Stenosis vs risk
•Download as PPT, PDF•
0 likes•262 views
The more stenotic a coronary segment is at baseline, the more likely it is to progress to occlusion or myocardial infarction. Less obstructive plaques, which far outnumber severely obstructive plaques, are responsible for most occlusions and infarctions because they are more likely to progress. Myocardial infarction often results from plaques that were only mildly or moderately obstructive months or years prior.
Report
Share
Report
Share
Recommended
Chaubal et al-2004-journal_of_ultrasound_in_medicine
Sonography and color Doppler imaging are valuable tools for evaluating and diagnosing aortoarteritis. The disease causes characteristic changes in large arteries that can be seen on ultrasound. Early findings include uniform wall thickening of arteries like the aorta and its branches. Over time, the disease can lead to luminal narrowing, stenosis, dilatation, aneurysms, and eventually occlusions of arteries. Color Doppler can detect decreased pulsatility and loss of normal blood flow patterns in affected vessels. The disease often involves multiple arteries and can be associated with secondary effects on organs like the heart and lungs. Ultrasound is useful for accurately diagnosing and monitoring the progression of aortoarteritis.
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. FearonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.Hypertrophic Obstructive Cardiomyopathy (HOCM)
This document discusses surgical management for hypertrophic obstructive cardiomyopathy (HOCM). It begins by defining HOCM and describing its genetic causes. It then discusses how HOCM can be anatomically classified and the morphology of septal hypertrophy and the mitral valve apparatus. The natural course of the disease and various treatment approaches are outlined, including supportive management, medical management, septal myectomy surgery, and alcohol septal ablation. Septal myectomy is described as the gold standard technique, aiming to relieve left ventricular outflow tract obstruction and mitigate mitral regurgitation. Outcomes of septal myectomy are generally good, but risks include heart block and residual gradients.
Hemodynamics for the heart failure
This article reviews the role of invasive hemodynamics in the care of patients across the
entire spectrum of human heart failure.
Conceptual principles of ventricular function, ventricular-arterial interaction, load
response, and ventricular interaction in the right and left heart are reviewed.
Principles and practice of invasive exercise testing are provided, along with detailed
discussions on the role of invasive hemodynamics in the evaluation and management of
advanced heart failure, shock, mechanical circulatory support, and pulmonary
hypertension.
Nice pics asc aorta aneurysm
This document discusses a 58-year-old woman referred for an ultrasound evaluation of her bicuspid aortic valve and aneurysmal ascending aorta. The ultrasound found a bicuspid aortic valve with mild insufficiency and stenosis, and an enlarged ascending aorta measuring 50 mm. A cardiac CT scan confirmed a large aortic aneurysm extending from the sinotubular junction to the proximal arch, with its largest diameter being 51x49 mm. Due to these findings and guidelines recommending surgery for aneurysms over 50 mm, the patient underwent a valve-sparing aortic root replacement.
Approach to left main bifurcation stenting
Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the
treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has
shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most
types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior
to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic
compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation
for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In
addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically
isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful
procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing
the chosen technique than the choice of metho
Left main disease final
- Left main coronary artery disease occurs in 5-7% of patients undergoing coronary angiography and is associated with high mortality if left untreated. The left main artery supplies a large portion of the heart.
- Left main disease can be caused by atherosclerosis, infections, inflammation, anomalies, or compression. Atherosclerosis particularly affects areas of low shear stress like the bifurcation.
- Percutaneous coronary intervention or coronary artery bypass grafting may be considered for treatment depending on the patient's characteristics and complexity of the disease. Outcomes are generally better when intravascular ultrasound is used to guide stenting of left main lesions. Patient selection is important to achieve good long-term results.
EES or CABG NEJM
- A randomized trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) in over 1900 patients with left main coronary artery disease.
- At 3 years, PCI was found to be noninferior to CABG for the primary endpoint of death, stroke, or myocardial infarction. However, the rate of revascularization was 5% higher in the PCI group.
- Early adverse events such as myocardial infarction, bleeding, and renal failure within 30 days were lower with PCI, but adverse events increased between 30 days and 3 years for PCI compared to CABG. Long-term follow up is still needed to compare outcomes.
Recommended
Chaubal et al-2004-journal_of_ultrasound_in_medicine
Sonography and color Doppler imaging are valuable tools for evaluating and diagnosing aortoarteritis. The disease causes characteristic changes in large arteries that can be seen on ultrasound. Early findings include uniform wall thickening of arteries like the aorta and its branches. Over time, the disease can lead to luminal narrowing, stenosis, dilatation, aneurysms, and eventually occlusions of arteries. Color Doppler can detect decreased pulsatility and loss of normal blood flow patterns in affected vessels. The disease often involves multiple arteries and can be associated with secondary effects on organs like the heart and lungs. Ultrasound is useful for accurately diagnosing and monitoring the progression of aortoarteritis.
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. Fearon
PCI & AimRadial 2018 | FFR in Left Main Disease - William F. FearonInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.Hypertrophic Obstructive Cardiomyopathy (HOCM)
This document discusses surgical management for hypertrophic obstructive cardiomyopathy (HOCM). It begins by defining HOCM and describing its genetic causes. It then discusses how HOCM can be anatomically classified and the morphology of septal hypertrophy and the mitral valve apparatus. The natural course of the disease and various treatment approaches are outlined, including supportive management, medical management, septal myectomy surgery, and alcohol septal ablation. Septal myectomy is described as the gold standard technique, aiming to relieve left ventricular outflow tract obstruction and mitigate mitral regurgitation. Outcomes of septal myectomy are generally good, but risks include heart block and residual gradients.
Hemodynamics for the heart failure
This article reviews the role of invasive hemodynamics in the care of patients across the
entire spectrum of human heart failure.
Conceptual principles of ventricular function, ventricular-arterial interaction, load
response, and ventricular interaction in the right and left heart are reviewed.
Principles and practice of invasive exercise testing are provided, along with detailed
discussions on the role of invasive hemodynamics in the evaluation and management of
advanced heart failure, shock, mechanical circulatory support, and pulmonary
hypertension.
Nice pics asc aorta aneurysm
This document discusses a 58-year-old woman referred for an ultrasound evaluation of her bicuspid aortic valve and aneurysmal ascending aorta. The ultrasound found a bicuspid aortic valve with mild insufficiency and stenosis, and an enlarged ascending aorta measuring 50 mm. A cardiac CT scan confirmed a large aortic aneurysm extending from the sinotubular junction to the proximal arch, with its largest diameter being 51x49 mm. Due to these findings and guidelines recommending surgery for aneurysms over 50 mm, the patient underwent a valve-sparing aortic root replacement.
Approach to left main bifurcation stenting
Despite the recent developments that have been made in the field of percutaneous left main (LM) intervention, the
treatment of distal LM bifurcation remains challenging. The provisional one-stent approach for LM bifurcation has
shown more favorable outcomes than the two-stent technique, making the former the preferred strategy in most
types of LM bifurcation stenosis. However, elective two-stent techniques, none of which has been proven superior
to the others, are still used in patients with severely diseased large side branches to avoid acute hemodynamic
compromise. Selecting the proper bifurcation treatment strategy using meticulous intravascular ultrasound evaluation
for side branch ostium is crucial for reducing the risk of side branch occlusion and for improving patient outcomes. In
addition, unnecessary complex intervention can be avoided by measuring fractional flow reserve in angiographically
isolated side branches. Most importantly, good long-term clinical outcomes are more related to the successful
procedure itself than to the type of stenting technique, emphasizing the greater importance of optimizing
the chosen technique than the choice of metho
Left main disease final
- Left main coronary artery disease occurs in 5-7% of patients undergoing coronary angiography and is associated with high mortality if left untreated. The left main artery supplies a large portion of the heart.
- Left main disease can be caused by atherosclerosis, infections, inflammation, anomalies, or compression. Atherosclerosis particularly affects areas of low shear stress like the bifurcation.
- Percutaneous coronary intervention or coronary artery bypass grafting may be considered for treatment depending on the patient's characteristics and complexity of the disease. Outcomes are generally better when intravascular ultrasound is used to guide stenting of left main lesions. Patient selection is important to achieve good long-term results.
EES or CABG NEJM
- A randomized trial compared percutaneous coronary intervention (PCI) using everolimus-eluting stents to coronary artery bypass grafting (CABG) in over 1900 patients with left main coronary artery disease.
- At 3 years, PCI was found to be noninferior to CABG for the primary endpoint of death, stroke, or myocardial infarction. However, the rate of revascularization was 5% higher in the PCI group.
- Early adverse events such as myocardial infarction, bleeding, and renal failure within 30 days were lower with PCI, but adverse events increased between 30 days and 3 years for PCI compared to CABG. Long-term follow up is still needed to compare outcomes.
Bon Secours Heart Valve Center
This document discusses mitral valve disease and treatment options such as surgical repair/replacement and the MitraClip procedure. Some key points:
- Mitral regurgitation (MR) is the most common valve problem and increases in prevalence with age. Left untreated, MR can lead to heart failure and death.
- Surgical treatment has traditionally been the only option to reliably reduce MR, but many patients are considered too high-risk for surgery.
- The MitraClip procedure is a minimally invasive treatment that fills this gap for inoperable patients by using a clip to repair the mitral valve and reduce MR without open heart surgery.
- Clinical trials show the MitraClip procedure reduces MR
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.
Inherited aortopathy2022
Inherited aortopathy can cause complications like aortic dissection and repeated surgeries. This document discusses inherited aortopathies associated with congenital heart defects. Primary aortic dilatation is mainly associated with coarctation of the aorta, bicuspid aortic valve, and conotruncal abnormalities. Secondary dilatation can occur after congenital heart surgery when non-aortic tissue is used. The most serious complication is aortic dissection. Guidelines exist for investigating and treating this life-threatening event, with consideration of underlying hereditary disorders.
Smoaj.000572
Occurrence of a mural thrombus in a diseased descending thoracic aorta (atherosclerotic or aneurysmal) is a well-known and commonly encountered vascular entity. However, thrombus formation in a normal appearing descending thoracic aorta (NADTA) is rarely reported in literature so far. We present an
unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male. He presented at our center in the emergency department with acute onset abdominal pain and underwent a contrast enhanced CT scan that confirmed mural thrombus in
NADTA.
CT Imaging for Acute Aortic Syndrome
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
Coronary ectasia
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
Randomized comparison of everolimus eluting stents and sirolimus-eluting stents
This study compared everolimus-eluting stents (EES) to sirolimus-eluting stents (SES) in 500 STEMI patients undergoing primary angioplasty. No significant differences were found between the EES and SES groups in major adverse cardiac events, death, reinfarction, or target vessel revascularization. However, the EES group had a significantly lower rate of stent thrombosis compared to the SES group at 3-year follow-up. Therefore, among STEMI patients undergoing primary angioplasty, EES was found to have similar efficacy as SES but was associated with a reduced risk of stent thrombosis.
06 FFR Matsuo aimradial2017 - Serial stenosis
06 FFR Matsuo aimradial2017 - Serial stenosisInternational Chair on Interventional Cardiology and Transradial Approach
- The document discusses strategies for assessing and treating serial coronary lesions using fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).
- It presents a case of a patient with three sequential lesions who underwent FFR assessment and treatment of the lesion with the largest pressure drop, followed by reassessment of FFR.
- The document also discusses using iFR pullback mapping to identify focal versus diffuse disease and to aid in lesion selection for planned percutaneous coronary intervention when multiple lesions are present.HOCM
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as an increased left ventricular wall thickness of 15 mm or more that is not due to abnormal loading conditions. HCM is caused by mutations in sarcomere genes. Symptoms can include left ventricular outflow tract obstruction and complications such as heart failure, atrial fibrillation, and sudden cardiac death. The document discusses the diagnosis of HCM using echocardiography, cardiac MRI and other imaging tools. It also reviews treatments such as medications, surgical myectomy to relieve outflow tract obstruction, alcohol septal ablation, implantable cardioverter-defibrillators and heart transplantation.
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.Acute Aortic Syndrome
This document provides an overview of acute aortic syndrome (AAS), including aortic dissection, intramural hematoma, penetrating aortic ulcer, and ruptured aortic aneurysm. It discusses the pathophysiology, imaging appearance and protocols, classification systems, and reporting considerations for each condition. CT and MRI are highlighted as the primary imaging modalities. The radiologist plays an important role in diagnosing AAS, determining treatment approaches such as endovascular intervention, and evaluating outcomes through follow up imaging. Proper technique and systematic reporting of anatomic details are essential for clinical management of these life-threatening aortic emergencies.
Coronary ectasia
CORONARY ANEURYSM
CORONARY ECTASIA
MANAGEMENT \
ACUTE CORONARY SYNDROME
WARFARIN
PTFE
DES
BMS
Penetrating Atherosclerotic Ulcer
Penetrating atherosclerotic ulcer (PAU) is an ulcerating atherosclerotic lesion that penetrates the aortic wall. CT is often used to evaluate PAU, showing features like a focal outpouching with adjacent hematoma. While some cases progress slowly, PAU carries a risk of complications like rupture. Treatment depends on factors like symptoms, expansion rate, and surgical risk. Careful monitoring is important due to variable prognosis.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathy
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Coronary Artery Aneurysms and Ectasia
This document summarizes the morning report of a 59-year-old man with a history of kidney transplant, SLE, and prior STEMI managed with thrombus extraction. He presented with recurrent chest pain. Key findings include inferolateral wall perfusion defect on nuclear stress test. The report reviews coronary aneurysms/ectasia classification, etiologies including atherosclerosis, Kawasaki disease, inflammatory disorders. The patient's systemic lupus erythematosus and transplant status suggest an inflammatory cause is possible. Evaluation and management of antiplatelet therapy is discussed.
Bifurcation stenting
Significant unprotected left main (LM) coronary artery disease is present in <10% of patients undergoing coronary angiography. In autopsy research, a mean LM length of 10.8 mm ± 5.2 mm (range 2–23 mm), mean LM diameter 4.9 mm ± 0.8 mm and mean angle between the left anterior descending (LAD) and left circumflex (LCx) of 86.7° ± 28.8° has been described. This angle value positively correlated with LM length.2 Further studies showed that long LM developed stenoses more frequently near the distal bifurcation compared to near the ostium (77% versus 18%).7 It is also worth emphasising that LM bifurcation disease is rarely focal and that both sides of the carina are almost never disease-free. Furthermore, continuous plaque from the LM into the proximal LAD artery has been reported in 90% of cases.8 Summarised below are the most crucial LM peculiarities (in comparison with non-LM bifurcations), which should be taken into consideration when distal LM stenosis PCI is planned:
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
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.
Role of echocardiography in acute myocardial infraction
Echocardiography is useful in the diagnosis and management of acute myocardial infarction (AMI) for several reasons:
1. It can detect regional wall motion abnormalities (RWMAs) that occur prior to ECG changes during a coronary occlusion, aiding early diagnosis.
2. It is recommended to evaluate ventricular function, detect mechanical complications like thrombus, and stratify risk in patients with confirmed AMI.
3. RWMAs seen on echocardiography localize the area of infarction and correspond to the coronary artery territory. Complications like ventricular septal defects and mitral regurgitation can also be identified.
Symposium jang
This document summarizes research on using optical coherence tomography (OCT) to characterize coronary plaques. OCT uses near-infrared light to generate high-resolution cross-sectional images of tissue microstructure. Researchers studied 357 arterial segments ex vivo using OCT and validated plaque types (fibrous, calcific, lipid-rich) against histology with high accuracy. A pilot clinical study of 10 patients found OCT feasible and safe for in vivo coronary imaging before and after percutaneous coronary intervention, identifying a variety of plaque types and stent appositions. While blood obstruction and motion artifacts posed challenges, the results support further evaluation of OCT as a potential "optical biopsy" tool.
Stefanadis
Thermography is a new technique for detecting atherosclerotic plaque vulnerability. A new catheter-based system called the Epiphany Thermography System can precisely measure plaque temperature and has shown higher temperatures in proximal versus distal plaque segments. Studies have found that greater temperature differences between segments correlate with increased risk of future cardiac events, with optimal sensitivity of 86% and specificity of 79%. Preliminary research also indicates statin therapy may lower plaque temperatures and heterogeneity. Further clinical studies are still needed but thermography shows promise as an early detection method for vulnerable plaques.
Tct arrow pics, landscape
The document describes results from experiments examining iron uptake and macrophage presence in the periaortic and pericoronary fat of mice, rabbits, and humans with atherosclerosis. Mice and rabbits genetically modified to be prone to atherosclerosis showed greater iron uptake and more macrophages in the periaortic fat compared to controls. In humans, macrophages were found not just in atherosclerotic plaques but also in the surrounding pericoronary fat tissue.
More Related Content
What's hot
Bon Secours Heart Valve Center
This document discusses mitral valve disease and treatment options such as surgical repair/replacement and the MitraClip procedure. Some key points:
- Mitral regurgitation (MR) is the most common valve problem and increases in prevalence with age. Left untreated, MR can lead to heart failure and death.
- Surgical treatment has traditionally been the only option to reliably reduce MR, but many patients are considered too high-risk for surgery.
- The MitraClip procedure is a minimally invasive treatment that fills this gap for inoperable patients by using a clip to repair the mitral valve and reduce MR without open heart surgery.
- Clinical trials show the MitraClip procedure reduces MR
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.
Inherited aortopathy2022
Inherited aortopathy can cause complications like aortic dissection and repeated surgeries. This document discusses inherited aortopathies associated with congenital heart defects. Primary aortic dilatation is mainly associated with coarctation of the aorta, bicuspid aortic valve, and conotruncal abnormalities. Secondary dilatation can occur after congenital heart surgery when non-aortic tissue is used. The most serious complication is aortic dissection. Guidelines exist for investigating and treating this life-threatening event, with consideration of underlying hereditary disorders.
Smoaj.000572
Occurrence of a mural thrombus in a diseased descending thoracic aorta (atherosclerotic or aneurysmal) is a well-known and commonly encountered vascular entity. However, thrombus formation in a normal appearing descending thoracic aorta (NADTA) is rarely reported in literature so far. We present an
unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male. He presented at our center in the emergency department with acute onset abdominal pain and underwent a contrast enhanced CT scan that confirmed mural thrombus in
NADTA.
CT Imaging for Acute Aortic Syndrome
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
Coronary ectasia
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
Randomized comparison of everolimus eluting stents and sirolimus-eluting stents
This study compared everolimus-eluting stents (EES) to sirolimus-eluting stents (SES) in 500 STEMI patients undergoing primary angioplasty. No significant differences were found between the EES and SES groups in major adverse cardiac events, death, reinfarction, or target vessel revascularization. However, the EES group had a significantly lower rate of stent thrombosis compared to the SES group at 3-year follow-up. Therefore, among STEMI patients undergoing primary angioplasty, EES was found to have similar efficacy as SES but was associated with a reduced risk of stent thrombosis.
06 FFR Matsuo aimradial2017 - Serial stenosis
06 FFR Matsuo aimradial2017 - Serial stenosisInternational Chair on Interventional Cardiology and Transradial Approach
- The document discusses strategies for assessing and treating serial coronary lesions using fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).
- It presents a case of a patient with three sequential lesions who underwent FFR assessment and treatment of the lesion with the largest pressure drop, followed by reassessment of FFR.
- The document also discusses using iFR pullback mapping to identify focal versus diffuse disease and to aid in lesion selection for planned percutaneous coronary intervention when multiple lesions are present.HOCM
This document provides an overview of hypertrophic cardiomyopathy (HCM). It defines HCM as an increased left ventricular wall thickness of 15 mm or more that is not due to abnormal loading conditions. HCM is caused by mutations in sarcomere genes. Symptoms can include left ventricular outflow tract obstruction and complications such as heart failure, atrial fibrillation, and sudden cardiac death. The document discusses the diagnosis of HCM using echocardiography, cardiac MRI and other imaging tools. It also reviews treatments such as medications, surgical myectomy to relieve outflow tract obstruction, alcohol septal ablation, implantable cardioverter-defibrillators and heart transplantation.
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.Acute Aortic Syndrome
This document provides an overview of acute aortic syndrome (AAS), including aortic dissection, intramural hematoma, penetrating aortic ulcer, and ruptured aortic aneurysm. It discusses the pathophysiology, imaging appearance and protocols, classification systems, and reporting considerations for each condition. CT and MRI are highlighted as the primary imaging modalities. The radiologist plays an important role in diagnosing AAS, determining treatment approaches such as endovascular intervention, and evaluating outcomes through follow up imaging. Proper technique and systematic reporting of anatomic details are essential for clinical management of these life-threatening aortic emergencies.
Coronary ectasia
CORONARY ANEURYSM
CORONARY ECTASIA
MANAGEMENT \
ACUTE CORONARY SYNDROME
WARFARIN
PTFE
DES
BMS
Penetrating Atherosclerotic Ulcer
Penetrating atherosclerotic ulcer (PAU) is an ulcerating atherosclerotic lesion that penetrates the aortic wall. CT is often used to evaluate PAU, showing features like a focal outpouching with adjacent hematoma. While some cases progress slowly, PAU carries a risk of complications like rupture. Treatment depends on factors like symptoms, expansion rate, and surgical risk. Careful monitoring is important due to variable prognosis.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathy
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Coronary Artery Aneurysms and Ectasia
This document summarizes the morning report of a 59-year-old man with a history of kidney transplant, SLE, and prior STEMI managed with thrombus extraction. He presented with recurrent chest pain. Key findings include inferolateral wall perfusion defect on nuclear stress test. The report reviews coronary aneurysms/ectasia classification, etiologies including atherosclerosis, Kawasaki disease, inflammatory disorders. The patient's systemic lupus erythematosus and transplant status suggest an inflammatory cause is possible. Evaluation and management of antiplatelet therapy is discussed.
Bifurcation stenting
Significant unprotected left main (LM) coronary artery disease is present in <10% of patients undergoing coronary angiography. In autopsy research, a mean LM length of 10.8 mm ± 5.2 mm (range 2–23 mm), mean LM diameter 4.9 mm ± 0.8 mm and mean angle between the left anterior descending (LAD) and left circumflex (LCx) of 86.7° ± 28.8° has been described. This angle value positively correlated with LM length.2 Further studies showed that long LM developed stenoses more frequently near the distal bifurcation compared to near the ostium (77% versus 18%).7 It is also worth emphasising that LM bifurcation disease is rarely focal and that both sides of the carina are almost never disease-free. Furthermore, continuous plaque from the LM into the proximal LAD artery has been reported in 90% of cases.8 Summarised below are the most crucial LM peculiarities (in comparison with non-LM bifurcations), which should be taken into consideration when distal LM stenosis PCI is planned:
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
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.
Role of echocardiography in acute myocardial infraction
Echocardiography is useful in the diagnosis and management of acute myocardial infarction (AMI) for several reasons:
1. It can detect regional wall motion abnormalities (RWMAs) that occur prior to ECG changes during a coronary occlusion, aiding early diagnosis.
2. It is recommended to evaluate ventricular function, detect mechanical complications like thrombus, and stratify risk in patients with confirmed AMI.
3. RWMAs seen on echocardiography localize the area of infarction and correspond to the coronary artery territory. Complications like ventricular septal defects and mitral regurgitation can also be identified.
What's hot (19)
Randomized comparison of everolimus eluting stents and sirolimus-eluting stents
Randomized comparison of everolimus eluting stents and sirolimus-eluting stents
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSIC
Left main revascularization dr md toufiqur rahman DM FSCAI FRCP FAPSIC
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathy
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathy
Role of echocardiography in acute myocardial infraction
Role of echocardiography in acute myocardial infraction
Viewers also liked
Symposium jang
This document summarizes research on using optical coherence tomography (OCT) to characterize coronary plaques. OCT uses near-infrared light to generate high-resolution cross-sectional images of tissue microstructure. Researchers studied 357 arterial segments ex vivo using OCT and validated plaque types (fibrous, calcific, lipid-rich) against histology with high accuracy. A pilot clinical study of 10 patients found OCT feasible and safe for in vivo coronary imaging before and after percutaneous coronary intervention, identifying a variety of plaque types and stent appositions. While blood obstruction and motion artifacts posed challenges, the results support further evaluation of OCT as a potential "optical biopsy" tool.
Stefanadis
Thermography is a new technique for detecting atherosclerotic plaque vulnerability. A new catheter-based system called the Epiphany Thermography System can precisely measure plaque temperature and has shown higher temperatures in proximal versus distal plaque segments. Studies have found that greater temperature differences between segments correlate with increased risk of future cardiac events, with optimal sensitivity of 86% and specificity of 79%. Preliminary research also indicates statin therapy may lower plaque temperatures and heterogeneity. Further clinical studies are still needed but thermography shows promise as an early detection method for vulnerable plaques.
Tct arrow pics, landscape
The document describes results from experiments examining iron uptake and macrophage presence in the periaortic and pericoronary fat of mice, rabbits, and humans with atherosclerosis. Mice and rabbits genetically modified to be prone to atherosclerosis showed greater iron uptake and more macrophages in the periaortic fat compared to controls. In humans, macrophages were found not just in atherosclerotic plaques but also in the surrounding pericoronary fat tissue.
256 spatial encoding part 2
1. MRI uses spatial encoding gradients and radiofrequency pulses to selectively excite slices of tissue and encode spatial information in the MRI signal. 2. Frequency encoding gradients encode left-right spatial information, while phase encoding gradients are applied in the orthogonal direction to fully spatially encode each image slice. 3. Fourier transformation is used to reconstruct images from the spatially encoded MRI data.
V2n31
This document summarizes an editorial discussing a study that found erythrocyte membranes may play a role in atheromatous core formation. The study observed glycophorin-rich cores in pulmonary artery plaques from patients with chronic thromboembolic pulmonary hypertension. Glycophorins are erythrocyte membrane proteins. This suggests thromboembolic material (erythrocyte membranes) contributed to core formation. However, extrapolating these findings to coronary atherosclerosis is challenging given differences in disease etiology and timing of intraplaque hemorrhage. While erythrocyte membranes contain lipid-rich and scavenger receptor-binding constituents associated with atherosclerosis, more evidence is needed to support their direct contribution to
258 dr renu virmani
Dr. Renu Virmani is the Chairperson of the Department of Cardiovascular Pathology at the Armed Forces Institute of Pathology in Washington, DC. She received her medical degrees in India and has held positions at multiple universities in the United States. Dr. Virmani has established an independent research program focused on cardiovascular pathology, publishing over 300 papers. Her work has helped establish an international reputation for evaluating devices and the pathology of sudden coronary death.
Non enhancement mri of rabbit1
The document summarizes two MRI scans of a rabbit aorta. The first scan used a superficial coil but lacked penetration, so a volume coil was used for the second scan. The second scan obtained 27 slices with improved parameters. Fat suppression imaging was also performed but requires further optimization to improve results and identify artifacts.
The prev of inf cells in nonrupt a. plaque pasterkamp- part 2
The prev of inf cells in nonrupt a. plaque pasterkamp- part 2Society for Heart Attack Prevention and Eradication
This document discusses various definitions of arterial remodeling used in post-mortem and intravascular ultrasound research. It notes that the different definitions lead to large variations in reported prevalence numbers for expansive, intermediate, and constrictive remodeling. The definitions are analyzed and some are noted to only be suitable for certain study types. It concludes that careful consideration of the remodeling definition used is needed when reporting prevalences, as without a gold standard or serial studies, the reference sites may not be free of atherosclerotic disease and could be remodeled as well.114 evaluation of atherosclerotic plaque
1. The study measured temperature, pH, and lactate levels in atherosclerotic plaques from human and animal subjects.
2. They found significant heterogeneity and variation in pH within and between plaques. Lipid-rich areas had higher temperatures and lower pH compared to calcified areas.
3. Inverse correlations were observed between temperature and pH in human carotid plaques and rabbit aortas, but not in human umbilical arteries.
4. The results suggest that inflammation increases plaque temperature and decreases pH through increased metabolic activity of macrophages and anaerobic glycolysis producing lactate. Low pH may promote plaque vulnerability through activation of matrix-degrading enzymes.
Towards immune modulation vp
This document discusses potential immune-based therapies for modulating atherosclerosis and vulnerable plaque. It suggests that targeting specific antigens, co-stimulatory molecules, cytokines, vaccines, recombinant proteins, antibodies, cells, or small molecule drugs could help shift the immune response away from pathogenic Th1 immunity toward protective Th2 immunity. Certain cytokines like IL-10 and TGFβ may be protective, while IFNγ and TNFα aggravate disease. Immunization experiments with oxidized LDL and heat shock protein 65 have shown promise in reducing lesions in animal models. Statins and pentoxifyllin may also help by inhibiting Th1 responses. However, general immunosuppression poses side effects, so focused immune modulation is a more viable strategy
Vp watch editorial - v2 n2- 2002
I. This document discusses various animal models that have been used to study atherosclerosis and plaque rupture, including quail, pigeons, chickens, dogs, monkeys, pigs, rats, rabbits, and mice. It provides details on the characteristics of atherosclerotic lesions developed in each model.
II. It focuses on newer models, including a rabbit model that allows induced plaque rupture and a double knockout LDL/apoE mice model that spontaneously develops extensive coronary lesions and myocardial infarctions at a young age, more closely mimicking human coronary heart disease.
III. However, it notes that while these models improve study of clinical atherosclerosis complications, it remains unclear how closely their plaque pathophysiology and coagulation systems
227 which serum should be used
1) The document discusses interleukin-18 (IL-18), an inflammatory cytokine that plays a role in atherosclerosis and plaque instability. Studies have shown IL-18 is overexpressed in atherosclerotic plaques and higher levels predict future cardiovascular events.
2) One study found serum IL-18 levels were significantly higher in coronary artery disease patients who suffered fatal cardiovascular events compared to those who did not. High IL-18 levels were an independent predictor of death even after adjusting for other risk factors.
3) By blocking IL-18 or its receptor in animal models, atherosclerotic plaque development and instability was reduced, suggesting IL-18 promotes plaque inflammation and vulnerability, in part by stimulating interferon-gamma production
Vp lightlab kolstad (industry)
This document describes LightLab OCT technology which uses optical coherence tomography to provide high-resolution real-time imaging of plaque in arteries. It can characterize plaque through morphological imaging as well as spectroscopic, polarization, Doppler, and elastography imaging. These advanced imaging modes give information on plaque structure, composition, and characteristics to help clinicians select and guide appropriate therapies.
Spio cytokinejan28-2
This study aimed to compare the presence of iron particles in macrophage-rich atherosclerotic plaques in apo E-deficient mice under normal conditions versus after administration of cytokines TNF-alpha and IL-1beta. Eight female mice were divided into two groups, with five receiving an injection of TNF-alpha and IL-1beta and three receiving a saline injection as a control. All mice then received an injection of iron particles. After seven days, the mice were euthanized and their aortas examined for iron staining and plaque formation.
Vogel endothelial function cv es
This document discusses endothelial dysfunction as a marker for cardiovascular events. It summarizes that impaired endothelium-dependent dilation in the coronary and brachial arteries provides prognostic information about future cardiovascular events, with worse endothelial dysfunction correlating to higher event rates. Various clinical tests are presented that measure endothelial function in these arteries. The document also suggests endothelial dysfunction may serve as an index for gauging therapeutic responses, as certain treatments are shown to improve endothelial function and reduce cardiovascular event rates.
The fat fed apoe ko mouse- chris jackson- u of bristol
The fat fed apoe ko mouse- chris jackson- u of bristolSociety for Heart Attack Prevention and Eradication
This study examined plaque rupture in the brachiocephalic arteries of 98 fat-fed apolipoprotein E knockout mice over time. Ruptured plaques were significantly larger, more occlusive, had thinner fibrous caps, more previous ruptures, and a greater lipid burden than intact plaques. The earliest ruptures occurred after 7 weeks on a high-fat diet. A pravastatin treatment significantly reduced sudden deaths, suggesting statins may prevent plaque rupture.Spio mri studies by dr naghavi
1) The document discusses a study using magnetic resonance imaging (MRI) to detect active atherosclerotic plaque in mice after injection of superparamagnetic iron oxide (SPIO) nanoparticles.
2) The study found that SPIO nanoparticles were taken up by macrophages within atherosclerotic plaques, darkening the plaques on post-injection MRI scans.
3) Histological analysis confirmed iron particle presence within plaques that correlated with macrophage density, supporting MRI's ability to detect plaque inflammation.
Thermography iii
Thermography is a new catheterization technique using a 3.3F over-the-wire catheter with a basket of 5 temperature sensors and a central blood thermo couple. The study assessed temperature recordings, catheter steerability, and coronary angiograms in 12 patients undergoing thermography of suspected coronary lesions. Temperature increases of up to 0.36°C were detected in focal areas, or "hot spots", in 4 of the 11 patients, which could indicate plaque rupture sites. Thermography was successfully performed in 92% of cases and showed good steerability.
Vp meeting orlando2003_new template
The document discusses ways to improve prediction of coronary events beyond the traditional Framingham Risk Score (FRS). It finds that adding C-reactive protein (CRP) measurement to the FRS results in a better model that significantly improves risk prediction, especially for those at intermediate risk. Measuring coronary artery calcium via scanning also seems to enhance prediction over the FRS alone. However, these findings require replication in other patient populations before firmly concluding CRP and calcium scoring can modify physician interpretation of patient risk based on the FRS.
Viewers also liked (19)
The prev of inf cells in nonrupt a. plaque pasterkamp- part 2
The prev of inf cells in nonrupt a. plaque pasterkamp- part 2
The fat fed apoe ko mouse- chris jackson- u of bristol
The fat fed apoe ko mouse- chris jackson- u of bristol
Similar to Stenosis vs risk
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
This document summarizes a study that evaluated occlusive diseases in cervical arteries of patients with acute ischemic stroke using CT angiography. The study analyzed CTA images of 50 patients to determine the percentage with vascular stenosis or occlusion. It found that 76% of patients showed neck vessel involvement, with 26% having luminal narrowing and 8% having complete occlusion. While many vessels showed atherosclerotic changes, only 45 of 300 total vessels analyzed showed significant luminal narrowing or plaque formation. The study concludes there is a significant correlation between atherosclerotic changes in neck vessels and occurrence of acute ischemic stroke.
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...
This study aimed to correlate 2D speckle tracking echocardiography with coronary angiography results in 100 patients with non-ST elevation myocardial infarction (NSTEMI). Echocardiography, including speckle tracking, was performed to assess wall motion abnormalities and territorial longitudinal strain. Coronary angiography identified the culprit artery. Speckle tracking showed high sensitivity and specificity in identifying the culprit artery compared to angiography results, with sensitivity of 93.3% for left anterior descending artery, 82.7% for left circumflex, and 84% for right coronary artery. This suggests speckle tracking may help localize coronary stenosis and identify which NSTEMI patients could benefit from revascularization.
Cardiac CT Angiography to detect Myocardial Bridging
CTCA is a reliable non-invasive tool for detecting myocardial bridging in coronary artery disease. [The study] found an 8.2% frequency of myocardial bridging in 219 patients with coronary artery disease who underwent CTCA. CTCA allows for visualization of the length and depth of the bridging artery and measurement of stenosis. While myocardial bridging can be clinically significant when associated with hemodynamic changes, in most cases it remains asymptomatic. CTCA is an emerging alternative to other invasive tests for diagnosing myocardial bridging.
What is New in Cardiac CT? In Search of the Comprehensive and Conclusive Hear...
Coronary CT Angiography (CT) with its noninvasive cross sectional information has seen remarkable growth in recent years. With the introduction of the new generation scanners, like the 320-slice CT, it has risen to a whole new level. Percent diameter stenosis determined with the use of 320-slice CT shows good correlation with Invasive catheter angiogram (ICA) without significant underestimation or overestimation. Plaque composition on CT regardless of lesion severity has emerged as a strong predictor of major cardiac events. The percentage stenosis mismatch between CT and ICA can be explained by the 2 dimensional nature of ICA and its interpretive inconsistencies. In the upcoming years, we need to evolve from focusing on lumen stenosis to a comprehensive assessment of CAD and its impact on patient outcome.
IJA_140116
This document presents a rare case report of a 30-year-old woman diagnosed with Takayasu arteritis who presented with both aneurysmal dilation and stenosis of the right common carotid artery. Imaging revealed aneurysmal dilation of the right innominate and proximal right common carotid arteries as well as a 75% focal stenosis in the right common carotid artery distal to the dilation. Treatment with prednisone resulted in improvement of symptoms and normalization of inflammation markers. The concurrent presence of aneurysmal dilation and stenosis from Takayasu arteritis in the same vessel is an exceptionally rare finding.
Anesthesia and perioperative care for aortic surgery
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Risk factors
Anesthesia and perioperative care for aortic surgery
Acute aortic syndrome describes life-threatening conditions of the thoracic aorta including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. These conditions involve acute lesions of the aortic tunica media and can be distinguished by imaging techniques. Recent advances in imaging and treatment have increased awareness of these conditions and emphasized the importance of early diagnosis and management. The most common cause is aortic dissection, which occurs when blood tears the intimal layer, separating the media into an inner and outer layer. Other causes include intramural hematoma where blood enters the media without an intimal tear, and penetrating ulcers where atherosclerotic lesions erode the intima and media. Proper
Hemodynamics of valvular disorders as measured by cardiac catheterization - U...
This document provides an overview of how cardiac catheterization can be used to evaluate valvular heart disorders by measuring hemodynamics and pressures. Key findings include:
- Aortic stenosis causes a pressure gradient between the left ventricle and aorta due to obstruction of blood flow. Catheterization can precisely measure this gradient.
- Aortic regurgitation results in backward blood flow from the aorta to left ventricle during diastole due to inadequate valve closure. The regurgitant fraction can be calculated.
- Abnormal pressures may be seen in the left ventricle, left atrium, and aorta depending on the specific valvular disorder and degree of dysfunction.
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...Crimsonpublisherssmoaj
Acute type A aortic dissection is a catastrophic event in which blood exits the vascular lumen and dissects the media, creating a false lumen. Surgery is the best possible treatment but it is complex. The surgical team needs to understand the anatomy and physiopathology before dealing with the repair. While there are just a few surgical solutions for the repair of the dissected ascending aorta, debate is still ongoing about the best surgical option for the disease involving the arch and the descending aorta. Late reoperations are relatively common on the aortic valve and/or the distal aorta after primary repair. Results are excellent in specialized centers with high volume and complexity. Lifelong follow-up is required in survivors.Left main disease and bifurcation percutaneous coronary artery disease treatment
Revascularization of both left main and bifurcation lesions is currently considered an important feature of complex percutaneous coronary intervention (PCI), whereas stenting distal left main bifurcation is fairly challenging. Recent evidence shows that such lesions are associated with an increased risk of ischemic events. There is no universal consensus on the optimal PCI strategy or the appropriate type and duration of antithrombotic therapy to mitigate the thrombotic risk. Prolonged dual antiplatelet therapy or use of more potent P2Y12 inhibitors have been investigated in the context of this high-risk subset of the population undergoing PCI. Thus, while complex PCI is a growing field in interventional cardiology, left main and bifurcation PCI constitutes a fair amount of the total complex procedures performed recently, and there is cumulative interest regarding antithrombotic therapy type and duration in this subset of patients, with decision-making mostly based on clinical presentation, baseline bleeding, and ischemic risk, as well as the performed stenting strategy
management of LV thrombus
This review article summarizes the current literature on left ventricular thrombus (LVT) prevalence, risk factors, diagnosis, and treatment. The key points are:
1) The reported prevalence of LVT following ST-elevation myocardial infarction (STEMI) has decreased from historical rates of 20-40% to current rates of around 2-5% due to improved reperfusion techniques.
2) Predictors of LVT include anterior STEMI (especially involving the left ventricular apex), reduced ejection fraction, severe diastolic dysfunction, and large infarct size.
3) Cardiac magnetic resonance imaging has the highest diagnostic accuracy for detecting LVT, followed by echocardiography when used with contrast agents
Neurosurgical management of ischemic stroke
This document summarizes neurosurgical management of cerebrovascular accidents (CVAs) and spontaneous intracerebral hemorrhage (sICH). It discusses the pathophysiology and clinical presentation of ischemic stroke and transient ischemic attacks. Imaging techniques for evaluation including CT, CTA, MRI, and MRA are outlined. Endovascular and surgical revascularization options for acute ischemic stroke are described, including limitations of intravenous thrombolysis. The document also reviews evaluation and management of atherosclerotic carotid artery stenosis, indicating criteria for medical management, carotid endarterectomy, and carotid angioplasty/stenting.
Carotid revascularization in cad patients
Carotid artery disease is common in patients with coronary artery disease undergoing coronary artery bypass grafting (CABG). The incidence of perioperative stroke after CABG is around 1.6-3.1%, with risks increased by factors like aortic atherosclerosis, atrial fibrillation, prior stroke, and carotid stenosis. Strokes are often embolic and occur during or soon after surgery. Asymptomatic carotid stenosis alone may not increase stroke risks significantly, but bilateral or recently symptomatic stenosis does. Careful screening and management of atherosclerotic risk factors can help reduce perioperative stroke risks in patients with coexisting carotid and coronary artery disease.
Left ventricular function evaluation
This document discusses techniques for evaluating left ventricular function in patients with ischemic cardiomyopathy, including multigated angiography (MUGA), myocardial perfusion scintigraphy using thallium-201 or technetium-99m tracers, gated cardiac single photon emission computed tomography (SPECT), and positron emission tomography (PET). SPECT and PET can assess myocardial perfusion, function, volumes, and viability. Segmental analysis of wall motion and calculations of ejection fraction from gated imaging provide prognostic information. The identification of viable but ischemic tissue has implications for the potential benefits of revascularization.
Similar to Stenosis vs risk (14)
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Evaluation of Occlusive Diseases in Cervical Arteries in Patients of Acute Is...
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...
Correlation Between ECG Changes and 2D Speckle Tracking Echocardiography with...
Cardiac CT Angiography to detect Myocardial Bridging
Cardiac CT Angiography to detect Myocardial Bridging
What is New in Cardiac CT? In Search of the Comprehensive and Conclusive Hear...
What is New in Cardiac CT? In Search of the Comprehensive and Conclusive Hear...
Anesthesia and perioperative care for aortic surgery
Anesthesia and perioperative care for aortic surgery
Anesthesia and perioperative care for aortic surgery
Anesthesia and perioperative care for aortic surgery
Hemodynamics of valvular disorders as measured by cardiac catheterization - U...
Hemodynamics of valvular disorders as measured by cardiac catheterization - U...
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...
Stanford Type A Aortic Dissection: a Complex Disease for Patients and Cardiot...
Left main disease and bifurcation percutaneous coronary artery disease treatment
Left main disease and bifurcation percutaneous coronary artery disease treatment
More from Society for Heart Attack Prevention and Eradication
AHA SHAPE Symposium 2017 Dr. Naghavi Presentation
AHA SHAPE Symposium 2017 Dr. Naghavi PresentationSociety for Heart Attack Prevention and Eradication
This document discusses developing an artificial intelligence system to predict short-term cardiovascular disease (CVD) events. The goal is to eradicate unexpected heart attacks by predicting risk similar to hurricane forecasts. Existing studies are cited that show over 50% of heart attacks are first symptoms of underlying disease. The document outlines previous work by SHAPE to define vulnerable patients and release guidelines. It proposes using machine learning on existing cohort data to develop algorithms predicting heart attacks within 12 months, and validate the system. The hope is this can trigger preventative actions and add over 10 years to life expectancy. Funding is needed to implement the proposed "Machine Learning Vulnerable Patient Project".AHA SHAPE Symposium 2017 Dr. Kloner Presentation
Triggers of cardiovascular events can include physical and emotional stress. Stress from events like earthquakes, blizzards, intense sporting games, and overexertion from activities like snow shoveling have been shown to increase the risk of acute cardiovascular outcomes like myocardial infarction. While modern therapies have improved cardiovascular health, research continues to show temporary increases in cardiovascular mortality associated with highly emotional sporting events even in recent years. Managing risk factors, reducing stress, and utilizing preventative therapies may help reduce the impact of triggers on cardiovascular health.
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland PresentationSociety for Heart Attack Prevention and Eradication
The document introduces the All of Us Research Program, which aims to collect health data from one million Americans to advance precision medicine research. It was announced by President Obama in 2015. The program receives funding from the federal government and private partners. It collects various types of health data from participants through surveys, health records, samples, and devices. The data is stored and shared securely while protecting privacy. The goal is to generate new medical discoveries and more personalized healthcare through collaboration between researchers and participants.AHA SHAPE Symposium 2017 Dr. Yen Presentation
A machine learning model outperformed the ACC/AHA Pooled Cohort Equations Risk Calculator in detecting high-risk asymptomatic individuals and recommending statin treatment for cardiovascular disease prevention in the Multi-Ethnic Study of Atherosclerosis. The machine learning model used support vector machines and data augmentation to derive a CVD risk predictor from nine variables in the MESA study population. It demonstrated higher sensitivity, specificity, and AUC compared to the ACC/AHA risk calculator, recommending statin treatment for fewer individuals while missing fewer cardiovascular events.
AHA SHAPE Symposium 2017 Dr. Slomka Presentation
This document discusses machine learning applications in cardiac imaging presented by Piotr Slomka. It describes how machine learning can improve image analysis, diagnosis, and risk prediction. Machine learning combines multiple data points like imaging and clinical data to predict outcomes. Deep learning can perform tasks like image segmentation. Machine learning provides quantitative scores that predict disease, need for intervention, or patient outcomes to help clinicians. The goal is to integrate machine learning into clinical decision making.
Vu lplaque1 pasterkamp
This document summarizes a post-mortem study examining the prevalence of inflammatory cells in non-ruptured atherosclerotic plaques. The study found that moderate or heavy staining for macrophages was present in 45% of femoral artery cross-sections and 84% of femoral arteries had at least one cross-section with moderate/heavy inflammation. There was no observed relationship between the degree of inflammation in the left and right coronary arteries within individuals, indicating the level of local inflammation is locally determined with little predictive value for other arteries.
Vulnerable plaque vulnerable patient
The document provides guidelines for defining vulnerable plaque and vulnerable patients from the Association for Eradication of Heart Attack. It outlines major and minor histopathological and clinical criteria for vulnerable plaque including active inflammation, thin fibrous cap with large lipid core, endothelial denudation, and stenosis. Potential screening and diagnostic methods are discussed at the plaque, systemic, and blood levels ranging from non-invasive imaging to intravascular techniques. Different types of vulnerable plaque that can cause acute coronary events are also categorized.
Vulnerable plaque overview
Vulnerable plaque refers to dangerous forms of atherosclerotic plaques that can rupture or induce thrombosis, disrupting blood flow. The document discusses the history and research around vulnerable plaque, including pioneers in the field and emerging techniques to detect vulnerable plaque such as intravascular ultrasound, optical coherence tomography, and magnetic resonance imaging. It summarizes that vulnerable plaques are typically characterized by a thin fibrous cap, large lipid core, and presence of macrophages.
Vulnerable patient talk in poland
The document summarizes research on vulnerable plaques and markers of vulnerability. It finds that ruptured plaques are the most common type of culprit lesion, accounting for around 70% of cases. Major criteria for defining vulnerable plaque include outward remodeling, endothelial dysfunction, and a thin fibrous cap with a large lipid core. Both plaque morphology and activity need to be assessed to identify vulnerability.
Vulnerable patient slides without movies
This document contains a summary of a presentation on vulnerable patient syndrome. It includes PowerPoint slides and videos on defining and identifying vulnerable plaques and patients. It thanks sponsors for their support of the educational event. The slides define vulnerable plaques as those likely to rupture in the future, causing heart attacks, and provide criteria for identifying them based on morphology and activity. Biomarkers and conditions that increase plaque and myocardial vulnerability are also summarized. The presentation outlines a pyramid approach for screening, diagnosing, and treating vulnerable patients annually to help reduce heart attacks and their high costs.
Vulnerable patient mar 04
This document discusses triggers for sudden cardiac arrest (SCA) and death (SCD). It notes that over 2/3 of SCD cases are unable to be predicted due to a lack of well-established risk factors. While population risk factors can identify at-risk groups, they cannot predict risk for individuals. The document explores various biological, anatomical, and environmental factors that can precipitate fatal arrhythmias and discusses how the timing of transient initiating events is critical for the development of ventricular tachyarrhythmias. It emphasizes that myocardial electrophysiological processes likely determine the onset or lack of VT/VF/SCD and that immediate access to automated external defibrillators is needed to save lives.
Vulnerable (thrombogenic blood
This document summarizes presentations from symposia on vulnerable plaque and discusses the relationship between plaque, blood, and patients in atherothrombosis. It notes that multiple factors like diabetes, smoking, and hyperlipidemia can make blood more thrombogenic and moderate the severity of acute events after plaque rupture. Statins, aspirin, and other drugs that target tissue factor or thrombin pathways may be promising antithrombotic agents by inhibiting thrombosis initiation and propagation.
Vuln shape aha 2005
The document discusses vulnerable plaque and challenges in detecting and treating it. It describes various imaging techniques for detecting vulnerable plaque such as thermography, MRI, CT angiography, and optical coherence tomography. However, it notes that while these can identify high-risk features, it remains unclear what exactly defines vulnerable plaque and whether imaging findings truly correlate with risk. The document also notes that while statins reduce events, the relationship between plaque burden and events is unclear, and better defining and detecting the disease is still needed before new therapies can be developed.
Vuln plaque poster burke
1) The study examined 92 hearts from patients with severe coronary artery disease who died suddenly. The hearts were sectioned and plaque types were classified.
2) The number of "vulnerable" plaques, particularly thin cap atheromas, was highest in hearts of patients who died from acute plaque rupture and lowest in those with incidental disease.
3) Thin cap atheromas and other unstable plaque types were concentrated in the proximal coronary segments, similar to the distribution of plaque ruptures. The study suggests vulnerable plaques contribute to acute coronary syndromes and are non-uniformly distributed within the coronary arteries.
Vp watch editorial_slide 25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch editorial_slide25
This document discusses drug-coated stents for preventing restenosis. It summarizes a study showing that stents coated with sirolimus via a polymer matrix reduced restenosis by 50% by inhibiting cell proliferation. Adding dexamethasone provided no additional benefit. Other studies also showed sirolimus inhibits smooth muscle cell proliferation. If results of the RAVEL trial showing "zero" restenosis at 210 days hold true long-term, sirolimus-coated stents may become the standard therapy for coronary revascularization. Questions are raised about whether coating vulnerable plaques could be a primary treatment and if multiple vulnerable plaques would all be stented.
Vp watch editorial_slide25short-
1) Drug-coated stents, particularly those coated with sirolimus, have shown promise in reducing restenosis compared to bare metal stents. Sirolimus inhibits cell proliferation and has been shown in studies to reduce intimal hyperplasia and restenosis in animal models by 50% or more.
2) A study by Suzuki et al. found that a sirolimus-coated stent reduced restenosis by 50% through inhibiting cellular proliferation in a dose-dependent manner compared to a bare metal stent. Adding dexamethasone to the coating did not provide additional benefit.
3) If results of the RAVEL clinical trial showing "zero" restenosis out to 5 years
Vp watch2002
I. This document discusses various animal models that have been used to study atherosclerosis and plaque rupture, including quail, pigeons, chickens, dogs, monkeys, pigs, rats, rabbits, and mice. It provides details on the types of lesions developed and similarities to human disease for each model.
II. The double knockout LDL/apoE mice are highlighted as offering improvements in studying clinical complications of atherosclerosis like human heart disease. However, it is unclear how closely they model vulnerable plaques.
III. Questions are raised about how closely the coagulation systems of these animal models resemble humans and whether any model fully captures repeated plaque ruptures and the role of aging in natural history as seen in humans.
Vp symposium31602
Trans-Blood Vision is a patented infrared technique that uses short-wave infrared wavelengths to see directly through blood. It has the potential to find vulnerable plaque lesions without first entering them, determine their size and surface characteristics in high resolution, and look at their material constituents both on and below the surface. While it cannot provide direct visual guidance for therapy or penetrate as deeply as ultrasound, combining it with augmentative technologies could allow for real-time multi-mode detection, analysis, and therapy guidance of vulnerable plaque lesions. The document concludes that Trans-Blood Vision warrants significant investigation, possibly in combination with other emerging technologies.
Vpschoenhagen
This study used intravascular ultrasound to examine arterial remodeling and plaque characteristics in 131 patients with either stable angina or recent unstable symptoms. Patients with unstable presentations had greater plaque burden at the culprit lesion despite similar luminal narrowing, and a greater extent of positive arterial remodeling compared to those with stable angina. The culprit lesions in unstable patients also showed a higher rate of echolucent plaque morphology. This suggests that bulky, remodeled plaques may be more vulnerable to rupture, leading to acute coronary syndromes. Further prospective study is needed to better understand the relationship between clinical presentation and plaque features.
More from Society for Heart Attack Prevention and Eradication (20)
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
AHA SHAPE Symposium 2017 Dr. Greenland Presentation
Recently uploaded
The Electrocardiogram - Physiologic Principles
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Top Effective Soaps for Fungal Skin Infections in India
Swisschem Dermacare has mentioned the List of The Best Antifungal Soap In India 2022. All of these soaps are trusted by various Dermatology Experts.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Ketone bodies and metabolism-biochemistry
This slide consists of all the topics of ketone . This can be used for exam purpose for writing about Diabetic keto acidosis etc . Thank you
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Histololgy of Female Reproductive System.pptx
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Artificial Intelligence Symposium (THAIS)
Artificial Intelligence Symposium (THAIS). Parc Taulí. Sabadell
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Top 10 Best Ayurvedic Kidney Stone Syrups in India
we have mentioned the best 10 ayurvedic Kidney Stone Syrups. You can check all these products and choose the best one for yourself.
share - Lions, tigers, AI and health misinformation, oh my!.pptx
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
A Classical Text Review on Basavarajeeyam
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Recently uploaded (20)
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis - Definition , Evaluation and Management .pdf
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Top 10 Best Ayurvedic Kidney Stone Syrups in India
share - Lions, tigers, AI and health misinformation, oh my!.pptx
share - Lions, tigers, AI and health misinformation, oh my!.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Cell Therapy Expansion and Challenges in Autoimmune Disease
Cell Therapy Expansion and Challenges in Autoimmune Disease
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
CHEMOTHERAPY_RDP_CHAPTER 6_Anti Malarial Drugs.pdf
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Stenosis vs risk
- 1. Figure 2. Bar graphs showing stenosis severity and associated risk of coronary occlusion and myocardial infarction (MI) as evaluated by serial angiographic examination. The more stenotic an individual coronary segment is at baseline, the more frequently it progresses to occlusion (top37 ) and/or gives rise to infarction (middle38 ). Because less- obstructive plaques by far outnumber severely obstructive plaques, most occlusions and infarctions result from progression of the former plaques (52 vs 21 and 29 vs 10, respectively), ie, MI evolves most frequently from plaques that are only mildly to moderately obstructive months to years before infarction (bottom). The bar graphs are constructed from data published by (top) Alderman et al37 ; (middle) Nobuyoshi et al38 ; and (bottom) Ambrose et al,40 Little et al,41 Nobuyoshi et al,38 and Giroud et al.39 Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657-71. Coronary Artery Surgery Study (CASS)
- 2. Coronary Artery Surgery Study (CASS) stenosis severity and progression to occlusion
- 3. Stenosis severity and progression to MI
- 4. Falk E, Fuster V. Atherogenesis and its determinants. In: Hurst’s The Heart. McGraw-Hill, NY 2001
- 5. Coronary Artery Surgery Study (CASS)
- 8. Significance of spontaneous obstruction of high degree coronary artery stenoses between diagnostic angiography and later percutaneous transluminal coronary angioplasty. Danchin N, Oswald T, Voiriot P, Juilliere Y, Cherrier F. Among 265 patients with severe coronary artery stenoses amenable to percutaneous transluminal coronary angioplasty, 13 (5%) developed new total coronary occlusion of the vessel to be dilated during the period between diagnostic coronary angiography and repeat coronary angiography at the time of the operation. Time from diagnostic to "therapeutic" angiography (76 +/- 74 vs 31 +/- 31 days, p less than 0.0001), degree of coronary stenosis on diagnostic angiography (85 +/- 7 vs 80 +/- 8%, p less than 0.05) and impaired coronary flow distal to the narrowing (Thrombolysis in Myocardial Infarction grade 2: 38 vs 10%, p less than 0.01) were the only variables related to the occurrence of spontaneous coronary occlusion. The clinical course of the patients who developed new total coronary occlusion was remarkably favorable. Twelve of the 13 patients had unchanged or improved anginal symptoms. The electrocardiogram at rest remained unchanged in 11 patients and there was no transmural myocardial infarction. Eight patients had 2 ventriculograms and the mean ejection fraction remained unchanged (only 2 patients had greater than 5% decrease in ejection fraction between the 2 examinations). Spontaneous occlusion of high degree coronary artery stenoses is not unusual and is usually well tolerated, presumably due to the development of collateral circulation. Am J Cardiol. 1989;63:660-2.