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Acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Suraj Kumar, Gurpreet S Wander
An invasive strategy leads to improved outcomes and is favoured for the majority of patients; the urgency of angiography (performed with the goal of revascularization) depends on the presence or absence of high-risk features (Table 24.2) [4]. If initial medical therapy stabilizes the patient's hemodynamic condition and relieves ischemic discomfort, angiography can proceed within 12 to 24 hours. An even more delayed approach (with angiography performed within 25 to 72 hours) is an option for patients at lower immediate risk. In patients whose condition is unstable, urgent PCI is performed, as it is for patients with STEMI. In low-risk patients, a non-invasive stress test (preferably with imaging) for inducible ischaemia is recommended before deciding on an invasive strategy.
Other devices and how to use them
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
During infusion with thrombolytic agent, the patient undergoes intermittent laboratory analysis including hematocrit, platelet level, thrombin level, prothrombin time, and partial thromboplastin time. If the thrombin level drops below 100 IU/mL, the lytic agent should be stopped. The complications of chemical thrombolysis increase with the time required for the infusion and the overall dose. A typical dosing regimen for tPA for an occluded lower extremity bypass is to lace the clot with 2–6 mg of tPA then run the infusion at 1 mg/hour for 4 hours and then decrease it to 0.5 mg/hour after that. Most of the improvement that can be expected will be seen within the first 8 hours. Typically, if there is a change clinically or if several hours have gone by, then it is time to repeat the angiography and check the progress. Chemical thrombolysis may be combined with aspiration thrombectomy. A standard aspiration catheter may be placed over the guidewire and used to aspirate any thrombus that can be removed in this manner.
Applications in radiology
Published in Sam Beddar, Luc Beaulieu, Scintillation Dosimetry, 2018
Daniel E. Hyer, Ryan F. Fisher, Maxime Guillemette
a particular position in the body. The catheter can then be used to take pressure measurements in the chambers and vessels of the heart in order to diagnose potential cardiac disease. Contrast dye can also be injected through the catheter in order to visualize the vessels and inspect them for blockages in a process known as angiography, depicted in Figure 11.15.
In-hospital outcomes of angiography versus intravascular ultrasound-guided percutaneous coronary intervention in ST-elevation myocardial infarction patients
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Mazin Khalid, Neel Kumar Patel, Birendra Amgai, Ahmed Bakhit, Mowyad Khalid, Paritosh Kafle, Sandipan Chakraborty, Vijay Gayam, Osama Mukhtar, Yuri Malyshev, Arsalan Hashmi, Jignesh Patel, Jacob Shani, Vinod Patel
Our analysis showed a statistically significant difference in the rate of coronary dissection in patients undergoing IVUS with a fourfold increase in the OR. This increase might be due to factors related to the culprit lesion. As angiography is an invasive procedure; therefore, it is considered operator dependent, and the complications can be attributed to the different techniques used during the procedure. IVUS has been widely used to assist in the diagnosis of spontaneous coronary artery dissection due to better visualization of the flap or intramural hematoma [20]. The high number of coronary artery dissection cases observed in the IVUS group may be due to a primary spontaneous coronary artery dissection (SCAD) presenting as a STEMI, rather than an iatrogenic dissection caused by the procedure. Available literature reported a general complication rate of 0.5% to 4% when IVUS is used. The reported complications included coronary spasms, coronary dissection, femoral artery aneurysms, and rarely coronary rupture [1]. SIPS trial reported similar coronary dissection in 3% of the cases where IVUS was utilized and 3.2% in angiography arm [21].
Recent advances in stent-assisted coiling of cerebral aneurysms
Published in Expert Review of Medical Devices, 2020
Soliman Oushy, Lorenzo Rinaldo, Waleed Brinjikji, Harry Cloft, Giuseppe Lanzino
Gory et al enrolled 20 patients with wide-neck bifurcation aneurysms in a prospective, multicenter trial of the Barrel stent. Nineteen patients were successfully treated with Barrel stent-assisted coil embolization. Complete occlusion at 12 months was seen in 15/19 (63%) patients. The reported rate of what the authors considered a successful treatment (neck remnant plus complete occlusion) was 79%. One (5.3%) subject experienced a major stroke nine months after Barrel stent placement during a scheduled orthopedic surgery. Muhl-Benninghaus et al reported their experience in a retrospective series of 17 patients who underwent Barrel stent placement [73]. Complete occlusion or neck remnant was observed in 16/17 (94.1%) of aneurysms on immediate post-treatment angiography. One patient experienced a transient ischemic attack without any permanent neurological complications. Adequate occlusion was observed in all 13/17 (76.5%) patients who underwent follow-up angiography at 3 months [73]. Kabbasch et al reported a similar occlusion rate in their retrospective experience with the Barrel stent. Of the 21 patients who underwent stent-assisted coiling, 19 (90%) patients experienced immediate complete occlusion. Twenty patients had short-term and mid-term follow-up angiography (median: 282 days, range: 17–591 days), with 19 (95%) instances of complete occlusion, 2 in-stent thrombosis, and 1 in-stent stenosis [74]. Although the results seem promising, it is important to consider that the aforementioned studies did not compare the Barrel Stent to other adjunct devices or the standard of care.
Device profile of the Resolute Onyx Zotarolimus eluting coronary stent system for the treatment of coronary artery disease: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2020
Moritz Blum, Davide Cao, Roxana Mehran
The Resolute Onyx Core trial was a prospective single-arm registry performed at 11 centers across the United States (US). [28] Patients with up to two de-novo coronary lesions undergoing PCI for stable or unstable angina were included. Only R-Onyx stents with diameters between 2.25 and 4 mm were allowed in this study. The study protocol mandated a DAPT duration of 6 to 12 months. All patients were scheduled for follow-up angiography at 8 months after the procedure. The primary endpoint of the study was late lumen loss (LLL) at 8 months, as determined by quantitative coronary angiography (QCA). A historical cohort from the RESOLUTE US Clinical Trial, which had received Resolute ZES, served as comparator. A 0.20 mm difference after adjustment for propensity score quintile was pre-specified as non-inferiority margin. The study enrolled 75 patients with 78 coronary lesions. LLL at 8 months was 0.24 ± 0.39 mm, compared to 0.36 ± 0.52 mm in the historical Resolute Integrity cohort, resulting in a difference of −0.13 mm with a one sided upper 95% confidence interval of −0.02 mm after propensity score adjustment. Thus, non-inferiority (p < 0.001) was demonstrated and post-hoc testing for superiority was significant (p = 0.029) in favor of the R-Onyx stent. [28] Findings from the Resolute Onyx Core trial showed that angiographic outcomes with the R-Onyx stent were not only non-inferior, but superior compared to the historical Resolute ZES cohort.