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'Percutaneous Transluminal Coronary Angioplasty' (41674)


Feb
2018

Inadequate stent expansion due to rigid calcified may result in restenosis lesions, but the available options are limited.
We report a case via the trans-radial approach of the severely underexpanded freshly deployed stent due to heavily calcified plaques DIAGNOSES:: Coronary angiography revealed that there was no adequate expansion of the freshly deployed stent.
Under the guide of intravascular ultrasound (IVUS), rotational atherectomy (RA) successfully ablated the stent layers and the protruding calcified plaque.

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Jan
2018

Drug eluting stents (DES) have been increasingly being used for treatment of coronary artery disease (CAD) and have been shown to be very effective in prevention of primary in-stent restenosis (ISR). However DES have been increasingly associated with acute to subacute risk of stent fractures (SF). There is also a paucity of data about different management strategies for SF, especially in the long term.

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Feb
2018

We present a case of an 80-year-old Turkish female patient with diabetes who suffered an acute myocardial infarction (AMI) and underwent percutaneous coronary balloon angioplasty (PTCA)/stenting. Due to new ischaemic episodes, a second PTCA/stenting had to be preformed 6 days later, which revealed a partial restent thrombosis. This case report raises several important issues.

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Feb
2018

Barriers to successful left ventricular lead placement within the coronary venous anatomy may include focal stenoses, thromboses, phrenic nerve stimulation, vessel tortuosity, small vessel caliber, non-excitable tissue and valve presence. A large series describing the utilization of coronary venous angioplasty (CVAP) for relief of these issues is absent in the literature.
We report our experience for all patients treated with CVAP in a single-center 13-year experience.

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Feb
2018

We report a case of percutaneous coronary intervention for spontaneous multi-vessel coronary dissection including the left main coronary artery. This case suggests that intracoronary imaging is useful for understanding the complex anatomy and for choosing the appropriate management for effective revascularization. Furthermore, cutting balloon angioplasty prior to stenting is useful for preventing the longitudinal extension of the intramural hematoma and avoiding unnecessary stent implantation.

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Jan
2018

Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death.

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Jan
2018

The occurrence of stent thrombosis (ST) in real world scenario is far different from that mentioned in the literature. Our study identifies the various parameters of ST.
This is a prospective observational-cohort study where-in consecutive patients who received successful percutaneous transluminal angioplasty (PTCA) over the study period of 1-year was included and were followed for 1-year from the primary procedure.

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Dec
2017

Longitudinal stent compression is a rare phenomenon, which has been increasingly reported in recent years.
Following 2 stents implanted into the middle and proximal segments of the left anterior descending (LAD) artery, longitudinal stent compression occurred when a post-dilation balloon was introduced into the proximal stent opening.
The intravenous ultrasound (IVUS) examination revealed overlapping at the opening of the proximal stent and poor stent adherence.

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Mar
2018

The evolution of coronary stents.

Expert Rev Cardiovasc Ther 2018 Mar 5;16(3):219-228. Epub 2018 Feb 5.
Peter McKavanagh, George Zawadowski, Naveed Ahmed, Michael Kutryk
Percutaneous coronary intervention (PCI) is 40 years old this year. From its humble beginnings of experimental work, PCI has transitioned over years with coronary artery stenting now a standard medical procedure performed throughout the world. Areas covered: The conversion from plain old balloon angioplasty (POBA) to the present era of drug eluting stents (DES) has been driven by many technological advances and large bodies of clinical trial evidence.

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Jan
2018

Radiation dose from complex cardiac procedures are of concern due to lengthy fluoroscopic screening time and vessel complexities. This study intends to assess radiation dose based on angiographic projection and vessel complexities for clinical protocols used in performing percutaneous transluminal coronary angioplasty (PTCA) procedure. Dose area product (DAP), reference air kerma (Ka,r) and real time monitoring of tube potentials and tube current for each angiographic projection and dose setting were evaluated for 66 patients who underwent PTCA using flat detector system.

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Jan
2018

To evaluate the safety and feasibility of treating de novo coronary lesions with paclitaxel-eluting balloon.This is a retrospective study, which enrolled 76 patients with 80 de novo coronary lesions treated with paclitaxel-eluting balloons(<30% residual stenosis and there was no blood flow limited dissection after pretreatment) from April 2015 to November 2016 in Guangdong general hospital. The data of basic characteristics,procedures,devices and follow-up information were retrieved and analyzed.

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Jan
2018

To evaluate the efficacy of paclitaxel-coated balloon for de novo coronary lesions with diameters ≥ 2.8 mm.This prospective study included 215 consecutive patients with 238 de novo lesions, who received paclitaxel-coated balloon angioplasty in Beijing Hospital from May 2014 to June 2016.

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Jan
2018

Although exercise testing has become a standard procedure before discharge for patients with acute coronary syndrome, a fatal accident during the test is extremely rare. A 60-year-old man was admitted for a non-ST-segment elevation myocardial infarction. A coronary angiogram showed stenosis at the distal lesion of the circumflex, and a balloon angioplasty was performed.

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Jan
2018

For patients experiencing an acute coronary syndrome (ACS), a crucial time to assess their prognosis and future management is at discharge from hospital.
To identify patients' risk factors of mortality during post-discharge period following an ACS hospitalization.
We studied 672 consecutive ACS patients hospitalized and discharged alive between 2002 and 2004.

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Jan
2018

Background Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. We aimed to evaluate the management of coronary artery perforation in Sulaimaniyah, Iraq. Methods A retrospective review of our medical records from 2009 to 2016 identified 24 patients (15 males, 9 females) with coronary artery perforation.

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Dec
2017

Percutaneous coronary interventions (PCIs) are generally performed in adults with ischaemic heart disease, but reports of experience in the paediatric population are relatively limited.
To report indications, interventional techniques and procedural outcomes for PCI in children treated in two French institutions.
Medical records of all children in whom a PCI was attempted in two French tertiary institutions between 1998 and 2015 were systematically reviewed.

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Dec
2017

Drug coated balloons (DCBs) are new on stented-based anti-proliferative drug delivery systems, recently introduced in interventional cardiology. Their primary aim is to transfer an anti-proliferative drug to reduce the subsequent neo-intima hyperplasia and to maintain the normal vessel diameter and function.
A review of the most recent influential studies about DCBs in all the fields of interventional cardiology has been performed.

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Jan
2018

A 43-year-old man was admitted to our hospital with ST-segment elevation acute coronary syndrome. He had experienced myocardial infarction 19 months previously, and a bare-metal stent (BMS) had been implanted in the culprit distal right coronary artery at another hospital. Emergency coronary angiography showed thrombotic in-stent occlusion of the BMS.

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Dec
2017

Balloon angioplasty revolutionised percutaneous treatment for coronary artery disease four decades ago, but vessel-threatening dissections, elastic recoil and restenosis were major drawbacks to an otherwise successful long-lasting intervention. Subsequent advances with bare metal stents and then drug eluting stents followed, aiming to mitigate the risks of acute vessel closure and restenosis. However, stent implantation often necessitates dual antiplatelet therapy for a prolonged period of time, which in itself can lead to adverse outcomes, especially in the frail elderly population at higher risk of bleeding.

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Oct
2017

Coronary artery disease of the septal perforator branches can lead to clinical ischemia and conduction abnormalities. Performing interventional procedures in these vessels is frequently impossible because they are small, which makes it difficult to approach them and to select appropriate equipment. Larger septal perforator branches have been treated percutaneously in a few patients; however, the clinical effectiveness and long-term outcomes are not known.

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Oct
2017

Interventionalists encounter widely different coronary anatomies during left main coronary artery stenting. Optimal percutaneous coronary intervention in left main disease necessitates stents that achieve adequate apposition and adapt to frequently disparate diameters in the same lesion, without the need for overexpansion. Until recently, stent designs have hampered the treatment of very large lesions in left main arteries.

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Dec
2017

The antifibrinolytic agent tranexamic acid (TXA) is widely used for the prevention and treatment of hyperfibrinolytic states, such as in severe polytrauma. It can also be used for the systemic prevention of hemorrhage in elective orthopedic procedures. In this review, we assess the efficacy and risks of the prophylactic administration of tranexamic acid before major endoprosthetic surgery of the hip and knee.

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Dec
2017

Thin-high signals (THS), detectable by optical coherence tomography (OCT), represent the paclitaxel coverage of in-stent restenotic tissue. This study was conducted to assess the relationship between THS and angiographic outcomes by means of quantified post-procedural frequency-domain OCT (FD-OCT) analysis. From January 2014 to July 2016, 41 patients underwent FD-OCT-guided percutaneous coronary intervention using paclitaxel-coated balloon (PCB) to prevent in-stent restenosis.

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Dec
2017

Drug eluting balloon is a non-stent technology in which an effective homogenous delivery of anti-proliferative drug processed to the vessel wall through inflated balloon. This is done to restore luminal vascularity in order to treat atherosclerosis, in-stent restenosis and reduce risk of late thrombosis without implanting a permanent foreign object. The balloon technology relies on the concept of targeted delivery of drug which helps in rapid healing of vessel wall and prevents the proliferation of smooth muscle cell.

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Dec
2017

Electrocardiographic findings at first medical contact and direct transfer to the catheterization laboratory are important in acute total occlusion of the left main coronary artery. Simultaneous emergency angioplasty and intra-aortic balloon pump implantation might be beneficial in overcoming the patient's most critical hemodynamic instability.

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Dec
2017

Significant progress has been made in the percutaneous coronary intervention technique from the days of balloon angioplasty to modern-day metallic drug-eluting stents (DES). Although metallic stents solve a temporary problem of acute recoil following balloon angioplasty, they leave behind a permanent problem implicated in very late events (in addition to neoatherosclerosis). BRS were developed as a potential solution to this permanent problem, but the promise of these devices has been tempered by clinical trials showing increased risk of safety outcomes, both early and late.

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Dec
2017

Drug-eluting stents (DES) represent a significant evolution in the treatment of patients with acute myocardial infarction with ST elevation. However, stent-related adverse events have led to an introduction of drug-coated balloons (DCB) applied particularly to bifurcation lesions, in-stent restenosis and small vessel disease. The aim of this study was to determine whether a DCB-only strategy has a similar safety profile and equal angiographic and clinical outcomes to DES implantation in primary percutaneous coronary intervention (pPCI).

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Feb
2018

Angioplasty with paclitaxel-coated balloons (PCB) is recommended for treatment of patients with coronary in-stent restenosis (ISR) according to European clinical practice guidelines. Most clinical trials have investigated iopromide-based PCB and there is a paucity of data comparing efficacy against butyryl-tri-hexyl citrate (BTHC)-based PCB. Our aim was to compare the performance of two widely-used PCB in the treatment of coronary ISR.

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Nov
2017

The efficacy of final kissing balloon (FKB) inflation in one-stent techniques for bifurcation lesions is controversial. The goal of the present study was to investigate the impact of FKB on long-term clinical outcomes in one-stent strategies.
A literature search of the PubMed, Embase, and Cochrane Library databases was undertaken through August 2017.

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Dec
2017

Percutaneous coronary intervention for the treatment of a severe calcified lesion is still one of the most technically challenging areas of interventional cardiology. Calcified lesions are a cause of stent underexpansion, which significantly increases the subsequent risks of in-stent restenosis and thrombosis, even when drug-eluting stents are used. In this report, we describe the usefulness of prolonged inflations using a scoring balloon catheter (Scoreflex) for severe calcified lesions.

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Dec
2017

Invasive-fractional flow reserve (FFR) is the reference standard to evaluate functional ischemia of coronary arteries, and is used to decide if percutaneous transluminal coronary angioplasty is necessary. Recently, computed tomography-derived FFR (CT-FFR) is emerged as an alternative non-invasive method.
To evaluate the effect of reconstruction methods and image parameters on the accuracy of CT-FFR calculation.

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Nov
2017

Congenital coronary anomalies (CCAs) and coronary artery disease (CAD) arouse intense scientific and clinical interest in sports medicine and sports cardiology medical communities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercise stress testing represent the first instrumental assessment to evaluate electrocardiographic changes during effort. Coronary computed tomography angiography (CCTA) is an advanced accurate noninvasive imaging modality for excluding CAD and abnormalities of origin and course of coronary vessels.

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Nov
2017

Percutaneous coronary intervention (PCI) for patients with in-stent restenosis (ISR) is generally considered safe and effective. However, due to increased tissue hardness, PCI for calcified intra-stent ISR is technically challenging. Here, we report severe angioplasty-related complications in a patient presenting with calcified, recurrent ISR following PCI.

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Oct
2017

The aim of the study was to evaluate the occurrence, duration and impact of time delays to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI).
A total of 357 consecutive STEMI patients enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. In order to identify the causes behind a possible treatment delay, we constructed four different time points which included: 1) symptom onset to hospital arrival, 2) hospital arrival to arrival in the catheterization laboratory, 3) hospital arrival to first balloon inflation, and 4) time from arrival in the catheterization laboratory to first balloon inflation in addition to total ischemic time.

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Sep
2016

Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases.

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Dec
1969

To explore circadian variation in the effectiveness of percutaneous transluminal coronary angioplasty (PTCA) to treat ST-elevation myocardial infarction (STEMI) To explore the effects of circardian variation on infarct extension and in-hospital complications.
Observational retrospective cohort study including patients with PTCA-treated STEMI in a tertiary care university hospital between March 2003 and August 2009. The independent variable of interest was the time of onset of STEMI symptoms, grouped in 6-hour time frames.

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Jan
2018

More recent immune thrombocytopenia (ITP) treatment strategies enhance platelet production with the use of thrombopoietin receptor agonists (TPO-RA) such as eltrombopag. Patients receiving TPO-RA agents may be at an increased risk of thromboembolism, however the pathophysiology and common underlying risk factors are not well understood. We present the case of a young asplenic woman on eltrombopag for chronic ITP with acute myocardial infarction involving the right coronary artery.

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Oct
2017

The degree of left main coronary artery (LM) lesions is one of the main factors that predetermine the survival rate of patients with coronary heart disease. Below is a description of a clinical case of a successful stenting in a young 35 year old patient with a severe LM obstruction and an underlying acute coronary syndrome (ACS). Urgent stenting in such clinical situations have been found to be very effective and safe as demonstrated below in the following case study.

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Nov
2017

Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions.
The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions.

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Jan
2018

VCSim3: a VR simulator for cardiovascular interventions.

Int J Comput Assist Radiol Surg 2018 Jan 27;13(1):135-149. Epub 2017 Oct 27.
Przemyslaw Korzeniowski, Ruth J White, Fernando Bello
Effective and safe performance of cardiovascular interventions requires excellent catheter/guidewire manipulation skills. These skills are currently mainly gained through an apprenticeship on real patients, which may not be safe or cost-effective. Computer simulation offers an alternative for core skills training.

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Dec
2017

Limited evidence suggests that multifactorial interventions for control of glucose, blood pressure, and lipids reduce macrovascular complications and mortality in patients with type 2 diabetes. However, safe and effective treatment targets for these risk factors have not been determined for such interventions.
In this multicentre, open-label, randomised, parallel-group trial, undertaken at 81 clinical sites in Japan, we randomly assigned (1:1) patients with type 2 diabetes aged 45-69 years with hypertension, dyslipidaemia, or both, and an HbAof 6·9% (52·0 mmol/mol) or higher, to receive conventional therapy for glucose, blood pressure, and lipid control (targets: HbA<6·9% [52·0 mmol/mol], blood pressure <130/80 mm Hg, LDL cholesterol <120 mg/dL [or 100 mg/dL in patients with a history of coronary artery disease]) or intensive therapy (HbA<6·2% [44·3 mmol/mol], blood pressure <120/75 mm Hg, LDL cholesterol <80 mg/dL [or 70 mg/dL in patients with a history of coronary artery disease]).

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Oct
2017

Pulmonary vein stenosis or occlusion (PVS/O) following catheter ablation of atrial fibrillation is a rare but potentially severe complication. Treatment options include angioplasty with or without stent implantation, but data on outcome and optimal treatment strategy are limited. We report long-term results after catheter-based treatment of patients with symptomatic PVS/O.

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Jan
2018

Contemporary chronic total occlusion (CTO) percutaneous coronary interventional (PCI) techniques are increasingly dependent upon dissection and reentry techniques (DARTs) especially for long occluded lesions. DARTs can result in compressive hematomas during CTO interventions and traditional treatment with balloon angioplasty and/or coronary stenting are often suboptimal and may extend the hematoma distally. We describe the novel use of a cutting balloon to "express" these compressive hematomas and restore antegrade coronary blood flow.

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Sep
2017

Despite the improvement of outcomes after the introduction of bare metal and drug eluting stents for the treatment of CAD, certain type of patients have still an increased risk of stent failure. An alternative is represented by drug-eluting balloons (DEB). This innovation could give potential benefits in particular for the in-stent restenosis (ISR) and the de-novo lesions.

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Oct
2017

Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change.
This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI.

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Dec
1969

Physical activity after coronary revascularization.

Rev Port Cardiol 2017 10 16;36(10):729-730. Epub 2017 Oct 16.
Roberto Palma Dos Reis

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