Introduction
In 1977, percutaneous transluminal coronary angioplasty (PTCA) was introduced to dilate narrow coronary arteries. Over the years, the development of the procedure knocked down major anatomical obstacles. Typically the procedure involves a small incision into the leg, a catheter is inserted through the groin vein and is then steered to the blocked coronary vessel via a guide wire. On the tip of the catheter is a deflated balloon. Once at the congested region of the artery the balloon is inflated, causing plaque to compress against the artery wall, dilating the artery and restoring blood to flow [1]. The initial success was demoted by the occurrence of elastic recoil. Nevertheless, scientist over came these drawbacks (well so they thought), by mounting a bare-metal stent (BMS) on the balloon of the catheter [2]. Jacques Puel and Ulrich Sigwart inserted the first stent into a human coronary artery in 1986. The inflation of the balloon caused the minute expandable metal to implant into the vessel, causing the vessel to expand and remain expanded. The hindrance of elastic recoil was believed to be defeated, therefore in 1994 the U.S Food and Drug Administration approved the use of the first Palmaz-Schatz stent [3]. The insertion of BMS did initially improve results, mainly by reducing the risk of abrupt closure and improving long-term results. However, a new barrier was exposed in the form of In-Stent Restenosis (ISR). The new problem included negative remodelling and neointimal formation. One way to combat ISR was the concept of “coating” the metallic stent with an anti-proliferative pharmacological agent. The drug coated stents, referred to as drug eluting stents (DES), delivered the drug locally from the surface of the...
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...st generation SES. The second generation EES showed superior clinical and safety over PES in the SPIRT trails. Highly significant data in TLF, MACE, stent thrombosis and target lesion revascularization was demonstrated in favour of EES. However, second generation DES may not be the “be all” of what they are made out to be. A number of clinical trail’s report negative information for ZES. ENDEAVOR I and III trails and Kandazri et al. observed significantly higher rates of in-stent late lumen loss ZES verses SES. Furthermore, SORT-OUT III trails also observed negative results for ZES, reporting considerable increases in stent thrombosis, myocardial infarction and target lesion revascularisation. On comparing both of the second generation DES together, mixed results were obtained. ESTROFA-2 reported low rates of thrombosis in both ZES and ESS. Explain difference....
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
27-Ussia GP, Scarabelli M, Mulè M, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.Am J Cardiol 2011;108:1772–6.
Endovascular stent graft repair is designed to help reinforce a weakened aorta. Endovascular surgery is performed inside the aorta using thin, long tubes called catheters to place a stent surrounded with a fabric liner. Endovascular stent grafting uses an endovascular stent graft to reinforce the wall of the aorta and to help keep the damaged area from rupturing and developing into a potentially serious health problem that can be fatal and cause massive internal bleeding.
For Great Artery Stenosis in Children with Congenital Cardiac Disease." Cardiology in the Young 22.2 (2012): 178-183. Academic Search Premier. Web. 17 Nov. 2013.
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
In today’s society, people are gaining medical knowledge at quite a fast pace. Treatments, cures, and vaccines for various diseases and disorders are being developed constantly, and yet, coronary disease remains the number one killer in the world.
Coronary artery bypass graft surgery is a procedure that can be life-saving for patients with heart disease, but it also carries risks after the procedure that can impact patient outcomes negatively. Because over 395,000 Americans have CABG surgery each year, and the risk-adjusted mortality rate for patients is 2%, according to Centers for Disease Control (CDC) statistics, health care professionals must find ways of reducing risks and complications to improve the outcomes for many patients (Ferguson, 2012). Heart disease is often comorbid with other conditions, like lung disease, peripheral arterial disease, hypertension, and diabetes, which can raise the risk of complications (Ferguson, 2012; Nejati-Namin, Ataie-Jafari, Amirkalali, Hosseini, Sheik Hathollahi, & Najafi, 2013). Complications that can arise following surgery include atrial fibrillation, prolonged inflammatory reactions, a build up of fluid near the heart, accelerated atherosclerosis, and nearby vein or artery blockage (Gokalp, Ilhan, Gurbuz, Cetin, Kocaman, Erdogan, & … Satiroglu, 2013; Ferguson, 2012; Scheiber-Camoretti, Mehrotra, Ling, Raman, Beshai, & Bowman, 2013; Sicaja, Starcevic, Sebetic, Raguz, & Vuksanovic, 2013). These complications can lead to increased lengths of stay, increased readmission rates, risk of further complications, failure of the bypass graft, cognitive dysfunction and memory loss, patient suffering, and even death (Ferguson, 2012; Gokalp et al., 2013; Sicaja et al., 2013). In turn, nurses, other care providers, and institutions may face negative consequences themselves, including a risk of lawsuits, increased employee workload, higher per-patient costs, reduced or withheld private insurance, Medicaid, and Medicare reimbursements, auditing...
In combination all of these treatment options can be used to minimize death and risk from cardiovascular disease. In order to stop its rise, fundamental changes have to be made in the Western way of life, so that secondary prevention methods and surgeries do not become a necessity. There is a long road ahead, but it is a path that must be paved if any sweeping changes are to occur.
Coronary heart disease came in the public eye in the mid-20th century as a disease of pandemic magnitudes and it continues to be a major cause of death in the western world. The fundamental cause of coronary heart disease is Atherosclerosis. The term “atherosclerosis” is the combination of two Greek words which correctly imply the elements of the lesion. The first being “athero” the greek work for gruel which parallels to the necrotic core at the base plaque formation, and “sclerosis” from the Greek word hardening, corresponding to the fibrous cap on the outer layer of the plaque. (Vulnerable Atherosclerotic Plaque : Strategies for Diagnosis and Management, 1, 2)
This procedure is popular because it is less invasive and requires less recovery time than bypass surgery (Sharma, Farber, & Menard, n.d.). In angioplasty, a catheter guides a balloon and stent through the artery to the blockage. Once the stent is in place, the physician or surgeon expands the balloon, which causes the stent to expand and push against the walls of the artery, widening the blood vessel and increasing blood flow through the
For angioplasty, a special catheter (a long, thin, hollow tube) is inserted into a blood vessel and guided to the blocked coronary artery. The catheter has a tiny balloon at its tip. Once the catheter is in place, the balloon is inflated at the narrowed area of the coronary artery. This presses the plaque or blood
The American Heart Association and American college of Cardiology guidelines suggest thrombolysis only in hemodynamically stable patients with non-obstructive PVT (5) while The American College of Chest Physicians recommends thrombolysis as first line therapy for thrombi < 0.8cm2 (8). Due to the nature of the prosthesis type and thrombus, the size of the thrombusmass could not be measured in our
Serruys P. W, Gershlick A. H (2005)’ Handbook of drug-eluting stents’ Taylor and francis group: Oxonia
...ry stent is a small metal tube that expands inside a coronary artery. The stent is placed during or after angioplasty. This procedure prevents the artery from ever closing up again.A surgery that treats CHD is Coronary Artery Bypass Surgery. This surgery creates new paths for the blood to flow to the heart. In this surgery the surgeon takes a vein from the leg or artery from the chest or wrist. The surgeon then attaches it to the coronary artery. The other surgery that treats Coronary Heart Disease is called Minimally Invasive Heart Surgery. In this surgery the artery bypass is done without stopping the heart. They put the patient on a heart-lung machine.
Per your request, I completed a literature search using UptoDate and GoogleScholar. I performed searches using the terms, drug eluding stents, antiplatelet therapy duration, pci and stents, and antithrombotic therapy. I found some information that may help in answering your question.