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The Keio Journal of Medicine Sep 2001More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first... (Review)
Review
More than 20 years have passed since percutaneous transluminal coronary angioplasty (PTCA) was introduced for the treatment of coronary artery disease. During the first decade, PTCA outcome had improved significantly. However, acute occlusive complications and restenosis remained as significant limitations of the procedure. During the second decade, new procedures, such as stents and atherectomy (directional coronary atherectomy, and Rotablator) had been introduced and had a significant impact on the outcome of percutaneous coronary intervention (PCI). In addition to the improvements in the equipment, the use of glycoprotein IIb/IIIa inhibitors to prevent platelet aggregation has reduced procedure-related complications. PCI continues to evolve with new developments such as distal protection devices to prevent distal embolism, brachytherapy and drug-eluting stents to prevent restenosis. These new technologies may play a significant role in expanding the applications of PCI in the future.
Topics: Angioplasty, Balloon, Coronary; Atherectomy, Coronary; Coronary Angiography; Coronary Disease; Humans; Recurrence; Stents
PubMed: 11594037
DOI: 10.2302/kjm.50.152 -
JACC. Cardiovascular Interventions May 2018
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Coronary Restenosis; Drug-Eluting Stents; Humans; Treatment Outcome
PubMed: 29798775
DOI: 10.1016/j.jcin.2018.03.014 -
Journal of Ayub Medical College,... 2020Stents are now deployed in almost 95% of all percutaneous coronary interventions (PCIs). Recent advances in balloon and stent technology has improved the technique of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Stents are now deployed in almost 95% of all percutaneous coronary interventions (PCIs). Recent advances in balloon and stent technology has improved the technique of direct stent (DS) strategy, i.e., stent delivery without pre-dilatation instead of conventional stenting (CS), i.e., stent implantation after balloon pre-dilatation with multiple advantages.
METHODS
This randomized controlled trial was conducted at the Cardiology. Department, Punjab Institute of Cardiology, Lahore from April to September, 2017. One hundred patients who were being treated by percutaneous coronary intervention (PCI) were enrolled into two Groups e.g., Group I & group II. 50 patients undergoing direct stenting were enrolled in group I and 50 patients undergoing stenting after balloon pre-dilatation were enrolled in group II after randomization. All patients were treated by single type drug eluting or bare metal stents. Chi square test was used for association and t-test for mean difference between two groups in comparison to post dilatation, fluoroscopy time, procedure time, amount of contrast used, procedural success, side branch compromise, slow flow. The p-value of ˂ 0.05 was significant.
RESULTS
This study consisted of 76 males and 24 females out of a total count of 100, with the average age of 52.2±0.01 years. Overall, 43 (43%) patients were diabetic and overall, 44 (44%) were hypertensive. Most of the patients 55 (55%) had PCI to LAD. Average fluoroscopy time 4.l±2.5 minutes in Group I was significantly lesser as compared to 6.7±3.8 minute group II (p-value <0.05). The average procedure time was also marginally lesser in Group I, 23.4±11.6 in comparison to the second Group 33.7±14 (p-value <0.05). Side branch compromise was observed in 10 (20%) in the first group as compared to 8 (16%) the second group.
CONCLUSIONS
In comparison to stenting preceded by balloon predilatation, direct stenting is a safer and more feasible procedure with respect to radiation exposure, cost and time duration of the procedure.
Topics: Angioplasty, Balloon, Coronary; Coronary Disease; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Stents
PubMed: 32584005
DOI: No ID Found -
Journal of the American College of... Aug 2010Coronary artery stents revolutionized the practice of interventional cardiology after they were first introduced in the mid-1980s. Since then, there have been... (Review)
Review
Coronary artery stents revolutionized the practice of interventional cardiology after they were first introduced in the mid-1980s. Since then, there have been significant developments in their design, the most notable of which has been the introduction of drug-eluting stents. This paper reviews the benefits, risks, and current status of Food and Drug Administration-approved drug-eluting stents.
Topics: Angioplasty, Balloon, Coronary; Animals; Clinical Trials as Topic; Coronary Restenosis; Coronary Vessels; Device Approval; Drug-Eluting Stents; Humans; Stents; United States
PubMed: 20797502
DOI: 10.1016/j.jacc.2010.06.007 -
Cleveland Clinic Journal of Medicine Nov 2008Aortic valve replacement via open heart surgery, although still the standard treatment for severe symptomatic aortic valve stenosis, is not an option for many patients... (Review)
Review
Aortic valve replacement via open heart surgery, although still the standard treatment for severe symptomatic aortic valve stenosis, is not an option for many patients with severe symptoms, and these patients are often left with suboptimal strategies such as medical management or balloon valvuloplasty. But over the last 5 years improvements in percutaneous approaches to implantation of prosthetic aortic valves have made it a potential therapeutic option for these patients. Technical and device issues are being refined, and percutaneous aortic valve replacement is showing promise in ongoing clinical trials.
Topics: Angioplasty, Balloon, Coronary; Aortic Valve; Aortic Valve Stenosis; Catheterization; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans
PubMed: 19068962
DOI: 10.3949/ccjm.75.11.805 -
JACC. Cardiovascular Interventions Mar 2019
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Cohort Studies; Femoral Artery; Treatment Outcome
PubMed: 30846090
DOI: 10.1016/j.jcin.2018.12.032 -
JACC. Cardiovascular Interventions Jun 2009Coronary chronic total occlusions (CTOs) are commonly encountered complex lesions identified in 15% of all patients referred for coronary angiography. Chronic total... (Review)
Review
Coronary chronic total occlusions (CTOs) are commonly encountered complex lesions identified in 15% of all patients referred for coronary angiography. Chronic total occlusion remains the most powerful predictor of referral for coronary bypass surgery. The benefits of CTO percutaneous coronary intervention (PCI) include symptom relief, improved left ventricular function, and potentially a survival advantage associated with success when compared with failed CTO-PCI. Data from the NCDR (National Cardiovascular Data Registry) suggest that CTO-PCI attempt rates in the U.S. have not changed over the past 5 years despite significant advances in techniques and technology, some of which we review here. Additionally, these data highlight a major disparity in attempt rates based on operator PCI volume. Remaining barriers to attempting CTO-PCI in the U.S. include operator inexperience, the perception of increased risk of CTO-PCI, and financial disincentives to operators and hospitals. To overcome operator inexperience, participation in CTO clubs, the invitation of guest operators, and a dedicated CTO day can be implemented at institutions committed to learning advanced CTO-PCI techniques so that operators can overcome the barriers and offer patients access to percutaneous therapy when it is clinically indicated.
Topics: Angioplasty, Balloon, Coronary; Chronic Disease; Clinical Competence; Coronary Occlusion; Cost-Benefit Analysis; Education, Medical, Graduate; Health Care Costs; Healthcare Disparities; Humans; Patient Selection; Recovery of Function; Risk Assessment; Treatment Outcome; United States; Ventricular Function, Left
PubMed: 19539249
DOI: 10.1016/j.jcin.2009.02.008 -
Catheterization and Cardiovascular... Jul 2020In a coronary bifurcation bench model, to determine the effects of side branch (SB) wire crossing position and balloon position on the stent scaffolding after the final... (Comparative Study)
Comparative Study
OBJECTIVES
In a coronary bifurcation bench model, to determine the effects of side branch (SB) wire crossing position and balloon position on the stent scaffolding after the final proximal optimization technique (POT).
BACKGROUND
POT performed as a final step after SB dilatation or kissing balloon inflation (KBI) has been widely advocated despite limited evidence.
METHODS
Thirty-one stent implantations in bifurcation phantoms were performed using a one-stent provisional technique with (KBI) (n = 13), with POT-side-POT technique (n = 12) or with the two-stent culotte technique (n = 6). SB wiring was performed through either a proximal or a distal stent cell and confirmed by optical coherence tomography. Final POT was performed with the balloon positioned either across or proximal to the SB takeoff. The area of the opened stent cell in front of the SB was assessed by 3D reconstructed microcomputation tomography scans performed before and after Final POT.
RESULTS
In cases with metallic carina, final POT across the SB takeoff caused SB rejailing. Regardless of stent technique and wire position, a Final POT across the SB takeoff reduced the SB cell opening area by 43% [32%;58%] (n = 15). The largest reduction (54-70%) was found after the POT-side-POT technique in procedures with a proximal wiring. Final POT performed proximal to the SB takeoff caused limited or no SB cell opening area reduction (4% [0.6%;6%] [n = 16]).
CONCLUSION
Final POT with balloon positioned across the SB takeoff in a narrow angle bifurcation reduces largest stent cell area in front of the SB ostium and may cause SB rejailing in cases with metallic carina.
Topics: Angioplasty, Balloon, Coronary; Coronary Vessels; Drug-Eluting Stents; Humans; Materials Testing; Models, Anatomic; Models, Cardiovascular; Prosthesis Design
PubMed: 32087046
DOI: 10.1002/ccd.28801 -
Journal of the American College of... Jan 1990
Topics: Angioplasty, Balloon, Coronary; Cardiopulmonary Bypass; Coronary Disease; Humans; Risk Factors
PubMed: 2295740
DOI: 10.1016/0735-1097(90)90171-k -
EuroIntervention : Journal of EuroPCR... Feb 2018Avoiding side branch occlusion is challenging when treating bifurcation lesions. A newly designed stent system called the prewire channel stent (PWCS) with a side... (Comparative Study)
Comparative Study
AIMS
Avoiding side branch occlusion is challenging when treating bifurcation lesions. A newly designed stent system called the prewire channel stent (PWCS) with a side channel positioned between the metallic mesh material and the balloon is introduced. We aimed to compare the time taken to position the PWCS against that for a conventional stent.
METHODS AND RESULTS
The PWCS and a conventional stent were used in a pig model. The time taken from the starting point with the stent outside the body to reaching the bifurcation of the vessel ready for further procedures such as balloon dilatation through the stent mesh opening and double kissing balloon technique, etc., was compared in the conventional stent and PWCS groups. The time taken in the PWCS stent group included the time from sending the stent from outside the body to the desired position of the bifurcation of the vessels of the heart, releasing the stent and pulling back the balloon (SB time). The time taken in the conventional stent included the time from sending the stent from outside the body to the desired position of the bifurcation of the vessels of the heart, releasing the stent, pulling back the balloon (SB time), and wire exchange (WE time). The SB times for the PWCS and the conventional stent groups were not different (28.5±3.8 vs. 25.25±0.75 seconds, n=4). The PWCS group did not have "wire exchange," and had no WE time, which was 28.5±5.7 seconds in the conventional stent group. The total time spent in the PWCS group was 28.5±3.8 seconds, which was shorter than the 53.75±6.2 seconds (n=4, p<0.05) in the conventional stent group.
CONCLUSIONS
The PWCS makes "wire exchange" in the side branch (SB) unnecessary and it can be as easily manipulated as a conventional stent.
Topics: Angioplasty, Balloon, Coronary; Animals; Cardiac Catheters; Coronary Angiography; Coronary Vessels; Metals; Models, Animal; Operative Time; Prosthesis Design; Stents; Sus scrofa; Time Factors
PubMed: 29061546
DOI: 10.4244/EIJ-D-17-00513