1,721,424 research outputs found
Post-TAVI PCI
No full textTranscatheter aortic valve implantation (TAVI) with a self-expanding prosthesis can create new more complex anatomies for one to navigate in order to gain access to the coronary ostia. In other words, the geometrical relationships between a given patient’s cardiac anatomy and the implanted prosthesis location and/or its orientation in turn may hinder coronary access and even cause coronary obstruction. Hence, the standardization of coronary techniques and deep understandings of procedural implications are needed for improving the management of patients treated by TAVI. This chapter discusses the various transcatheter valve types and how they will impact access to the coronary arteries and means to do so
Hybrid Cardiac Imaging for the Invasive Cardiologist
No full textFor decades Coronary Angiography (CA) has represented the gold standard for the diagnosis and management of coronary artery disease (CAD). Today, invasive cardiologists can overcome the limits of such a binary approach, based on the definition of obstructive or nonobstructive stenosis, and go deeply into the characterization of individual coronary atherosclerosis. Indeed, several auxiliary imaging techniques allow a more accurate definition of global coronary atherosclerotic burden and single plaque composition. These techniques, integrating CA “luminal” data, assure a better definition of CAD pathophysiology and detection of vulnerable lesions, resulting in improved stratification of individual cardiovascular risk. Furthermore, this hybrid invasive approach can be used to monitor the response to specific intensive pharmacotherapy aiming to reduce atherosclerosis progression. This chapter reviews the main characteristics of imaging modalities currently available to invasive cardiologists, summarizes clinical evidence supporting their use, and illustrates possible future medical implications
Experimental investigation of the local blood flow pattern in stented coronary bifurcations
No full textNot availabl
The 4G/5G polymorphism of PAI-1 promoter gene as a risk factor for myocardial infarction: A meta-analysis approach
No full textBackground. The 4G allele of the 4G/5G polymorphism in the promoter region of the PAI-1 gene has been recently reported to predict the risk of myocardial infarction (MI) in a small group of young men. Subsequent studies have produced conflicting results. To further evaluate the association of the 4G/5G polymorphism with the risk of MI, we carried out a meta-analysis of all published studies. Methods and Results. Eight retrospective case-control studies on MI patients and a prospective study were considered. In total, 1521 MI cases and 2120 control subjects were analyzed. The overall distribution of genotypes was: 20.4% 5G/5G, 47.1 % 5G/4G and 32.5% 4G/4G in cases and 28.9% 5G/5G, 47.9% 5G/4G and 23.2% 4G/4G in controls. Across all studies, the mean odds ratio for MI was 1.30 (Clgj: 1.08 to 1.57; P=0.005) for 4G/4G versus 5G/5G genotypes and 1.21 (CI95: 1.03 to 1.42; P=0.02) for 5G/4G+4G/4G versus 5G/5G genotypes. The odds ratio appeared to be increased in high risk populations (i.e. with coronary artery stenosis or non-insulin-dependent diabetes) (OR 4G/4G vs 5G/5G: 2.18; CI95: 1.34 to 3.56). Conclusions. This meta-analysis supports an association of the 4G allele with MI risk. The sample size and the design of the studies included in the overview and the light association found with the risk of MI, all call for other prospective, adequately powered studies, conducted separately in low and high risk subjects
Jailed balloon protection: A new technique to avoid acute side-branch occlusion during provisional stenting of bifurcated lesions. Bench test report and first clinical experience
No full textAims: Provisional stenting with drug-eluting-stents is actually adopted to treat most of bifurcated lesions. A major drawback of this technique is the risk of side-branch (SB) closure after main vessel (MV) stenting. Methods and results: We set-up, and bench tested, a novel technique for SB protection based on the placement of a balloon in the SB during MV stenting. The uninflated balloon, which remains jailed under the stent struts, serves to reduce both carina and plaque shifts due to its SB ostium spatial occupation. If SB flow is preserved after MV stenting, the jailed balloon is removed uninflated. If the SB becomes occluded after MV stenting, the jailed balloon may either be used as a marker and a favourable angle modifier to facilitate rewiring or can be dilated to try to restore SB flow. SB rewiring and kissing balloon inflation must be performed to correct stent deformation or malapposition. This novel technique has been successfully adopted in 20 patients with complex (55% unprotected left main, 85% Medina 1,1,1 lesions) true bifurcated lesions undergoing drug-eluting-stent implantation. Conclusions: The jailed balloon protection is a novel technique aimed at improving SB protection during provisional stenting of bifurcated lesions considered at high risk of SB compromise after MV stenting
Percutaneous removal of an embolized port catheter: Description of a new coaxial recovery tochnique including a case-report
No full textThe achievement of coaxiality between recovery device and embolized tubular foreign bodies like central venous catheters is a key point to achieve percutaneous removal. To facilitate this target, we designed a coaxial retrieval loop-snare device using a modified coronary guiding catheter and a coronary 0.014′ guidewire. This new technique has been bench tested and then successfully used to remove a long Port-A catheter's fragment embolized into the right sided heart. © 2008 Wiley-Liss, Inc
Images in cardiology: intramyocardial septal branches of a dual LAD selectively visualized within a no reflow area
No full textN
Abdominal Infrarenal Aortic Stenosis Approached Through a Full Transradial Approach: A Case Series
No full textSix consecutive patients (3 men; mean age, 63 +/- 14 years; age range, 38-81 years) with infrarenal abdominal aortic stenosis underwent unilateral or bilateral transradial approach for stenting of the aortic lesion. In 4 cases, isolated aortic stenting was performed through single transradial approach (in 2 cases with precise alignment to the proximal end of previously deployed iliac stents), whereas in the other 2 cases bilateral transradial approach was used for aortic stenting followed by bilateral stenting of the proximal iliac arteries. Either a "bare-on-the-wire" or a " support-catheter" technique was used, according to patient anatomy and technical requirements. The median follow-up was 14.3 months, at which time all patients had relief of symptoms without thromboembolic or bleeding complications. In this performance and safety evaluation, full transradial approach was effective and safe for treating infrarenal aortic stenosis that is isolated or associated with iliac disease
- …
