Tag Archives: percutaneous coronary intervention

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

Background Radial artery is the preferred route of access for percutaneous coronary intervention (PCI) as the femoral artery is associated with a greater incidence of bleeding complications.1–5 Often such complications require open surgical repair.4,6 However, percutaneous treatment with covered stents may represent an alternate option. Case presentation A man in his 50s, fit and well and on no routine medications, developed chest pain and posterior ST-elevation myocardial infarction (STEMI) with 2 mm ST-elevation in posterior leads V7, 8 and 9, and 2 mm ST-depression in leads V2 and 3, complicated by cardiogenic shock and out-of-hospital c

Introduction Coronavirus disease-2019 (COVID-19) was declared a pandemic by the World Health Organization on 12th March 2020.1 Subsequently, on 20th March 2020, the National Health Service (NHS) England in collaboration with the British Cardiovascular Society (BCS), the British Cardiovascular Interventional Society (BCIS) and the British Heart Rhythm Society (BHRS) published guidelines for the management of cardiology patients during the coronavirus pandemic.2 Briefly, the guidelines recommended that: all non-urgent elective inpatient/day case procedures should be postponed primary percutaneous coronary intervention (PCI) should continue to b

Introduction While many in the interventional cardiology community consider the debate of routine radial versus femoral access for coronary angiography to be all but over,1-5 there, nonetheless, continues to be a wide variation in the uptake of transradial access worldwide.6,7 Even putting the preferences of transradial enthusiasts aside, it also seems that patients who have had experience of both access routes prefer use of the radial artery.8 Nonetheless, femoral access undoubtedly continues to remain relevant in situations such as large bore and complex intervention, the need for mechanical support devices, and structural intervention. One

Background, epidemiology and rationale for study The PIONEER AF-PCI (Open-Label, Randomized, Controlled, Multicenter Study Exploring Two Treatment Strategies of Rivaroxaban and a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy in Subjects with Atrial Fibrillation who Undergo Percutaneous Coronary Intervention) trial addressed an important medical question, which is potentially relevant for the 20–45% of atrial fibrillation (AF) patients who also have coronary artery disease and are likely to undergo percutaneous coronary intervention (PCI). Prior to the PIONEER AF-PCI trial, there was an unmet need for evidence-based recommendati

The COMBO™ dual therapy stent REDUCE (Short-term Dual Anti Platelet Therapy in Patients with ACS Treated with the COMBO Dual-therapy Stent), a physician-initiated, prospective, multi-centre, randomised study, was conducted in 36 hospitals in Europe and Asia, enrolling a total of 1,496 ACS patients. The study was designed to demonstrate non-inferiority of a strategy of short-term (three months) dual antiplatelet therapy (DAPT) compared to standard 12-month DAPT in patients with ACS treated with a dual-therapy stent. The stent used in the study COMBO™ (OrbusNeich) is a sirolimus-eluting stent with an abluminal biodegradable polymer matrix,

Approximately 20–30% of patients with AF, who are continuously taking an oral anticoagulant to reduce their risk of AF-related stroke, have coexisting coronary artery disease and may require PCI. The current practice of administering triple therapy with warfarin and two antiplatelet agents in patients with AF after a PCI is associated with high rates of major bleeding. RE-DUAL PCI tested an alternative treatment strategy: dual therapy with dabigatran and a single antiplatelet agent (P2Y12 inhibitor). Selected for one of the meeting’s hotline sessions and simultaneously published in the New England Journal of Medicine (https://doi.org/10.

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Figure 1. Patient chest X-ray showing a ‘full metal jacket’ Her physical examination and vital signs were unremarkable. Routine blood tests had been requested. Resting 12-lead electrocardiogram (ECG) showed left bundle branch block; no previous ECGs were available for comparison. A chest X-ray was performed, which gave another clue to the diagnosis… The chest radiograph (figure 1) shows clear lung fields, normal cardiac contour and, more importantly, a radio-opaque structure across the anterior surface of her heart. This is sometimes termed a ‘full metal jacket’, implying extensive stenting of a coronary artery in its entirety f

Introduction It is accepted that coronary revascularisation with coronary artery bypass graft surgery (CABG) provides both symptomatic and prognostic benefit in patients with multi-vessel coronary artery disease (mvCAD).1,2 Both percutaneous coronary intervention (PCI) and CABG provide better relief of angina symptoms than medical therapy alone.1,3 Large, randomised-controlled trials (RCTs), in recent years, have demonstrated that CABG offers an improved outcome in patients with complex three-vessel coronary artery disease (CAD), especially in those with co-existing diabetes mellitus.4,5 However, in patients with one- or two-vessel CAD, PCI o