Tag Archives: stents

Case 1 – off-label use A 57-year-old man was referred to the chest pain clinic for further investigation with complaints of progressive dyspnoea on minimal exertion, consistent with New York Heart Association (NYHA) class 3 symptoms. His past medical history included hypertension, hypercholesterolaemia, ischaemic heart disease (ST-elevation myocardial infarction in 2003 requiring percutaneous coronary intervention [PCI] to the distal right coronary artery [RCA]) and a high body mass index (BMI). On examination his vital signs were normal and there were no significant clinical findings. He underwent an electrocardiogram (ECG), routine blood

Introduction The evolution of modern percutaneous coronary intervention (PCI), with miniaturisation of technology, improved device delivery and ancillary devices available to facilitate completion of complex cases, has opened the doors of the catheterisation laboratory to both elderly patients with complex coronary anatomy, as well as those with multiple comorbidities that might have otherwise historically been considered unfit for coronary intervention. As a direct result of this, cardiologists are increasingly treating highly calcified, severely obstructed and chronically occluded coronary vessels.1 Highly calcified vessels are considerably

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

Introduction Renal artery stenosis (RAS), traditionally the preserve of the nephrologist, is a condition of increasing interest to the cardiologist. Ninety per cent of RAS is caused by atherosclerosis and the risk factors for renal atherosclerosis and coronary atherosclerosis are the same. Furthermore, the presence of RAS alters the prognosis of co-existent cardiac disease, most notably cardiac failure and ischaemic heart disease, both directly1–3 and via its sequelae of renal failure and hypertension. Finally, the treatments for the disease, both medical and interventional, are familiar to the cardiologist, who can employ much of the knowl

Likely candidates for drug-eluting stents are those in whom the coronary artery is less than 3 mm in diameter, or the segment of the artery to be treated is longer than 15mm. The new draft guidance on drug-eluting stents, which was issued by NICE on 1st February 2008, is very different from the draft proposals that the agency had put out for comment last year. Those proposals stated that drug-eluting stents “do not represent a cost-effective use of National Health Service resources,” after taking into account the risks and benefits of drug-eluting stents as compared with bare-metal stents. The British Cardiovascular Society, the British C

No content available

No content available

No content available