Tag Archives: intervention

Professor Nick Curzen Consensus statement In response to the need for guidance and clarity, national consensus statements have been published as a consensus between the British Cardiovascular Society, the British Cardiovascular Intervention Society (BCIS), NHS England/Public Heath England and the Heart Rhythm Society (in the case of the PPE document). The rationale and considerations behind these statements is discussed more fully elsewhere.2 In brief, the guidance for the three contentious areas listed above is summarised as follows. Firstly, the recommendation was that the default treatment for STEMI in the UK should remain primary PCI, unl

This helpful, practical guide to interventional cardiology focuses on procedural and technical aspects rather than the overall clinical practice approach usually seen in larger textbooks. It assumes that clinical decision-making prior to starting the procedure has been sound, and approaches things from the perspective of already having a patient on the table. The content and chapters are fairly comprehensive and logical in their order, with increasingly complex or less commonly performed procedures towards the end of the book. I would have liked a specific chapter on rotational atherectomy and also perhaps one on some adjunctive methods to ev

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating

ARBITER 6: niacin superior to ezetimibe for slowing atherosclerosis Use of extended-release niacin resulted in a significant benefit on atherosclerosis compared with ezetimibe in patients already taking statins in the ARBITER 6-HALTS trial. The trial, presented at the meeting by Dr Allen Taylor (Medstar Research Institute, Washington DC, US), compared two distinct lipid-modifying strategies in patients with known vascular disease already on statins who had LDL-cholesterol levels <100 mg/dL (2.56 mmol/L) and moderately low HDL-cholesterol levels (<50 mg/dL [1.28 mmol/L]). Among the 363 patients enrolled in the study, half were randomised

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