional and hybrid approaches to CTO PCI incorporating techniques like antegrade and retrograde wiring, dissection, and re-entry.
3. The key to success is acquiring a variety of hybrid skills through teachable and reproducible methods in order to have multiple strategies for challenging cases.
Artis Ka Inins - CTO PCI retrograde case. Stucked retrograde wire
4th European Live Summit on Retrograde CTO Revascularization - May 8–9, 2015, in Zurich, Switzerland
Saturday 1415 – Saghatelyan - Patient with porcelain aorta
A 46-year-old man with risk factors of hypertension, hyperlipidemia, and history of chest radiation therapy was referred for PCI of an occluded right coronary artery (RCA). Coronary angiography revealed a heavily calcified proximal RCA occlusion near the origin along with a calcified aorta. The cardiologist attempted a retrograde approach using septal collaterals but had difficulty advancing the guidewire. An anchoring balloon in a side branch provided support to advance the wire through the collaterals. Reverse controlled antegrade and retrograde subintimal tracking (CART) was used to recanalize the occlusion. Stents were placed with difficulty due to heavy calcification. The procedure was successful but
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How to manage coronary dissections and intramural hematomas 2015
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Left Main Coronary Artery Disease- Management Strategy
Left Main Coronary Artery Disease- Management Strategy
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The Worst
08:45 CASE 7 - Galassi - 02. A Septal Perforation: The Best Of The Worst
08:15 Lombardi - Learning Antegrade Dissection and Re-entry
08:15 Lombardi - Learning Antegrade Dissection and Re-entry
Artis Ka Inins - CTO PCI retrograde case. Stucked retrograde wire
Artis Ka Inins - CTO PCI retrograde case. Stucked retrograde wire
Saturday 1415 – Saghatelyan - Patient with porcelain aorta
Saturday 1415 – Saghatelyan - Patient with porcelain aorta
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THIS A REVIEW OF THE MEDICAL COMPLEXITIES RELATED TO THE THERAPEUTIC MANAGEMENT OF ISCHEMIC MITRAL VALVE INSUFFICIENCY
ABDOMINAL AORTIC ANEURYSMS :SMALL AND LARGE
The document discusses the benefits of regular exercise for both physical and mental health. It notes that exercise can help reduce the risk of diseases like heart disease, diabetes, and some cancers. The document recommends that adults get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week to experience these health benefits.
FEMORAL ARTERY : STATE OF THE ART OF ENDOVASCULAR THERAPY
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
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Revisión exhaustiva de las complicaciones del stent carotídeo : indicaciones y sugerencias de como prevenir las complicaciones y como tratarlas cuando estas ocurren .-
CAROTID STENTING : TECHNICAL TIPS & TRICKS
This presentation helps to understand the Technical Tips and Tricks useful at the time of performing Carotid Stenting
DEEP VEIN THROMBOSIS & CATHETER DIRECTED MECHANICAL THROMBECTOMY
This presentation is directed to show the Catheter Directed Mechanical Thrombectomy in the Treatment of Iliofemoral Deep Vein Thrombosis ( includes analysis of recent clinical trials )
Left main coronary artery
Este documento discute la revascularización del tronco coronario izquierdo no protegido (TCI-NP) mediante cirugía de puentes coronarios versus intervención coronaria percutánea (ICP) con stents liberadores de fármacos. Los lineamientos actuales recomiendan la cirugía como tratamiento de primera línea para el TCI-NP. Sin embargo, varios estudios recientes muestran que la ICP con stents liberadores de fármacos puede tratar con éxito lesiones del TCI-NP con bajas tasas de mortalidad, infart
Endovascular Treatment of Critical Limb Ischemia
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Therapeutic window for stroke management
ACUTE STROKE
Therapeutic Window for Stroke Management:
from Logic to Logistics for Providing Improved Health Care
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TROMBOLISIS INTRA-ARTERIAL EN EVENTO CEREBRAL VASCULAR ISQUEMICO AGUDO
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ESTADO DEL ARTE: TERAPIA ENDOVASCULAR BASADA EN CATETERES PARA EL EVENTO CER...
UPDATE OF HIGH RISK PCI . . . IMPELLA vs IABP : INCLUDES THE SHOCK II TRIAL
UPDATE OF HIGH RISK PCI . . . IMPELLA vs IABP : INCLUDES THE SHOCK II TRIAL
ISCHEMIC MITRAL VALVE DISEASE: THERAPEUTIC CONUNDRUM
ISCHEMIC MITRAL VALVE DISEASE: THERAPEUTIC CONUNDRUM
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FEMORAL ARTERY : STATE OF THE ART OF ENDOVASCULAR THERAPY
STENT CAROTIDEO : COMO PREVENIR Y MANEJAR LAS COMPLICACIONES
STENT CAROTIDEO : COMO PREVENIR Y MANEJAR LAS COMPLICACIONES
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DEEP VEIN THROMBOSIS & CATHETER DIRECTED MECHANICAL THROMBECTOMY
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This quiz was conducted as a promotional event for the 2024 Annual Meet of Kerala Chapter of API.
More than 20 participants took part everyday !
How to Control Your Asthma Tips by gokuldas hospital.
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
What are the different types of Dental implants.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
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Pharmacology of 5-hydroxytryptamine and Antagonist
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It is mostly found in the brain, intestines, and blood platelets.
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SENSORY NEEDS B.SC. NURSING SEMESTER II.
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CLEAR ALIGNER THERAPY IN ORTHODONTICS .pptx
Dr. ZANAB FARHEEN FAYAZ ,MDS(ORTHODONTICS & DENTOFACIAL ORTHOPEDICS ).
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Know the difference between Endodontics and Orthodontics.
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Ageing, the Elderly, Gerontology and Public Health
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Skin Diseases That Happen During Summer.
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