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Journal Cover Interventional Cardiology Clinics
  [SJR: 0.162]   [H-I: 2]   [1 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 2211-7458 - ISSN (Online) 2211-7466
   Published by Elsevier Homepage  [2969 journals]
  • Global Challenges and Solutions
    • Abstract: Publication date: Available online 16 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Sameer Mehta, Roberto Botelho, Jamil Cade, Marco Perin, Fredy Bojanini, Juan Coral, Daniela Parra, Alexandra Ferré, Marco Castillo, Pablo Yépez

      Teaser Major disparities exist between developed and developing countries in the management of acute myocardial infarction (AMI). These pronounced differences result in significantly increased morbidity and mortality from AMI in different regions of the world. Lack of infrastructure, insurance, facilities, and skilled personnel are the major constraints. Primary percutaneous coronary intervention has revolutionized the treatment of AMI; however, its global use is limited by the listed constraints. Telemedicine provides an efficient methodology that can hugely increase access and accuracy of AMI management.

      PubDate: 2016-08-17T13:16:58Z
       
  • Controversies and Challenges in the Management of ST-Elevation Myocardial
           Infarction Complicated by Cardiogenic Shock
    • Abstract: Publication date: Available online 10 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Byung-Soo Ko, Stavros G. Drakos, Frederick G.P. Welt, Rashmee U. Shah

      Teaser The prognosis in ST-elevation myocardial infarction has improved with coronary care units, revascularization, and anticoagulant strategies; however, cardiogenic shock (CS) remains a highly fatal condition. Controversies remain about optimal pharmacologic therapies, revascularization strategies, the role of mechanical circulatory support (MCS), and evidence-based patient selection. The current informed consent paradigm for clinical trials creates challenges testing treatments in CS patients, who are too ill to consent and require immediate treatment. Several trials are underway comparing revascularization strategies and MCS options. Although the prognosis is grim, careful, new and existing treatments could change the course of this condition in the coming years.

      PubDate: 2016-08-14T12:12:53Z
       
  • Controversies in the Management of ST Elevation Myocardial Infarction
    • Abstract: Publication date: Available online 10 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Neeraj Shah, David Cox

      Teaser Anticoagulation is essential in patients with ST elevation myocardial infarction (STEMI) to prevent further thrombosis and to maintain patency of the infarct-related artery after reperfusion. The various anticoagulant medications available for use in patients with STEMI include unfractionated heparin (UFH), low-molecular-weight heparin, fondaparinux, and bivalirudin, a direct thrombin inhibitor. The authors review the current anticoagulation strategies for patients with STEMI undergoing primary percutaneous coronary intervention (PCI), fibrinolysis, or no reperfusion. The authors present the latest evidence and controversies on this topic, with a focus on bivalirudin versus UFH in the setting of primary PCI for STEMI.

      PubDate: 2016-08-14T12:12:53Z
       
  • Optimal Antiplatelet Therapy in ST-Segment Elevation Myocardial Infarction
    • Abstract: Publication date: Available online 12 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Rafael Harari, Usman Baber

      Teaser Cardiovascular disease is the leading cause of death worldwide. Case-fatality rates for myocardial infarction (MI) in the United States have decreased over the past decades, in large part due to advances in the treatment of acute MI and secondary preventive therapy after MI. Antiplatelet therapy remains the cornerstone of treatment of MI. This article reviews the current state of antiplatelet therapy in ST-segment elevation MI.

      PubDate: 2016-08-14T12:12:53Z
       
  • Management of Multivessel Disease and Cardiogenic Shock
    • Abstract: Publication date: Available online 13 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Amerjeet S. Banning, Anthony H. Gershlick

      Teaser Cardiogenic shock represents a state of low cardiac output and systemic hypoperfusion resulting in insufficient end-organ perfusion and consequent multiorgan failure. The main cause of this complication in the context of acute ST-elevation myocardial infarction is left ventricular dysfunction secondary to poor myocardial perfusion. In over 50% of cardiogenic shock cases, there is evidence of significant coronary stenosis within noninfarct-related arteries. Persistent ischemia in the noninfarct territory may contribute to ongoing hypotension. Currently, ESC and ACC/AHA/SCAI guidelines advocate complete revascularization in the context of multivessel coronary artery disease in the context of cardiogenic shock, although the evidence is weak.

      PubDate: 2016-08-14T12:12:53Z
       
  • Implementation of Regional ST-Segment Elevation Myocardial Infarction
           Systems of Care
    • Abstract: Publication date: Available online 13 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Christopher B. Fordyce, Timothy D. Henry, Christopher B. Granger

      Teaser Current guidelines recommend that communities create and maintain a regional system of ST-segment elevation myocardial infarction (STEMI) care that includes assessment and continuous quality improvement of emergency medical services and hospital-based activities. Availability and timely access is a challenge in many areas of the United States. This article reviews clinical trial data supporting the use of primary percutaneous coronary intervention as the optimal reperfusion strategy, and fibrinolysis as an option when this is not possible. It then describes the outcomes and benefits of implementing regional systems of STEMI care, and discusses ongoing challenges for STEMI system implementation, including inadequate data collection and feedback, and hospital and physician competition.

      PubDate: 2016-08-14T12:12:53Z
       
  • Controversies in the Management of ST-Segment Elevation Myocardial
           Infarction
    • Abstract: Publication date: Available online 6 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Taylor C. Bazemore, Sunil V. Rao

      Teaser This article discusses the controversies surrounding the use of transradial versus transfemoral approaches in the management of patients with ST-segment elevation myocardial infarction, beginning with a review of the benefits of transradial percutaneous coronary intervention (PCI) in this population. The unanswered questions about the mechanism underlying the mortality benefit of transradial PCI are discussed, concluding with recommendations for safe and effective strategies for adoption of the transradial approach to optimize outcomes in these high-risk patients.

      PubDate: 2016-08-10T10:47:36Z
       
  • In-Hospital ST Elevation Myocardial Infarction
    • Abstract: Publication date: Available online 5 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): Xuming Dai, Ross F. Garberich, Brian E. Jaski, Sidney C. Smith, Timothy D. Henry

      Teaser Timely reperfusion therapy reduces complications and improves survival in ST elevation myocardial infarction (STEMI). An effective chain of survival has been established for STEMIs occur in the community (outpatient STEMI). Recent studies have identified a subgroup of patients who develop STEMI while hospitalized for primary conditions, often not directly related to coronary artery disease (in-hospital STEMI or inpatient STEMI). This article summarizes current understanding of patient demographics, clinical characteristics, care delivery system and outcomes of in-hospital STEMI, comparing with outpatient STEMI. We also identified opportunities for quality improvement and proposed strategies and future directions to improve care for these patients.

      PubDate: 2016-08-06T09:48:54Z
       
  • False Activations for ST-Segment Elevation Myocardial Infarction
    • Abstract: Publication date: Available online 5 August 2016
      Source:Interventional Cardiology Clinics
      Author(s): David C. Lange, Ivan C. Rokos, J. Lee Garvey, David M. Larson, Timothy D. Henry

      Teaser First-medical-contact-to-device (FMC2D) times have improved over the past decade, as have clinical outcomes for patients presenting with ST-elevation myocardial infarction (STEMI). However, with improvements in FMC2D times, false activation of the cardiac catheterization laboratory (CCL) has become a challenging problem. The authors define false activation as any patient who does not warrant emergent coronary angiography for STEMI. In addition to clinical outcome measures for these patients, STEMI systems should collect data regarding the total number of CCL activations, the total number of emergency coronary angiograms, and the number revascularization procedures performed.

      PubDate: 2016-08-06T09:48:54Z
       
  • Controversies in the Treatment of Women with ST-Segment Elevation
           Myocardial Infarction
    • Abstract: Publication date: Available online 30 July 2016
      Source:Interventional Cardiology Clinics
      Author(s): Vivian G. Ng, Alexandra J. Lansky

      Teaser Coronary artery disease is the leading cause of death in women. Women with ST-segment elevation myocardial infarctions continue to have worse outcomes compared with men despite advancements in therapies. Furthermore, these differences are particularly pronounced among young men and women with myocardial infarctions. Differences in the pathophysiology of coronary artery plaque development, disease presentation, and recognition likely contribute to these outcome disparities. Despite having worse outcomes compared with men, women clearly benefit from aggressive treatment and the latest therapies. This article reviews the treatment options for ST-segment elevation myocardial infarctions and the outcomes of women after treatment with reperfusion therapies.

      PubDate: 2016-08-01T08:42:38Z
       
  • Coronary Stent Failure
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Dominik M. Wiktor, Stephen W. Waldo, Ehrin J. Armstrong

      Teaser Current-generation coronary drug-eluting stents are associated with low rates of restenosis and target lesion revascularization. However, several mechanisms of stent failure remain clinically important. Stent fracture may occur in areas of excessive torsion or angulation. Longitudinal stent deformation is related to axial stent compression owing to extrinsic forces or secondary devices that disrupt stent architecture. Stent recoil occurs when a stent does not deploy at its optimal cross-sectional area. Tissue prolapse between stent struts may also predispose patients to adverse outcomes. Prevention, recognition, and treatment of these stent failures are necessary to optimize patient outcomes after percutaneous coronary interventions.

      PubDate: 2016-07-03T00:59:34Z
       
  • Design and Clinical Considerations for Endovascular Stent Grafts
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Alexis Powell, Vikram S. Kashyap

      Teaser Endovascular treatment for aortic abnormality is an excellent alternative option for patients who are not good candidates for conventional open surgery. Although the technique of placing endovascular stent grafts has evolved since the first grafts, the basic principles remain the same. Use of endografts is limited by anatomic criteria, and advances in graft design have allowed for more widespread use for a broader patient range. The most important limitations to overcome are achieving high-quality aortic neck “healthy” landing zone, smaller-diameter delivery systems, and endografts that allow for more angled aortic necks.

      PubDate: 2016-07-03T00:59:34Z
       
  • Design and Comparison of Large Vessel Stents
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Sandeep M. Patel, Jun Li, Sahil A. Parikh

      Teaser Endovascular stenting has evolved over the last 50 years since its inception into the framework of management of vascular atherosclerotic disease. Stent design has evolved as lesion complexity has increased. Nevertheless, certain first principles regarding stent design have been recapitulated time and again with every iteration of endovascular stents. This article reviews principles of endovascular stent design and compares and contrasts key aspects of balloon expandable and self-expanding stents.

      PubDate: 2016-07-03T00:59:34Z
       
  • Bioresorbable Scaffolds
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Davide Capodanno

      Teaser Bioresorbable scaffolds (BRS) have been engineered to eliminate the theoretic stimulus to late coronary events, a caveat of conventional metallic drug-eluting stents (DESs). Outcome benefits of BRSs over current-generation DESs are expected to accrue after complete bioresorption. Before this timeframe, BRSs need to prove at least similarly safe and effective compared with DESs. Several randomized studies of the Absorb BRS have been made available. Several manufacturers are at the beginning of their line of clinical development of competing BRSs. This article reviews the contemporary clinical outcomes of the Absorb scaffold, and provides an updated state of the art on the other players in the BRS arena.

      PubDate: 2016-07-03T00:59:34Z
       
  • Antiproliferative Drugs for Restenosis Prevention
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Anwer Habib, Aloke Virmani Finn

      Teaser Cardiovascular disease is a leading cause of death and disability worldwide. Current treatment strategies aimed at treating the symptoms and consequences of obstructive vascular disease have embraced both optimal medical therapy and catheter-based percutaneous coronary intervention with drug-eluting stents. Drug-eluting stents elute antiproliferative drugs inhibiting vascular smooth muscle cell proliferation, which occurs in response to injury and thus prevents restenosis. However, all drugs currently approved for use in drug-eluting stents do not discriminate between proliferating vascular smooth muscle cells and endothelial cells, thus delaying re-endothelialization and subsequent vascular healing.

      PubDate: 2016-07-03T00:59:34Z
       
  • Contemporary Drug-Eluting Stent Platforms
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Ramon A. Partida, Robert W. Yeh

      Teaser First-generation drug-eluting stents significantly improved treatment of coronary disease, decreasing rates of revascularization. This was offset by high rates of late adverse events, driven primarily by stent thrombosis. Research and design improvements of individual DES platform components led to next-generation devices with superior clinical safety and efficacy profiles compared with bare-metal stents and first-generation drug-eluting stents. These design improvements and features are explored, and their resulting clinical safety and efficacy reviewed, focusing on platforms approved by the Food and Drug Administration currently widely used in the United States.

      PubDate: 2016-07-03T00:59:34Z
       
  • Endovascular Drug Delivery and Drug Elution Systems
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Abraham Rami Tzafriri, Elazer Reuven Edelman

      Teaser Endovascular drug delivery continues to revolutionize the treatment of atherosclerosis in coronary and peripheral vasculature. The key has been to identify biologic agents that can counter the hyperplastic tissue responses to device expansion/implantation and to develop effective local delivery strategies that can maintain efficacious drug levels across the artery wall over the course of device effects. This article reviews the evolution of endovascular drug delivery technology, explains the mechanisms they use for drug release, and provides a quantitative mechanistic framework for relating drug release mode to arterial drug distribution and effect.

      PubDate: 2016-07-03T00:59:34Z
       
  • The Systems Biocompatibility of Coronary Stenting
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Kumaran Kolandaivelu, Farhad Rikhtegar

      Teaser The coronary stent has propelled our understanding of the term “biocompatibility.” Stents are expanded at sites of arterial blockage and mechanically reestablish blood flow. This simplicity belies the complex reactions that occur when a stent contacts living substrates. Biocompatible seek to elicit the intended response; stents should perform rather than merely exist. Because performance is assessed in the patient, stent biocompatibility is the multiscale examination of material and cell, and of material, structure, and device in the context of cell, tissue, and organism. This review tracks major biomaterial advances in coronary stent design and discusses biocompatibility clinical performance.

      PubDate: 2016-07-03T00:59:34Z
       
  • Restenosis of the Coronary Arteries
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Julius B. Elmore, Emile Mehanna, Sahil A. Parikh, David A. Zidar

      Teaser Restenosis is a pathologic response to vascular injury, characterized by neointimal hyperplasia and progressive narrowing of a stented vessel segment. Although advances in stent design have led to a dramatic reduction in the incidence of restenosis, it continues to represent the most common cause of target lesion failure following percutaneous coronary intervention. Efforts to maximize restenosis prevention, through careful consideration of modifiable risk factors and an individualized approach, are critical, as restenosis, once established, can be particularly difficult to treat. Novel approaches are on the horizon that have the potential to alter the natural history of this stubborn disease.

      PubDate: 2016-07-03T00:59:34Z
       
  • The History of Coronary Stenting
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Christina Tan, Richard A. Schatz

      Teaser The history of coronary angioplasty began with the groundbreaking work of Andreas Grüntzig, who was the first to use balloon-expandable catheters for the treatment of flow-limiting atherosclerotic coronary artery lesions. Thereafter, early investigators tested self-expanding springs as a solution to abrupt closure and restenosis seen with balloon angioplasty but these devices suffered from difficult delivery and a high complication rate. Julio Palmaz and Richard Schatz introduced the first balloon-expandable stent as a mechanical support to improve vessel patency. Their pioneering work launched a new era in the treatment of coronary artery disease.

      PubDate: 2016-07-03T00:59:34Z
       
  • Contributors
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3




      PubDate: 2016-07-03T00:59:34Z
       
  • Contents
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3




      PubDate: 2016-07-03T00:59:34Z
       
  • Coronary and Endovascular Stents
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3




      PubDate: 2016-07-03T00:59:34Z
       
  • Stent Design: Past, Present, and Future
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Sahil A. Parikh



      PubDate: 2016-07-03T00:59:34Z
       
  • Copyright
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3




      PubDate: 2016-07-03T00:59:34Z
       
  • Interventional Cardiology Clinics
    • Abstract: Publication date: July 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 3
      Author(s): Matthew J. Price



      PubDate: 2016-07-03T00:59:34Z
       
  • Design Principles of Bioresorbable Polymeric Scaffolds
    • Abstract: Publication date: Available online 19 May 2016
      Source:Interventional Cardiology Clinics
      Author(s): Mary Beth Kossuth, Laura E.L. Perkins, Richard J. Rapoza

      Teaser The concept for a bioresorbable vascular scaffold combines the best features of the first 3 generations of percutaneous coronary intervention (namely), balloon angioplasty, bare metallic stents, and drug-eluting stents, into a single device. The principles of operation of a BRS follow 3 phases of functionality that reflect the different physiologic requirements over time; revascularization, restoration, and resorption. Most BRS designs make use of the continuum of hydrolytic degradation in aliphatic polyesters, such as poly(l-lactide), in which molecular weight, strength, and mass decrease progressively in 3 distinct stages, consistent with the in vivo requirements of each performance phase.

      PubDate: 2016-05-22T08:13:43Z
       
  • Pathology of Endovascular Stents
    • Abstract: Publication date: Available online 19 May 2016
      Source:Interventional Cardiology Clinics
      Author(s): Kenta Nakamura, John H. Keating, Elazer R. Edelman

      Teaser Contemporary endovascular stents are the product of an iterative design and development process that leverages evolving concepts in vascular biology and engineering. This article reviews how insights into vascular pathophysiology, materials science, and design mechanics drive stent design and explain modes of stent failure. Current knowledge of pathologic processes is providing a more complete picture of the factors mediating stent failure. Further evolution of endovascular stents includes bioresorbable platforms tailored to treat plaques acutely and to then disappear after lesion pacification. Ongoing refinement of stent technology will continue to require insights from pathology to understand adverse events, refine clinical protocols, and drive innovation.

      PubDate: 2016-05-22T08:13:43Z
       
  • Copyright
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2




      PubDate: 2016-03-22T23:00:23Z
       
  • Contributors
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2




      PubDate: 2016-03-22T23:00:23Z
       
  • Contents
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2




      PubDate: 2016-03-22T23:00:23Z
       
  • Complex coronary intervention
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2




      PubDate: 2016-03-22T23:00:23Z
       
  • Hemodynamic Support Devices for Complex Percutaneous Coronary Intervention
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2
      Author(s): Basil Alkhatib, Laura Wolfe, Srihari S. Naidu

      Teaser High-risk percutaneous coronary intervention (PCI) encompasses a growing portion of total PCIs performed and typically includes patients with high-risk clinical and anatomic characteristics. Such patients may represent not only a high-risk group for complications but also a group who may derive the most benefit from complete revascularization. Several hemodynamic support devices are available. Trial data, consensus documents, and guidelines currently recommend high-risk PCI aided by hemodynamic support devices, and this article discusses the patient populations who would benefit from such an approach, the available devices and strategies, and expected outcomes.

      PubDate: 2016-03-22T23:00:23Z
       
  • Interventional Cardiology Clinics
    • Abstract: Publication date: April 2016
      Source:Interventional Cardiology Clinics, Volume 5, Issue 2
      Author(s): Matthew J. Price



      PubDate: 2016-03-22T23:00:23Z
       
  • Antiplatelet Therapy in Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Alexander C. Fanaroff, Sunil V. Rao

      Teaser Platelets play a key role in mediating stent thrombosis, which is the major cause of ischemic events immediately after percutaneous coronary intervention (PCI). Antiplatelet therapy is therefore the cornerstone of antithrombotic therapy after PCI. However, the use of antiplatelet agents increases bleeding risk, with more potent antiplatelet agents further increasing bleeding risk. In the past 5 years, potent and fast-acting P2Y12 inhibitors have augmented the antiplatelet armamentarium available to interventional cardiologists. This article reviews the preclinical and clinical data surrounding these new agents, and discusses the significant questions and controversies that still exist regarding the optimal antiplatelet strategy.

      PubDate: 2016-02-16T17:44:56Z
       
  • The New Era of Interventional Cardiology: Tackling Complex Coronary
           Intervention
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Michael S. Lee



      PubDate: 2016-02-16T17:44:56Z
       
  • Percutaneous Coronary Intervention for Bifurcation Lesions
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Björn Redfors, Philippe Généreux

      Teaser This article summarizes treatment alternatives for coronary bifurcation lesions. It also reviews current definitions and classifications pertaining to bifurcation lesions and provides an overview of the impact of bifurcation lesions on clinical outcomes.

      PubDate: 2016-02-16T17:44:56Z
       
  • Acute Myocardial Infarction/Thrombectomy
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Jonathan Soverow, Manish A. Parikh

      Teaser This article focuses on specialized techniques and devices used in the most challenging cases of acute myocardial infarction. Areas where high-quality evidence is either clear or absent are avoided. Controversies in the use of support or thrombectomy devices, the addition of adjunct pharmacology, and the decision to treat nonculprit lesions are discussed. Recent years have seen a shift in guidelines to downgrading the use of assist devices in cardiogenic shock and aspiration thrombectomy, whereas consideration of nonculprit coronary intervention has been revived. These changes come in the wake of a series of large, practice-changing clinical trials.

      PubDate: 2016-02-16T17:44:56Z
       
  • Update on Coronary Chronic Total Occlusion Percutaneous Coronary
           Intervention
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Emmanouil S. Brilakis, Dimitri Karmpaliotis, Minh N. Vo, Mauro Carlino, Alfredo R. Galassi, Marouane Boukhris, Khaldoon Alaswad, Leszek Bryniarski, William L. Lombardi, Subhash Banerjee

      Teaser Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has significantly evolved during recent years. High success rates are being achieved by experienced centers and operators, but not at less-experienced centers. Use of CTO crossing algorithms can help improve the success and efficiency of these potentially lengthy procedures. There is a paucity of clinical trial data examining clinical outcomes of CTO PCI, which is critical for further adoption and refinement of the procedure. We provide a detailed overview of the clinical evidence and current available crossing strategies, with emphasis on recent developments and techniques.

      PubDate: 2016-02-16T17:44:56Z
       
  • In-stent Restenosis
    • Abstract: Publication date: Available online 13 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Michael S. Lee, Gaurav Banka

      Teaser In-stent restenosis (ISR) is the narrowing of a stented coronary artery lesion. The mean time from percutaneous coronary intervention (PCI) to ISR was 12 months with drug-eluting stents (DES) and 6 months with bare metal stents (BMS). ISR typically presents as recurrent angina. The use of DES has significantly reduced the rate of ISR compared with BMS. Predictors of ISR include patient, lesion, and procedural characteristics. Intravascular ultrasound, optical coherence tomography, and fractional flow reserve are important tools for the anatomic and hemodynamic assessment of ISR. Treatment options for ISR include percutaneous coronary intervention with DES.

      PubDate: 2016-02-16T17:44:56Z
       
  • Atherectomy Devices for the Treatment of Calcified Coronary Lesions
    • Abstract: Publication date: Available online 10 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Jeffrey W. Chambers, Ann N. Behrens, Brad J. Martinsen

      Teaser The presence of moderate and severe coronary artery calcification (CAC) is associated with higher rates of angiographic complications during percutaneous coronary intervention (PCI), as well as higher major adverse cardiac events compared with noncalcified lesions. Diabetes mellitus, a risk factor for CAC, is increasing in the United States. Vessel preparation before PCI with atherectomy can facilitate successful stent delivery and expansion that may otherwise not be possible. We review here CAC prevalence, risk factors, and impact on PCI, as well as the currently available coronary atherectomy devices including rotational atherectomy, orbital atherectomy, and laser atherectomy.

      PubDate: 2016-02-12T16:42:03Z
       
  • Antithrombotic Therapy in Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 12 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Xiaoyu Yang, Joanna Ghobrial, Duane S. Pinto

      Teaser Numerous agents are available for anticoagulation during percutaneous coronary intervention (PCI). These agents have been evaluated in a variety of clinical settings, including elective, urgent, and emergent PCI. Although unfractionated heparin remains a frequent choice, accumulating data support the use of newer agents to mitigate bleeding risk, especially in the setting of femoral access and concomitant use of glycoprotein IIb/IIa receptor inhibition. With several antithrombotic agents available, an assessment must be made regarding the ischemic and bleeding risks. This article summarizes existing data examining the benefits and limitations of the various anticoagulants and guidelines for their use.

      PubDate: 2016-02-12T16:42:03Z
       
  • Saphenous Vein Graft Interventions
    • Abstract: Publication date: Available online 11 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Michael S. Lee, Gopi Manthripragada

      Teaser Saphenous vein graft interventions compose a small but important subset of percutaneous coronary revascularization. Because of their unique biology, percutaneous angioplasty and stenting require tailored patient and lesion selection and modification of intervention technique to optimize outcomes. The use of embolic protection and appropriate adjunctive pharmacology can help minimize periprocedural complications, such as the no-reflow phenomenon. Recommendations for best practice in saphenous vein graft interventions continue to evolve with emerging research and therapy.

      PubDate: 2016-02-12T16:42:03Z
       
  • Management of Complications
    • Abstract: Publication date: Available online 11 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Peter P. Monteleone, Robert W. Yeh

      Teaser Percutaneous coronary intervention (PCI) has matured rapidly to tackle increasingly complex coronary disease. Operators must be aware of the incidence of the basic risks involved with coronary angiography and PCI to appropriately inform patients and obtain procedural consent. Even before a wire enters a coronary artery, specific risks, including vascular access complications, renal injury, allergic reaction, and radiation injury, are constantly present. With initiation of PCI, new risks to the coronary circulation arise. A fundamental knowledge of the presentation of these complications and expert ability to emergently manage them are of the utmost importance to the successful completion of PCI.

      PubDate: 2016-02-12T16:42:03Z
       
  • Risk Stratification for Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 10 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Davide Capodanno

      Teaser The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a semiquantitative angiographic score developed to prospectively characterize the disease complexity of the coronary vasculature. With more than 50 validation studies, the SYNTAX score is the most-studied risk model in the setting of percutaneous coronary intervention. In this article, the evolutionary journey of the SYNTAX score is reviewed, with emphasis on its sequential modifications and adaptations, now culminating in the development and validation of the SYNTAX score II.

      PubDate: 2016-02-12T16:42:03Z
       
  • Left Main Percutaneous Coronary Intervention
    • Abstract: Publication date: Available online 10 February 2016
      Source:Interventional Cardiology Clinics
      Author(s): Neil Ruparelia, Alaide Chieffo

      Teaser Significant unprotected left main stem (ULMS) disease is in approximately 5% to 7% of patients undergoing coronary angiography. Historically, coronary artery bypass grafting has been the gold standard treatment of these patients. With recent advances in stent technology, adjunctive pharmacotherapy, and operator experience, percutaneous coronary intervention (PCI) is increasingly regarded as a viable alternative treatment option, especially in patients with favorable coronary anatomy (low and intermediate SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) scores). This article aims to discuss the evidence supporting PCI for ULMS disease, current guidelines, and technical aspects.

      PubDate: 2016-02-12T16:42:03Z
       
 
 
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