As percutaneous coronary intervention (PCI) has advanced, improved technology and increased collective experience have led to a marked reduction in the need for emergency coronary artery bypass surgery (CABG), with only 0.15% of patients requiring emergency surgical intervention in 2002. In fact, PCI is now commonly practiced in hospitals without on-site cardiothoracic back-up, something that […]
Category: Interventional cardiology
Bedside genetic test identifies non-responders to Clopidogrel
Clopidogrel is an inactive prodrug that requires hepatic bioactivation via several cytochrome P450 enzymes, including CYP2C19. A number of different alleles of CYP2C19 have been identified; depending on the allele present the enzymatic activity of CYP2C19 can be normal, or reduced. […]
Intracoronary abciximab offers no extra benefit
Despite the introduction of primary angioplasty programmes for patients with acute ST-elevation myocardial infarction (STEMI), up to 70% of patients have impaired myocardial tissue perfusion even after successful treatment. As intracoronary delivery of abciximab results in much higher concentrations within the coronary artery when compared to intravenous administration, it is logical to propose that this […]
Biodegradable polymer stent shows promise in LEADERS
Drug eluting stents have reduced restenosis rates, and the need for further revascularisation after stenting, despite initial concerns over late stent thrombosis. This complication has been attributed to chronic inflammation and neoatherosclerosis induced by the durable polymers used in these stents. Biodegradable stents have been hypothesised to reduce this inflammatory burden, by degrading to leave […]
Hybrid revascularisation moves forward
Use of the left internal mammary artery (LIMA) in coronary artery bypass (CABG) procedures has led to 10 year patency rates approaching 90%, far surpassing rates for other graft types or for stents implanted percutaneously. Anastomosed to the left anterior descending artery, the LIMA provides reassuring protection in this critical territory, however it generally involves […]
Genetic factors related to early stent thrombosis
Dual anti-platelet therapy (DAPT) reduces cardiovascular events after PCI by more than 80%. However, stent thrombosis can occur in 0.5% to 4% of patients within the first year following PCI, with the majority occurring in the first month. Cayla et al. performed a case-control study using a candidate gene approach – looking in particular at […]
Drug-eluting stents superior for saphenous vein graft lesions
Whilst there has been an increase in the number of coronary artery bypassing graft (CABG) operations performed using internal mammary arteries, the majority are still performed using saphenous vein grafts. These vessels are more prone to occlusion, and treatment of this accounts for a significant proportion of all percutaneous intervention (6%). […]
Operator Experience Influences Carotid Stenting Outcomes
The US Food and Drug Administration (FDA) approved the first carotid stenting system in 2004, and since then the use of the procedure has steadily increased in America. However, carotid stenting is a technically demanding procedure, and several studies have noted a significant learning curve for operators performing the procedure. This study investigated the experience […]
High Residual Platelet Reactivity Predicts Future Cardiovascular Events
With the increased use of platelet function testing, high residual platelet reactivity (HRPR) has been found to associate with a high risk of ischaemic events following percutaenous coronary intervention (PCI). However, few data exist for patients with acute coronary syndromes (ACS). To this end, the Responsiveness to Clopidogrel and Stent Thrombosis 2-ACS (RECLOSE 2-ACS) study […]
CRISP-AMI: No role for counterpulsation in non-shock STEMI
Although door-to-balloon times have declined over the last few years, mortality rates from acute ST-elevation myocardial infarction (STEMI) have not improved. One proposed method to counteract this has been the routine use of intra-aortic balloon counter pulsation (IABC) during primary PCI; animal studies have suggested a reduction in infarct size, and a possible clinical benefit […]