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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Stable angina is managed by: Modifying lifestyleControlling risk factorsDrug treatmentRevascularization by coronary stenting or coronary artery bypass surgery
Acute coronary syndromes
Published in Henry J. Woodford, Essential Geriatrics, 2022
Patients may require transfer to a centre that can provide PCI. Ideally, STEMI is diagnosed pre-hospital and the initial ambulance transfer is to a PCI centre. To achieve this, an ECG must be performed at first contact with a healthcare professional. Trans-radial access for PCI is preferred due to lower local bleeding risk. Coronary stenting, with drug-eluting stents, is recommended rather than angioplasty.12 A parenteral anticoagulant, such as unfractionated heparin, is used around the time of the procedure. Initial post-procedure management should be on a coronary care unit. If PCI fails, for example, due to unsuitable vascular anatomy, then emergency surgical coronary artery bypass grafting may be considered. Older age is associated with increased coronary artery calcification, which increases the risk of complications such as artery dissection and stent thrombosis. Older people also tend to have more extensive arterial disease. Renal impairment increases the risk of adverse effects with the contrast used during PCI.
Cardiology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
In Kawasaki disease, an inflammatory myocarditis or pericarditis may occur at presentation. However, the major cardiac manifestation is the development of coronary artery aneurysms. Early treatment with immunoglobulin reduces the incidence of aneurysm formation; however, aneurysms are still seen, often in atypical cases or those that occur in infancy when it can be more difficult to recognise and give immunoglobulin early enough. Very large aneurysms are more liable to complications that include rupture (rarely) and stenosis with myocardial infarction. Stenosis can be treated by coronary stenting or bypass grafting. The long-term prognosis is still not defined but there is concern that even those without aneurysms may be at risk of accelerated atheromatous disease.
Clinical characteristics, risk factors, and prognostic analyses of coronary small vessel disease: a retrospective cohort study of 986 patients
Published in Postgraduate Medicine, 2023
Yue Chen, Xiao Cui, Liujun Jiang, Xiaolei Xu, Chaoyang Huang, Qiwen Wang
All patients who underwent coronary angiography and stent implantation at the First Affiliated Hospital of Zhejiang University School of Medicine in recent 1 year were consecutively enrolled. Of these, 986 participants were included. Patients who did not receive coronary stenting were not included in this study. Based on stent diameter, they were then divided into the CSVD group (stent diameter ≤2.5 mm, n = 308) or the non-CSVD group (stent diameter >2.5 mm, n = 678). When the patients had both ≤2.5 mm and >2.5 mm stents implanted, they were classified in the CSVD group. This study was approved by the ethical committee at the First Affiliated Hospital of Zhejiang University School of Medicine in compliance with the guidelines of the World’s Association Declaration of Helsinki.
“Tailored” antiplatelet bridging therapy with cangrelor: moving toward personalized medicine
Published in Platelets, 2022
Renato Valenti, Iacopo Muraca, Rossella Marcucci, Francesca Ciatti, Martina Berteotti, Anna Maria Gori, Nazario Carrabba, Angela Migliorini, Niccolò Marchionni, Marco Valgimigli
The management of patients with recently implanted coronary stents who need surgery or invasive diagnostic procedures is a very current topic, especially considering the aging population and the increasing burden of oncologic patients. It has been estimated that about 4–15% of patients undergoing coronary stenting will undergo surgery within the next year [1,2]. A large registry reported a 3.6% incidence of any surgery in the first month after stenting, mostly performed on an urgent basis (2.7%) [3]. The management of perioperative antithrombotic therapy in this setting remains challenging, having to deal with ischemic and hemorrhagic risk in a high-complexity clinical scenario. Early withdrawal of one or both antiplatelet drugs carries a significant risk of stent thrombosis. On the other hand, the bleeding risk associated with surgical or invasive procedures is significantly enhanced if concomitant antiplatelet therapy is not discontinued. Furthermore, data from a matched retrospective cohort reported a significant increase of post-operative adverse events in patients undergoing percutaneous revascularization, in particular during the first 60 days after stent placement [4].
Second generation drug-eluting stents: a focus on safety and efficacy of current devices
Published in Expert Review of Cardiovascular Therapy, 2021
Francesco Spione, Salvatore Brugaletta
This new generation of stents, such as the Nobori® (Terumo, Tokyo, Japan) and the BioMatrix® (Biosensors International, Kampong Ubi, Singapore) biolimus-eluting stent (BES) [13,14], have been developed with the aim of reducing the adverse long-term sequelae related to the persistence of durable polymers in the arterial wall beyond the period necessary to control drug release. Permanent polymer of first and second generation DES has been advocated as a trigger for chronic inflammatory response, which causes delayed vascular healing [15]. The subsequent degradation of the polymer coating, after a controlled drug-release, makes the stent surface similar to that of a BMS. Hence, the suppression of a chronic inflammatory stimulus may improve long-term clinical outcomes after coronary stenting [16].