1,721,343 research outputs found
[Fractional flow reserve to establish the indication for and guide myocardial revascularization]
No full textCatheter-based functional metrics of the coronary circulation
No full textIn patients with stable chest pain, decision making about treatment strategy should be based on anatomical and functional information on the coronary circulation. Traditionally, the functional data are obtained by non-invasive testing which aims at detecting and localizing 'myocardial ischemia.' Yet, the diagnostic accuracy of diagnostic testing is over-rated in the literature, so that in clinical practice, a sizable proportion of patients undergo a coronary angiogram without prior useful functional information. Therefore, several methods have been developed to obtain similar information in the catheterization laboratory. Here we review briefly some of these methods. Some of them are used routinely in clinical practice, and others are under development
From debulking to delivery: sequential use of rotational atherectomy and GuidezillaTM for complex saphenous vein grafts intervention
No full textPercutaneous coronary interventions (PCI) of old calcified saphenous vein grafts (SVGs) is challenging and is associated with a considerably high risk of adverse ischemic events in the short- and long-term as compared to native coronary arteries. We report a case in which a non-dilatable, calcified SVG lesion is successfully treated with rotational atherectomy followed by PCI and stenting with local stent delivery (LSD) technique using the GuidezillaTM guide extension catheter (5-in-6 Fr) in the "child-in-mother" fashion
Biomarkers of vulnerable plaque: The missing link with ischemia
No full textThe initial evaluation of chest pain in the emergency department is based on the patients clinical history, changes in the ECG and necrosis biomarkers. Although management of patients with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction with positive markers of myocardial damage is well defined, exclusion of coronary artery disease or myocardial ischemia in the remaining patients is more challenging. This group represents the majority of patients admitted for chest pain syndromes and that have a substantial risk of an adverse outcome. Given that troponin, as a marker of myocardial damage, detects terminal events in the cascade of acute coronary syndrome, there is a need to search for biomarkers that are able to identify patients at high risk, allowing rapid, bedside stratification. Data suggest that clinical events are prone to occur more frequently in patients with coronary artery stenosis associated with myocardial ischemia. Accordingly, identification of systemic biomarkers of ischemia could facilitate identification of high-risk patients with a high burden of coronary atherosclerosis and plaque rupture. We describe six biomarkers that have been linked to myocardial ischemia. Until now, these biomarkers of ischemia are relevant in order to exclude ischemic heart disease (high negative predictive value) but still lack specificity. Future prospective studies should be performed in larger and more diverse sets of patients presenting with ischemia, and in a complementary fashion in order to provide valuable tools for clinical decision making. © 2010 Future Medicine Ltd
Invasive functional testing in the cath lab as a routine investigation in INOCA: pros and cons
No full text
Fractional flow reserve to guide and to assess coronary artery bypass grafting
No full textThe aim of this review is to highlight the role of invasive functional evaluation in patients in whom coronary artery bypass graft (CABG) is indicated, and to examine the clinical evidence available in favour of fractional flow reserve (FFR) adoption in these patients, outline appropriate use, as well as point out potential pitfalls. FFR after CABG will also be reviewed, highlighting its correct interpretation and adoption when applied to both native coronary arteries and bypass grafts. Practice European guidelines support the use of FFR to complement coronary angiography with the highest degree of recommendation (Class IA) for the assessment of coronary stenosis before undertaking myocardial revascularization when previous non-invasive functional evaluation is unavailable or not conclusive. As a result, FFR has been adopted in routine clinical practice to guide clinicians decision as to whether or not perform a revascularization. Of note, due to the increasing confidence of the interventional cardiologists, FFR guidance is also being implemented to indicate or guide CABG. This is in anticipation of supportive clear-cut evidence, since recommendations for FFR adoption were based on randomized clinical trials investigating percutaneous coronary intervention (PCI) strategies in which patients with typical indications for CABG were excluded (e.g. left main disease, valvular disease, and coronary anatomy unsuitable for PCI). Based on the critical appraisal of the literature, FFR can play an important role in risk stratification and determining management strategy of patients either before or after CABG
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