Tag Archives: drug-eluting stent

Disease made worse? Dr Pitt O Lim When Grüntzig extended balloon angioplasty from the leg to the heart as a minimally invasive procedure for coronary atherosclerosis in 1977, there was a 10% rate of abrupt vessel closure (AVC), possibly causing a myocardial infarction (MI).1,2 At the time, cardiac surgeons stood by, rescuing these patients with emergency coronary artery bypass grafting (CABG). Bare-metal stent (BMS), a balloon-expandable metallic-mesh scaffold was introduced 10 years later to overcome this immediate complication. The drug-eluting stent (DES), marketed from 2003, overcomes BMS’s in-stent restenosis (ISR) due to healing tiss

Introduction Dr Pitt O Lim, Consultant Cardiologist The use of drug-coated balloon (DCB) in de novo coronary artery disease has seeped through into routine practice in recent years.1 Largely unnoticed by the mainstream community, ignored by multi-national device companies and rarely discussed at international meetings. Its development actually parallels that of first-generation drug-eluting stent (DES) from the early 2000s; pioneered, propagated and instructed by expert German operators.2,3 Its efficacy is proven for in-stent re-stenosis (ISR),4 small vessel disease,5,6 high-risk bleeder,7 and where stenting might be avoided, such as in Takay

Introduction Coronary angiography and intravascular ultrasound (IVUS) have traditionally been used for diagnosis of stent edge dissection.1 Optical coherence tomography (OCT), with better resolution (12 to 18 µm) as compared with IVUS (150–250 µm), has higher chances of detecting stent edge dissection. Reported incidences of stent edge dissection range from 5% to 23% by IVUS,2 compared with 20% to 56% by OCT.3 Angiographic results are often deceiving and trials have confirmed that OCT changes the initial PCI strategy in a significant number of cases.4 Case summary A 58-year-old, non-diabetic, non-hypertensive, tobacco-chewing man present

PARTNER: transcatheter valves just as good as surgery for high risk aortic stenosis Transcatheter aortic valve implantation (TAVI) is just as effective at reducing mortality as surgery for severe aortic stenosis in elderly patients whose age and overall health posed high risks for conventional surgery, according to the results of the PARTNER (Placement of AoRTic TraNscathetER Valve trial). However, stroke rates were higher in the trancatheter group. The transcatheter approach involves delivering a bioprosthetic valve to its target location with a catheter using either transfemoral access or trans-apical access (through the ribs) if peripheral

These results, from the TYCOON (Two-Year Clopidogrel Need) registry, were published online on September 28, 2009 in the American Journal of Cardiology. Current guidelines recommend at least 9-12 months of dual antiplatelet therapy (aspirin plus clopidogrel) following intervention with a drug-eluting stent to prevent thromboses, but authors of the TYCOON paper, wanted to investigate whether longer treatment would be better. The TYCOON database includes 897 consecutive patients who received a coronary stent in 2003 and 2004, about half of whom received a drug-eluting stent. Patients given a drug-eluting stent in 2003 were treated with clopidog

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