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JACC. Cardiovascular Interventions Jun 2020Although drug-eluting stents are still the default interventional treatment of coronary artery disease, drug-coated balloons (DCBs) represent a novel alternative... (Review)
Review
Although drug-eluting stents are still the default interventional treatment of coronary artery disease, drug-coated balloons (DCBs) represent a novel alternative therapeutic strategy in certain anatomic conditions. The effect of DCBs is based on the fast and homogenous transfer of antiproliferative drugs into the vessel wall during single balloon inflation by means of a lipophilic matrix without the use of permanent implants. Although their use is established for in-stent restenosis of both bare-metal and drug-eluting stents, recent randomized clinical data demonstrate a good efficacy and safety profile in de novo small-vessel disease and high bleeding risk. In addition, there are other emerging indications (e.g., bifurcation lesions, large-vessel disease, diabetes mellitus, acute coronary syndromes). Because the interaction among the different delivery balloon designs, doses, formulations, and release kinetics of the drugs used is important, there seems to be no "class effect" of DCBs. On the basis of the amount of recently published data, the International DCB Consensus Group provides this update of previous recommendations summarizing the historical background, technical considerations such as choice of device and implantation technique, possible indications, and future perspectives.
Topics: Angioplasty, Balloon, Coronary; Cardiac Catheters; Cardiovascular Agents; Clinical Decision-Making; Consensus; Coronary Angiography; Coronary Artery Disease; Drug-Eluting Stents; Equipment Design; Humans; Risk Factors; Treatment Outcome
PubMed: 32473887
DOI: 10.1016/j.jcin.2020.02.043 -
The Journal of Invasive Cardiology May 2020Accordion effect or concertina effect - also known as "crumpled coronary" - is an uncommon occurrence during coronary angioplasty. It usually has no major clinical...
Accordion effect or concertina effect - also known as "crumpled coronary" - is an uncommon occurrence during coronary angioplasty. It usually has no major clinical sequelae and should be differentiated from spasm, dissection, and thrombosis, which require special management.
Topics: Angioplasty, Balloon, Coronary; Coronary Angiography; Humans
PubMed: 32357138
DOI: No ID Found -
Catheterization and Cardiovascular... Nov 2020Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the...
BACKGROUND
Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the applied stenting technique may influence clinical outcome. Accordingly, bifurcation stenting classifications and technical sequences should be standardized to allow proper reporting and comparison.
METHODS
The European Bifurcation Club (EBC) is a multidisciplinary group dedicated to optimize the treatment of bifurcations and previously created a classification of bifurcation stenting techniques that is based on the first stent implantation site. Since some techniques have been abandoned, others have been refined and dedicated devices became available, EBC promoted an international task force aimed at updating the classification of bifurcation stenting techniques as well as at highlighting the best practices for most popular techniques. Original descriptive images obtained by drawings, bench tests and micro-computed-tomographic reconstructions have been created in order to serve as tutorials in both procedure reporting and clinical practice.
RESULTS
An updated Main-Across-Distal-Side (MADS)-2, classification of bifurcation stenting techniques has been realized and is reported in the present article allowing standardized procedure reporting in both clinical practice and scientific studies. The EBC-promoted task force deeply discussed, agreed on and described (using original drawings and bench tests) the optimal steps for the following major bifurcation stenting techniques: (a) 1-stent techniques ("provisional" and "inverted provisional") and (b) 2-stent techniques ("T/TAP," "culotte," and "DK-crush").
CONCLUSIONS
The present EBC-promoted paper is intended to facilitate technique selection, reporting and performance for PCI on bifurcated lesions during daily clinical practice.
Topics: Angioplasty, Balloon, Coronary; Clinical Decision-Making; Coronary Artery Disease; Humans; Stents; Treatment Outcome
PubMed: 32579300
DOI: 10.1002/ccd.29071 -
JACC. Cardiovascular Interventions Apr 2015
Topics: Angioplasty, Balloon, Coronary; Cardiology; Health Services Needs and Demand; Humans; India; Radiology, Interventional
PubMed: 25907096
DOI: 10.1016/j.jcin.2015.03.004 -
JACC. Cardiovascular Interventions Apr 2023
Topics: Humans; Treatment Outcome; Angioplasty, Balloon, Coronary; Paclitaxel; Coronary Restenosis; Coated Materials, Biocompatible; Coronary Angiography; Stents
PubMed: 37045497
DOI: 10.1016/j.jcin.2023.01.382 -
International Heart Journal Mar 2023Evidence on the effectiveness and comparative effectiveness of stent implantation and balloon angioplasty for native coarctation of the aorta (CoA) and recurrent CoA... (Meta-Analysis)
Meta-Analysis
Evidence on the effectiveness and comparative effectiveness of stent implantation and balloon angioplasty for native coarctation of the aorta (CoA) and recurrent CoA separately is lacking. The present meta-analysis was performed to assess the efficacy and safety of stent implantation and balloon angioplasty in native (NaCo) and recurrent (ReCo) CoA.A systematic computerized literature search was conducted to retrieve all relevant studies of stent implantation and balloon angioplasty for CoA. Both single-arm and comparative studies were included. Data on NaCo and ReCo were pooled separately.A post-procedure gradient of ≤ 20 mmHg was achieved in 97% and 92% of patients undergoing stent implantation and balloon angioplasty for NaCo, and in 98% and 90% for ReCo, respectively. A post-procedure gradient of ≤ 10 mmHg was achieved in 97% and 83% of patients undergoing stent implantation and balloon angioplasty for NaCo, and in 86% and 78% for ReCo, respectively. Comparative results confirmed that stent implantation provided a significantly higher success rate compared with balloon angioplasty (odds ratio [OR] = 2.09; 95% confidence interval [CI] = 1.13-3.86; P = 0.019) in treating NaCo. Incidences of all-cause complications, mortality, reintervention, and aneurysm formation were similar between the groups. Patients undergoing stent implantation had a significantly lower incidence of dissection (OR = 0.15; 95% CI = 0.02-0.92; P = 0.040).Current evidence indicates that stent implantation might have superior efficacy compared with balloon angioplasty for the treatment of NaCo with higher success rates and similar complication rates. However, whether this superior effect is also present in ReCo patients needs further evaluation.
Topics: Humans; Aortic Coarctation; Aorta; Angioplasty, Balloon, Coronary; Angioplasty, Balloon; Recurrence; Stents; Treatment Outcome
PubMed: 36682763
DOI: 10.1536/ihj.21-643 -
Journal of Electrocardiology 2022Acute coronary occlusion results in increased T-wave amplitude and ST-segment elevation in the ECG leads facing the ischemic region.
BACKGROUND
Acute coronary occlusion results in increased T-wave amplitude and ST-segment elevation in the ECG leads facing the ischemic region.
MATERIAL AND METHODS
We performed continuous ECG recording in 34 patients during balloon occlusion of the left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA). Delta (Δ) ST and ΔT amplitudes were calculated by subtracting the preinflation values from the values measured during balloon inflation.
RESULTS
Occlusion of the LAD resulted in greater increase in the amplitude of the T wave than of the ST segment in lead V2 (ΔT +3.4 mm, inter-quartile range [IQR] 1-6 mm; ΔST +1.4 mm, 0.5-3 mm). During RCA occlusion, ΔST and ΔT didn't differ significantly. LCx occlusion resulted in significant differences between ΔST and ΔT in all leads, except aVF and V3-V4. In two patients (LCx), we observed a biphasic ST-T response: an initial negative change of the T-wave amplitude was followed by a positive change in leads V1-V2. In leads II, III, aVF and V4-V6, there was an initial positive change, followed by a final negative change towards the end of the occlusion.
CONCLUSION
Continuous 12‑lead ECG recording during balloon occlusion of the LCx resulted in significant differences between the ΔST and ΔT values in all leads except aVF and V3-V4. LAD and RCA occlusion resulted in less evident differences between the ST-segment and T-wave changes. A change in polarity of T-wave changes during balloon occlusion (initial negative and final positive change, or vice versa) proved to be a rare finding.
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Arrhythmias, Cardiac; Coronary Occlusion; Electrocardiography; Humans
PubMed: 35738147
DOI: 10.1016/j.jelectrocard.2022.06.003 -
JACC. Cardiovascular Interventions Mar 2017
Topics: Angioplasty, Balloon, Coronary; Cardiac Catheters; Coronary Artery Bypass; Coronary Artery Disease; History, 20th Century; Humans; Risk Factors; Smoking; Time Factors; Treatment Outcome
PubMed: 28279324
DOI: 10.1016/j.jcin.2017.02.001 -
EuroIntervention : Journal of EuroPCR... Nov 2016Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential... (Review)
Review
Covered stents offer an effective bail-out strategy in vessel perforations, are an alternative to surgery for the exclusion of coronary aneurysms, and have a potential role in the treatment of friable embolisation-prone plaques. The aim of this manuscript is to offer an overview of currently available platforms and to report results obtained in prior studies.
Topics: Angioplasty, Balloon, Coronary; Coronary Aneurysm; Coronary Vessels; Humans; Stents; Treatment Outcome; Vascular System Injuries
PubMed: 27866138
DOI: 10.4244/EIJV12I10A210 -
JACC. Cardiovascular Interventions Jun 2016
Topics: Angioplasty, Balloon, Coronary; Brachytherapy; Coronary Restenosis; Humans; Stents
PubMed: 27339843
DOI: 10.1016/j.jcin.2016.04.033