Advanced applied interventional cardiology:
Gespeichert in:
| Weitere Verfasser: | |
|---|---|
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2010
|
| Schriftenreihe: | Cardiology clinics
28,1 |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XII, 189 S. zahlr. Ill., graph. Darst. |
| ISBN: | 9781437718003 |
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Datensatz im Suchindex
| _version_ | 1804148344826626048 |
|---|---|
| adam_text | Titel: Advanced applied interventional cardiology
Autor: Sharma, Samin K.
Jahr: 2010
Advanced Applied Interventional Cardiology
Contents
Foreword ix
Michael H. Crawford
Preface xi
Samin K. Sharma and Annapoorna S. Kini
Vulnerable Plaque: Definition, Diagnosis, and Treatment 1
Pedro R. Moreno
This article provides a systematic approach to vulnerable plaques. It is divided into 4
sections. The first section is devoted to definition, incidence, anatomic distribution,
and clinical presentation. The second section is devoted to plaque composition, set-
ting up the foundations to understand plaque vulnerability. The third section relates to
invasive plaque imaging. The fourth section is devoted to therapy, from conservative
pharmacologic options to aggressive percutaneous coronary intervention
alternatives.
Physiologic Lesion Assessment During Percutaneous Coronary Intervention 31
Narbeh Melikian, Francesca Del Furia, and Carlo Di Mario
The 2-dimensional silhouette image provided by coronary angiography has well-
recognized limitations. Angiographic images do not accurately represent the true
complexity of the luminal morphology in coronary disease and give no indication
of the functional influence of luminal changes on coronary blood flow. These limita-
tions are more pronounced in angiographically intermediate stenoses and in patients
in whom there is a clear discrepancy between the clinical picture and angiographic
findings. In such cases there is often poor concordance between the estimated
percentage angiographic stenosis and the corresponding intravascular ultrasound
image or noninvasive functional data. The validation and clinical availability of robust
and accurate physiologic indices, which can be used as an adjunct to diagnostic
angiography in the cardiac catheterization laboratory, have been pivotal in promot-
ing ischemia-driven coronary revascularization. Deferral or revascularization based
on such physiologic indices is associated with improved clinical outcome as well
as more favorable health economic data. Although there are several clinical indices,
fractional flow reserve remains the gold standard, with indications for physiologic
assessment of angiographic intermediate stenoses, including left main stem steno-
ses and ostial disease as well as serial lesions. The availability of such indices is
an important step in streamlining management of patients undergoing cardiac
catheterization by allowing routine provision of an all-in-one ischemia-driven
revascularization service.
Coronary Bifurcation Lesions: A Current Update 55
Samin K. Sharma, Joseph Sweeny, and Annapoorna S. Kini
Coronary bifurcations are prone to develop atherosclerotic plaque because of turbu-
lent blood flow and high shear stress. When compared with nonbifurcation coronary
interventions, bifurcation interventions have historically reported a lower rate of pro-
cedural success, higher procedural costs, longer hospitalization, and higher clinical
and angiographic restenosis. Treating bifurcation lesions is challenging, but a simple
algorithm based on the side branch size, stenosis, and angulation can be used. The
ongoing development of novel drug-eluting stent devices designed specifically for
Contents
coronary bifurcations and the large randomized clinical trials being conducted to
address their utility will add to the already present literature regarding treatment of
coronary bifurcation lesions.
Coronary Chronic Total Occlusion 71
John M. Gallaand Patrick L.Whitlow
Chronic total coronary occlusions (CTOs) are a frequent finding in patients with
coronary disease and remain one of the most challenging target lesion subsets
for intervention. CTOs have been reported in approximately one-third of patients
undergoing diagnostic coronary angiography. By nature of their complexity, CTO
percutaneous interventions (PCIs) are associated with lower rates of procedural
success, higher complication rates, greater radiation exposure, and longer proce-
dure times compared with interventions in non-CTO stenoses. Despite these obsta-
cles, reported benefits of successful CTO PCI include a reduction in symptoms and
improvement in both ventricular function and survival. This article examines the
technical challenges, procedural complications, and possible outcomes associated
with CTO PCI.
Percutaneous Coronary Intervention for Unprotected Left Main Coronary
Artery Stenosis 81
Seung-Jung Park and Young-Hak Kim
Because of the long-term benefit of coronary artery bypass graft (CABG) surgery
in medical therapy, CABG has been the standard treatment of unprotected left
main coronary artery (LMCA) stenosis. However, with the advancement of tech-
niques and equipment, the percutaneous interventional approach for implantation
of coronary stents has been shown to be feasible for patients with unprotected
LMCA stenosis. The recent introduction of drug-eluting stents (DESs), together
with advances in periprocedural and postprocedural adjunctive pharmacotherapies,
has improved outcomes of percutaneous coronary interventions (PCIs) for these
complex coronary lesions. This review evaluates the current outcomes of PCI with
DES in research conducted in several countries.
Drug-Eluting Stents: Issues of Late Stent Thrombosis 97
Gilles Lemesle, Gabriel Maluenda, Sara D. Collins, and RonWaksman
In in-stent restenosis, drug-eluting stents are superior compared with bare metal
stents. However, there are concerns about safety because of the reports of in-
creased risk of late and very late stent thrombosis. Stent thrombosis remains a major
pitfall in contemporary percutaneous coronary intervention, leading to high rates of
death and nonfatal myocardial infarction. A new standardized definition of stent
thrombosis was established to provide consistency in the reporting of this complica-
tion and to enable accurate and reliable data to be described for both types of
stents, bare metal and drug-eluting. This new consensual definition reflects a large
amount of new data reported in the literature. New generations of drug-eluting stents
with novel polymers, antiproliferative drugs, and improved platforms are now
approved and available for use. In this article, the authors provide a critical appraisal
of the safety of different drug-eluting stents based on the published clinical data
focusing on late and very late stent thrombosis.
Adjunct Therapy in STEMI Intervention 107
Sameer Mehta, Carlos E. Alfonso, Estefania Oliveros, Faisal Shamshad, Ana I. Flores,
Salomon Cohen, and Esther Falcao
ST-elevation myocardial infarction (STEMI) interventions have significantly reduced
mortality and morbidity from acute myocardial infarction. Compulsive management
Contents
of thrombus is a fundamental requirement of these interventions. A pragmatic
thrombus-guided management strategy is reviewed along with additional novel
therapeutic adjuncts for STEMI interventions.
Stem Cell Therapy for the Treatment of Acute Myocardial Infarction 127
Jonathan H. Dinsmoreand Nabil Dib
The last decade has been accompanied by great optimism and interest in the
concept of cell or tissue regeneration in the postinfarction myocardium. However,
despite the promise, progress was slow. Data derived from multiple controlled stud-
ies in hundreds of patients postmyocardial infarction have shown hints of potential
benefit but not of the magnitude anticipated. The complexity and hurdles to repair
the damaged myocardium have been more daunting than originally estimated. In
the end analysis, progress will be made incrementally. The promise for cell therapy
continues to be significant, but so are the challenges ahead. This article takes a fresh
look at the progress in myocardial regeneration. The authors look at the postmyocar-
dial environment for cues that may guide repair and they look closely at the clinical
data for evidence of cardiac regeneration. This evidence is used for suggestions on
how to best proceed with future work.
Percutaneous Techniques for Mitral Valve Disease 139
RobertoJ. Cubeddu and Igor F. Palacios
Over the past 25 years we have witnessed the development of transcatheter tech-
niques for treatment of valvular heart disease. For several years, percutaneous balloon
valvuloplasty has been used to treat stenotic valvular disease, including pulmonary ste-
nosis, rheumatic mitral stenosis, tricuspid stenosis, and, sometimes, congenital aortic
stenosis. However, major advancements in transcatheter valve repair and replacement
have revolutionized progress. Preliminary results of ongoing studies show promise in
the percutaneous treatment of mitral regurgitation. This article covers established per-
cutaneous techniques for treatment of mitral stenosis and reviews major recent ad-
vancements in the percutaneous treatment of mitral regurgitation.
Transcatheter AorticValve Implantation 155
Raquel del Valle-Fernandez, Claudia A. Martinez, and Carlos E. Ruiz
In the 7 years since the first implant, more than 7000 transcatheter aortic valve
implantations (TAVI) have been performed worldwide. This article describes the latest
available information on this field and the upcoming technological expectations.
Percutaneous Left Ventricular Support Devices 169
Kunal Sarkarand Annapoorna S. Kini
Several new-generation percutaneous support devices are available or are in different
stages of development for use in high-risk percutaneous coronary intervention (PCI),
cardiogenic shock, and for other indications. Preliminary studies have demonstrated
the feasibility and safety of these devices and the beneficial effect on hemodynamic pa-
rameters. In this article, the authors discuss (1) the percutaneous circulatory support de-
vices presently available and routinely used in the catheterization laboratory, (2) the
technical aspects involved with insertion and removal, and (3) relevant data from ran-
domized trials, meta-analyses, and registries about the benefits of their use in patients
with cardiogenic shock complicating ST segment elevation myocardial infarction and in
those with significant left ventricular systolic dysfunction undergoing complex PCI.
Index 185
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