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Antiplatelet therapy in interventional cardiology
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Coronary balloon angioplasty, by its very nature, causes atherosclerotic plaque rupture, exposure of the subendothelium to flowing blood, platelet adherence and aggregation, thrombin formation and the generation of fibrin. The coronary stent adds a potent thrombogenic stimulus to this already prothrombotic environment.7 For this reason, despite recent advances in coronary stenting, antiplatelet therapy is important to mitigate this inherent tendency to thrombosis.
Peri-operative risk assessment in cardiac patients
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Surgery should be delayed for one week after plain angioplasty and for four weeks after coronary stent implantation to allow for endothelialisation of the stent. Clopidogrel is recommended as long-term antithrombotic treatment in patients with coated stents, and the decision to stop this drug must be individualised. In patients with drug eluting stents, stopping clopidogrel before completing one year of treatment, increases the risk of stent thrombosis and myocardial infarction.
Optical coherence tomography for late stent failure
Published in Hiram G. Bezerra, Guilherme F. Attizzani, Marco A. Costa, OCT Made Easy, 2017
Tej Sheth, Anthony Fung, Catalin Toma
Although coronary stent technology continues to improve over time, clinical events from previously placed stents are commonly encountered. The two principal modes of late stent failure are in-stent restenosis and late stent thrombosis (ST). In both cases, a mechanistic understanding of the causes of stent failure may be obtained with optical coherence tomography (OCT). The excellent near-field resolution of OCT and the clear delineation of the stent vessel interface allow for the evaluation of intracoronary stents in great detail. Patients with stent failure are at elevated risk for recurrent events. OCT-based management has the potential to improve acute and long-term results in these patients.
MitraClip as bridge to mitral valve replacement in the setting of ischemic cardiogenic shock and papillary muscle rupture
Published in Acta Chirurgica Belgica, 2023
Eric E. Vinck, Juan C. Rendón, Maria P. Castillo, José J. Escobar, Alejandro Quintero Gómez, Sharoon Suárez, Clara I. Saldarriaga
A 68-year-old female Colombian patient vacationing in the United States, suffered an ST-elevated myocardial infarction resulting in severe mitral regurgitation with a flail valve leaflet secondary to papillary muscle rupture and a LVEF (Left Ventricular Ejection Fraction) of 35%. Figure 1(A) shows the obstructed culprit circumflex artery. Immediately following coronary stent placement (PCI), cardiac surgery was consulted. Due to the patient’s frail condition and cardiogenic shock, surgery was deferred and a MitraClip was placed (Figure 1(B,C)). The MitraClip placement reduced her mitral prolapse down to a moderate insufficiency. Three months later (back in Colombia), the patient developed worsening heart failure symptoms secondary to her mitral prolapse/regurgitation which had deteriorated back to a severe insufficiency with a LVEF of 49% (Figure 1(D)). During her outpatient follow-up with the cardiology department, surgical consultation was requested. She was taken to an elective surgery. Using a minimally invasive right peri-areolar technique, the native mitral valve and MitraClip were removed and a bio-prosthetic mitral valve was placed (Figure 2(A,B)). The patient had a successful recovery and is in follow-up (Figure 2(C)).
Long-term outcomes of extending dual antiplatelet therapy after drug-eluting stent implantation for acute coronary syndrome: a large single-center study
Published in Platelets, 2020
Jingjing Xu, Ying Song, Zhan Gao, Ping Jiang, Ru Liu, Huanhuan Wang, Shubin Qiao, Runlin Gao, Yuejin Yang, Bo Xu, Jinqing Yuan
The benefit of prolonging DAPT for more than 1 year is uncertain regarding the risk of bleeding. Moreover, Asian patients, especially Chinese patients, are considered to have a higher risk of bleeding [15,16], and conservative decisions are made to the prolonging of DAPT duration. The Taiwan ACS STENT Registry Study which contained 2221 patients with ACS, compared the outcomes between DAPT for ≤9 months vs. >9 months. The incidence of the primary outcome (composite of cardiovascular death, myocardial infarction, and stroke) was higher in patients receiving DAPT for ≤9 months compared with those receiving DAPT for >9 months at 1 year (3.5% vs. 1.6%, respectively; p = .0026). DAPT > 9 months was associated with a lower risk of the primary outcome (OR: = 0.725, 95% CI: 0.545–0.965). These data showed that long-duration of DAPT (>9 months) was common (57.9%) in Taiwan for patients with ACS undergoing PCI, and this duration of DAPT therapy might decrease the risk of the primary outcome [17]. The TIMI 38 Coronary Stent Registry enrolled 2110 patients (n = 1679 > 12 months from the index ACS), and the median follow-up time was 2.1 years. DAPT was continued in 554 (26%) patients. Recurrent ischemic events were similar between patients who continued DAPT and in those who discontinued DAPT (p = .74 for cardiovascular death/myocardial infarction/stroke; p = .72 for definite or probable stent thrombosis).
Spontaneous coronary artery dissection, a commonly overlooked etiology of acute coronary syndrome
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Ashish Kumar Roy, Moni Roy, Manajyoti Yadav, Kalyan C. Potu, Sudhir Mungee
Spontaneous coronary dissection remains a commonly overlooked cause of ACS with increasing number of cases now being recognized due to greater availability of invasive procedures and imaging modalities.SCAD is commonly associated with FMD in young females.Angiographic imaging with distal pruning and no improvement of blood flow noted with ballooning is consistent with SCAD.Treatment for SCAD may differ from atherosclerotic causes of ACS. Thrombolytic therapy, anticoagulant and coronary stent placement may be harmful in these cases.Differentiating SCAD from atherosclerotic disease is prudent to prevent unnecessary intervention that may be rather harmful for the patient.