Tag Archives: drug-eluting stents

Case history Figure 1. Intravascular ultrasound (IVUS) image showing gross malapposition between the original stent (black arrow) and the vessel wall (transparent arrow) A 44-year-old smoker with a history of hypertension, high cholesterol and positive family history presented with inferior wall ST-elevation myocardial infarction (STEMI). Angiography revealed the culprit was an occluded right coronary artery (RCA). A drug-eluting stent (Taxus element) 2.75 by 24 mm was deployed and the patient discharged with follow-up on dual antiplatelet therapy (DAPT) (aspirin and clopidogrel). Three years later he was re-admitted with another inferior STE

Dear Sirs, Ischaemic heart disease (IHD) is a major cause of mortality and morbidity, and percutaneous coronary intervention (PCI) is a mainstay of treatment. The management of IHD has been revolutionised by major advancements in the field of coronary angioplasty, starting with the use of balloons for percutaneous transluminal coronary angioplasty (PTCA) in 1977 by Gruentzig.1 However, their use was limited by acute recoil (approximately 40%), vessel dissection and a high re-stenosis rate (50%). To treat the acute problems of recoil and dissection (with acute vessel closure) and reduce the rate of re-stenosis, coronary stents were introduced

ACCORD/INVEST: do not aim for normal blood pressure in diabetes patients with CAD The results of two trials comparing intensive versus more conventional blood pressure lowering in patients with diabetes at high cardiovascular risk have suggested that intensive treatment is not necessary and may be harmful in this population. In the ACCORD BP (Action to Control Cardiovascular Risk in Diabetes – Blood Pressure) trial, while intensive blood pressure treatment did reduce the risk of stroke, it failed to reduce the overall risk of cardiovascular events in patients and was associated with an increase in adverse events due to antihypertensive ther

Introduction The use of drug-eluting stents (DES) has increased exponentially in recent years with a significant improvement in the rates of re-stenosis, target lesion and target vessel revascularisation.1-3 There appears to be little difference in short- to medium-term safety compared with bare metal stenting (BMS).4 Coronary thrombosis after stent implantation is well recognised, resulting in acute myocardial infarction and marked adverse outcome. Typically, it happens in the first 3–10 days after the procedure leading almost always to an acute myocardial infarction and not uncommonly to death. Late (>6 months) stent thrombosis is rare

Introduction Over the last 15 years there has been an almost exponential growth in the percutaneous coronary intervention (PCI) rate in the UK from less than 10,000 procedures in 1991 to over 70,000 in 2005 (British Cardiovascular Intervention Society [BCIS] audit data 2005). The National Service Framework (NSF) for Cardiology (http://www.csp.org.uk/uploads/documents/ebb_cr.pdf) has recommended revascularisation rates of 1,500 per million of population with either cardiac surgery or PCI as the mode of revascularisation. During the same time period the rate of coronary artery bypass graft (CABG) has remained relatively static with the ratio of

The position now So where does the current guidance leave us? First, it provides interventional cardiologists enough freedom to be able to treat most of our patients in what we consider to be an evidence-based manner. This desire to provide optimal care for our patients has been, incidentally, repeatedly and insidiously questioned over the last 12 months – but I will return to that issue later. In fact, I know that I am not alone in feeling that the guidance should have included diabetes as an indication for DES independent of the 3.0 mm/15 mm parameters. Are there any large observational or randomised series of stent activity that do not

Figure 1. Right anterior oblique (RAO) caudal view. A shows initial post-percutaneous coronary intervention angiographic result. B shows RAO caudal view of subacute stent thrombosis within paclitaxel stent in the left anterior descending artery (LAD). C shows RAO caudal view of probable tissue prolapse (arrow) within proximal LAD stent On this admission the electrocardiogram (ECG) showed peaked anterior T waves without ST elevation and urgent coronary angiography was undertaken demonstrating occlusion of the LAD artery distal to the first diagonal branch and within the stented segment. There was also the appearance of thrombus within the obtu

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