Tag Archives: percutaneous coronary intervention

Case report Figure 1. A shows an elongated cylindrical piece of tissue shown upon aspirating the sheath; B shows that on histopathology, this tissue was confirmed as arterial endothelium A 62-year-old woman was admitted with troponin positive acute coronary syndrome and was transferred to our centre for intervention. She underwent PCI via the right radial artery (RA). The RA was easily cannulated and a guide-wire passed. Due to resistance, a short non-hydrophilic introducer sheath could not be advanced and was changed to a long hydrophilic-coated sheath, which was introduced without difficulty. Aspirating the sheath showed an elongated cylind

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

Planning development The agreement drawn up by the Heart Team, within the Department of Health, and BCIS some years ago suggested that new centres should not be developed until existing provider units were at capacity. As more cath labs have been built and more cardiologists have been appointed it has been possible, particularly in the current National Health Service (NHS) climate, to make a case for local development of services regardless of whether current providers are able to cope with local demand or not. From a national and regional perspective it would be illogical to develop multiple small-volume centres while other existing centres,

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

Case report 1 A 51-year-old man with known dextrocardia presented with a 12-month history of angina and an early positive exercise electrocardiogram (ECG). His risk factors were hypertension, hyperlipidaemia and cigarette smoking. Physical examination revealed a right-sided apex beat and chest radiography confirmed the presence of dextrocardia. Figure 1. 12-lead electrocardiogram (ECG) in dextrocardia A 12-lead ECG (figure 1) showed sinus rhythm with a reduction in the R-wave voltage in the standard chest leads and a corresponding increase in the right-sided leads. Coronary angiography of the left coronary system (right sided) revealed minor

Dear Sirs We read with interest the recently published article and subsequent letters concerning the radial artery as a preferred access site for percutaneous coronary interventions (PCI).1 We think this debate should also include our cardiothoracic surgical colleagues. Although the radial artery has been used as a coronary artery bypass conduit for over 30 years,2 the initial results were disappointing due to problems with spasm and intimal hyperplasia and the technique was soon abandoned. With the availability of antispasmodic drugs and improved surgical techniques, the radial artery has once again become a popular conduit for coronary bypa

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

Introduction Stent thrombosis (ST) is a potentially life-threatening complication of coronary artery stent placement (percutaneous coronary intervention [PCI]). Concern about the incidence of ST is greatest in patients treated with drug-eluting stents (DES), in whom some evidence suggests there is a higher incidence than for bare metal stents (BMS).1–3 Recently reported meta-analyses from collections of randomised studies comparing BMS with either Cypher® or Taxus® DES have been interpreted as confirming this increase in risk for these drug-eluting devices.4 It is likely that ST is multi-factorial in its aetiology since evidence demonstra

Introduction Percutaneous coronary intervention (PCI) has become the most commonly used invasive treatment for patients with coronary heart disease (CHD).1 Despite great advances in equipment technology, the presence of severe vessel tortuosity, extreme angulation of side-branch ostia, stent jail, or lack of control at the interface of chronic total occlusions (CTO) can result in procedural failure or complications.2 In the treatment of a CTO, for instance, studies suggest that the most common cause of failure was inability to pass the guidewire across the occlusion.3 In these situations, the ability to re-configure working tip angulations of

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