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Coronary Angioplasty: Evolved to Perfection
Jagdish S Hiremath
CHAPTER 1:
Evolution of Coronary Angioplasty
HISTORY
ACUTE CORONARY SYNDROME
INTRACORONARY THROMBUS
CHRONIC TOTAL OCCLUSIONS
MULTIVESSEL AND LEFT MAIN DISEASE
BIFURCATIONS
CONCLUSION
CHAPTER 2:
An Overview of the History and Fundamentals of Coronary Stent Design
TIMELINE OVERVIEW
STENT TECHNOLOGIES
Deployment Mechanisms
Self-Expanding
Balloon Expandable
Fabrication Methods
Braided Wire
Knitted Wire
Formed Wire
Soldered or Welded Sheet, Hoops, Wire, etc.
Machined from Sheet
Machined from Tube
Balloon Expandable Stent Materials
Biocompatibility
Corrosion Resistance
Strength
Stiffness
Ductility
X-ray Attenuation
Permanent Metals
Bioabsorbable Materials
PERFORMANCE REQUIREMENTS
Deliverability to the Target Location
Flexibility
Pushability
Profile
Expandability at Target Location
Deployment Pressure
Compliance
Foreshortening
Recoil
Postdilatation Diameter
Scaffolding of the Vessel
Conformability
Minimize Vessel Injury
Minimize Disruption of Flow
Combat Restenosis
Promote Healing
Special Purpose Requirements
DESIGN OPTIMIZATION
Product Matrix
Stent Models
Designing for Expansion
Designing for Radial Strength
Designing for Deliverability
Designing for Scaffolding
Designing for Conformability
Developing an Optimized Stent
CONCLUSION
CHAPTER 3:
Percutaneous Coronary Intervention
INTRODUCTION
INDICATIONS
Post-coronary Artery Bypass Grafting Recurrence of Angina
CONTRAINDICATIONS
GUIDELINES
PCI BASED ON ANATOMIC LESION
Significance of Syntax Score
Chronic Total Occlusions
Saphenous Vein Graft
SPECIAL PATIENT CLASSES
Elderly
Diabetes
Women
Severe Renal Dysfunction
Dual Antiplatelet Therapy (DAPT) for Non-compliant Patients
Absence of On-site Cardiac Surgery Capabilities
PCI IN SPECIFIC CLINICAL SITUATIONS
UA/NSTEMI
ST-elevation Myocardial Infarction
CHAPTER 4:
Coronary Angioplasty for the Beginners
INITIAL MUSINGS
SETTING THE TONE
TAKE BACK AND APPLY
DECISIONS GALORE
BEYOND HAND SKILLS
WELCOME TO A FASCINATING WORLD
REFERENCE
CHAPTER 5:
Periprocedural Use of Drugs for Routine Percutaneous Coronary Intervention
ARMAMENTARIUM FOR THE INTERVENTIONIST: ARE WE BATTLE SAVVY ENOUGH?
ANTIPLATELETS
Aspirin
Clopidogrel
Cilostazol
Prasugrel
Ticagrelor
Cangrelor
Glycoprotein IIb/IIIa Inhibitors
Abciximab
Eptifibatide
Tirofiban
Present Recommendations for Gp IIb/IIIa Inhibition
Postprocedure Antiplatelet Therapy
ANTITHROMBOTICS
Unfractionated Heparin
Low Molecular Weight Heparin (LMWH)
Fondaparinux Sodium
Bivalirudin
ADJUVANT TREATMENT IN THE LABORATORY
Other Adjuvant Drugs
Beta Blockers
Calcium Channel Blockers
Angiotensin Converting Enzyme Inhibitors
Statins
Local Anesthetic
Cocktail for Radial Procedures
CHAPTER 6:
Hardware for Coronary Angioplasty
INTRODUCTION
GUIDE CATHETERS
Guide Catheter: Basic Structure
COMMONLY USED GUIDING CATHETERS
Judkins Catheters
Amplatz Catheters
Extra Back-up Catheters
Other Special Catheters
GUIDE CATHETER SELECTION FOR RADIAL INTERVENTION
GUIDE CATHETER FOR SAPHENOUS VEIN GRAFTS AND LEFT INTERNAL MAMMARY ARTERY INTERVENTIONS
CORONARY GUIDEWIRE
Basic Performance Requirements
Basic Guidewire Structure
CHARACTERISTICS AND CLASSIFICATION OF GUIDEWIRES
Workhorse Guidewires
Extra Support Guidewire
Guidewires for Totally Occluded Lesions
Controlled Drilling Strategy
Penetration Strategy
Sliding Strategy
Shaping the Wire Tip
BALLOON ANGIOPLASTY CATHETER PLATFORMS AND BALLOON ANGIOPLASTY PROCEDURE
Fixed Wire BA Catheters
Over-the-wire Balloon Catheter
Rapid Exchange (RX) Balloon Catheter
Preparation of Balloon Catheter
Balloon Catheter Inflation Kinetics
SPECIFIC BALLOON ANGIOPLASTY DEVICES
Compliant Versus Noncompliant Balloons
Perfusion Balloons
Plaque-incising Balloons
Drug-eluting Balloons
CORONARY STENTS
Historical Perspective
ANCILLARY HARDWARE
CHAPTER 7:
Fractional Flow Reserve
INTRODUCTION
BASIC CORONARY PHYSIOLOGY AND INTRAVASCULAR MEASUREMENTS
LIMITATIONS OF ANGIOGRAPHY AS THE GATEKEEPER FOR INTERVENTIONS
CLINICAL METHODS TO STUDY CORONARY PHYSIOLOGY
Flow Indices
Pressure Indices
Technique of Fractional Flow Reserve
CLINICAL SUPERIORITY OF FRACTIONAL FLOW RESERVE IN REVASCULARIZATION DECISIONS
FFR IN SELECTED CLINICAL POPULATIONS
LIMITATIONS OF FRACTIONAL FLOW RESERVE
CONCLUSION
CHAPTER 8:
Use of IVUS and OCT in Cath Lab
BACKGROUND
BASIC DIFFERENCES BETWEEN IVUS AND OCT
BASELINE VESSEL AND LESION EVALUATION
Basic Vessel Wall Anatomy
Plaque Analysis
Lesion Severity Assessment
IVUS in Assessment of Severity of LM Lesions
Procedure Optimization
Long-term Post-PCI Assessment
CHAPTER 9:
Difficult Situations of Angioplasty: Ectasia/Aneurysm and Thrombus
INTRODUCTION
DEFINITION AND PREVALENCE
PATHOGENESIS
CLINICAL COURSE AND NATURAL HISTORY
CLINICAL PRESENTATIONS AND DIAGNOSIS
MEDICAL MANAGEMENT
Risk Factors Modification
Antiplatelet and Anticoagulation Treatment
Renin-angiotensin Aldosterone System (RAAS) Inhibitors
Statin Therapy
Vasodilator and Antianginal Treatment
PERCUTANEOUS INTERVENTION IN CORONARY ARTERY ECTASIA
IMAGING TO HELP CORONARY ANGIOGRAPHY
Coronary Angiography
Intravascular Ultrasound
Optical Coherence Tomography
Fractional Flow Reserve
INTERVENTIONAL PHARMACOLOGY
Vasodilators
Nitroglycerin
Nitroprusside
Nicorandil
Verapamil
Adenosine
Vasodilators in the Treatment of No-flow or Slow-flow
Antiplatelet and Anticoagulation Treatment
Aspirin
Clopidogrel
Prasugrel
Ticagrelor
Cangrelor
Glycoprotein Receptor Inhibitors (GPI) and Parenteral Anticoagulation
Intracoronary Thrombolytic Therapy
Statin Therapy
Long-term Oral Anticoagulation Treatment
DEALING WITH THE THROMBUS
Thrombus in Coronary Artery and Its Impact
Distal Embolization
Aspiration Thrombectomy (AT)
STENT? NOT TO STENT? DEFERRED STENTING?
No Stent Implantation
Deferred Stent Implantation
PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN CORONARY ARTERY ECTASIA
WHICH STENT?
Bare Metal Stent (BMS) versus Drug-eluting Stent (DES) versus Bioresorbable Scaffold
Covered Stent
Peripheral Stent
Self-expanding Stents
SURGICAL TREATMENT OF CORONARY ARTERY ECTASIA
CHAPTER 10:
Multivessel Percutaneous Coronary Intervention: Interventional Cardiologist‘s Perspective
INTRODUCTION
MULTIVESSEL DISEASE
Multivessel Intervention in Patients with Stable Ischemic Heart Disease
SYNTAX
BEST STUDY
Multivessel Intervention in Patients with Acute Coronary Syndromes
Multivessel PCI in Patients with Diabetes
RECOMMENDATIONS
CHAPTER 11:
Multivessel Coronary Angioplasty: Cardiac Surgeons’ Viewpoint
INTRODUCTION
HISTORY
PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFT IN LOW RISK MULTIVESSEL CORONARY ARTERY DISEASE
RESULTS OF ARTERIAL REVASCULARIZATION THERAPIES STUDY II TRIAL
PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFT IN HIGH-RISK MULTIVESSEL CORONARY ARTERY DISEASE
QUALITY OF LIFE AFTER PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFT
COST EFFECTIVENESS OF PERCUTANEOUS CORONARY INTERVENTION VERSUS CORONARY ARTERY BYPASS GRAFT
CONCLUSION
Good Candidate for Percutaneous Transluminal Coronary Angioplasty
Good Candidate for Coronary Artery Bypass Graft
Final Remark
CHAPTER 12:
Left Main Stenting
INTRODUCTION
ASSESSMENT OF LMCA LESION
ANGIOGRAPHIC EVALUATION OF LMCA
FRACTIONAL FLOW RESERVE IN LMCA STENOSIS
IVUS TO GUIDE LMCA INTERVENTIONS
IVUS in Intermediate Lesions
PERIPROCEDURAL IVUS
LESION PREPARATION (ROTATIONAL ATHERECTOMY)
INTRA-AORTIC BALLOON PUMP
AORTO-OSTIAL UNPROTECTED LEFT MAIN PCI
MID-SHAFT LEFT MAIN PCI
LEFT MAIN BIFURCATION PCI
SUMMARY AND AUTHOR RECOMMENDATIONS
CHAPTER 13:
Coronary Chronic Total Occlusion Intervention Technique
INTRODUCTION
HISTOPATHOLOGICAL CONSIDERATIONS
CLINICAL CONSIDERATION AND PREPROCEDURAL PREPARATION
ANTEGRADE APPROACH
Guidewire Tip Shape
Guidewire Manipulation
Microcatheters
Antegrade Wire Escalation
Parallel Wire Technique
Anchor Techniques
Intravascular Ultrasound-guided Wiring Technique
Antegrade Subintimal Tracking
Retrograde Approach
CART TECHNIQUE
REVERSE CART® TECHNIQUE
Collateral Crossing with a Guidewire
Knuckled Wire Technique
Wire Rendezvous Technique
Management of ‘Device-Uncrossable’ CTO Lesions
Management of Complications
CONCLUSION
CHAPTER 14:
Primary Angioplasty in Myocardial Infarction
INTRODUCTION
STRATEGIES IN ACUTE STEMI
ADVANTAGE OF PRIMARY PCI OVER THROMBOLYTIC THERAPY
INTERVENTIONS DURING PAMI
PREVENTION OF DISTAL EMBOLIZATION IN PAMI
Thrombus Aspiration
COVERED STENTS
EMBOLIC PROTECTION DEVICES
GLYCOPROTEIN IIB/IIIA INHIBITORS
TIMING OF GPI ADMINISTRATION
INTRACORONARY VERSUS INTRAVENOUS GPI ADMINISTRATION
INTRACORONARY PHARMACOTHERAPY IN PAMI
Nicorandil
Nitroprusside
Adenosine
IC Fibrinolytics
Stenting in PAMI-BMS VS DES, Newer Generation DES, Role of BVS
BARE-METAL STENTS VERSUS DRUG-ELUTING STENTS
NEWER GENERATION DES
PRIMARY PCI IN SPECIAL SITUATIONS: NONCULPRIT ARTERY PCI IN STEMI
LEFT MAIN CORONARY ANGIOPLASTY IN PPCI
PPCI IN THE ELDERLY PATIENT
PPCI IN CARDIOGENIC SHOCK
PPCI IN CARDIAC ARREST SURVIVORS/UNCONSCIOUS PATIENT
PPCI AT HOSPITALS WITHOUT ONSITE CARDIAC SURGERY
CURRENT STATUS OF PRIMARY PCI IN INDIA AND CHALLENGES FOR STEMI SYSTEM OF CARE IN INDIA71,72
OCT-BASED CHARACTERIZATION OF PLAQUE MORPHOLOGY IN MANAGEMENT OF STEMI
CONCLUSION
CHAPTER 15:
Complications in Coronary Angioplasty
INTRODUCTION
PROCEDURAL COMPLICATION CATEGORIES2, 3
Contemporary Complications Rates for Percutaneous Coronary Intervention (PCI)4
IMPORTANT TIPS BEFORE GOING FOR PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
VASCULAR COMPLICATIONS
How to Reduce Transfemoral Access Complications?
Complications from Femoral Access for PCI
Reported Complications from Transradial Access for PCI
How to Reduce Transradial Access Complications?
Management of Femoral Vascular Complications
Acute Ischemia
Hematoma
Retroperitoneal Hemorrhage (RPH)
Pseudoaneurysm
Arteriovenous Fistulae
Neuropraxia
Infection
Management of Radial Vascular Complications
Compartment Syndrome
Vessel Perforation or Injury
Severe Vasospasm
COMPLICATIONS RELATED TO CORONARY BLOOD FLOW
Acute Myocardial Ischemia during Coronary Angioplasty
Vasospasm
Dissection of the Coronary Artery
Abrupt Closure of the Vessel
Perforation of the Coronary Artery
Prevention
Diagnosis and Management
THROMBUS FORMATION
Preventive Pharmacotherapy
Avoiding Iatrogenic Coronary Thrombus
Management of Thrombus Formation
AIR EMBOLISM
Treatment of Air Embolism
No-reflow Phenomenon
Treatment
Retained Equipment into the Coronary Tree
Nonsurgical Stent Retrieval
Stent Retrieval with Guidewire within the Stent
Stent Retrieval without Guidewire within the Stent
Stent-crush Technique
Forceps Removal
Prolonged Ischemia Leading to Myocardial Infarction, Urgent CABG and Death
Emergency CABG
Radiocontrast Hypersensitivity
Mild
Moderate
Severe
Bleeding
Stroke
Contrast-induced Nephropathy (CIN)
MINIMIZING THE RISK OF ACUTE KIDNEY INJURY
Periprocedural Hydration
Medications
Intraprocedural Strategies
The Choice and Use of Contrast Agents
Ten Golden Rules to Prevent Complications
CONCLUSION
CHAPTER 16:
Non-left-main Bifurcation Angioplasty
INTRODUCTION
HISTORY
PATHOPHYSIOLOGY
Endothelial Shear Stress
CLASSIFICATION OF BIFURCATION LESIONS
VARIOUS TECHNIQUES OF BIFURCATION STENTING
MAIN BRANCH STENTING ONLY
PROVISIONAL SIDE BRANCH TECHNIQUE
Approach
TWO-STENT STRATEGY AS INTENTION TO TREAT
T-stenting
V- and SKS Technique
Advantages
Limitations
Crush Technique (Fig. 16.7)
Advantages
Limitations
Culotte Technique (Fig. 16.8)
Advantage
Limitations
GUIDELINES
BIORESORBABLE SCAFFOLDS IN BIFURCATION LESIONS
Determining Size of BRS
Optimization Strategies
SB Ostial Dilatation
Routine FKBI is not recommended
Two Stent Technique
SUMMARY
CHAPTER 17:
Saphenous Vein Graft Intervention
INTRODUCTION
Very Early Postoperative Ischemia (<1 Month)
Early Postoperative Ischemia (1 Month–1 Year)
Late Postoperative Ischemia (>3 Years after Surgery)
Very Late Postoperative Ischemia
NATURAL HISTORY OF SVG DISEASE
THROMBOSIS
INTIMAL HYPERPLASIA
ATHEROSCLEROSIS
INDICATIONS FOR INTERVENTION
DIFFICULTIES AND METHODS
ACCESS SITE AND GUIDING CATHETER CHOICE
EMBOLIC PROTECTION
CHOICE OF STENT
PLAQUE SEALING IN SVG
CHAPTER 18:
Interventions from the Upper Limb: Transradial Approach
CHALLENGES IN TRANSRADIAL INTERVENTIONS
RADIAL ARTERY ACCESS
Patient Selection
Patient Set-up
Radial Artery Puncture
Arterial Access
Technique of Hemostasis
Cannulating the Coronaries: Techniques and Tips
Gaining Access to the Ascending Aorta (Figs 18.3A to E)
Catheter Choice in Case of Difficulty to Reach the Ascending Aorta
Guidewire of Choice
Catheter Selection for TRI
Diagnostic Catheter Selection
Alternate Strategy (Fig. 18.5)
Right Coronary Cannulation (Fig. 18.6)
Single Catheter Strategy
Left Coronary Cannulation with Tiger Catheter (Fig. 18.7)
Right Coronary Cannulation with Tiger Catheter (Fig. 18.8)
Guide Catheter Selection for TRI
Left Coronary Guide Catheter Selection for TRI
Right Coronary Guide Catheter Selection for TRI
Enhancing the Guide Catheter Back-up Support
TRANSRADIAL PROCEDURES: TRAVERSING LOOPS AND TORTUOSITIES
Tortuosity of the Radial or Brachial Artery (Fig. 18.11)
Antebrachial Loop in TRI (Fig. 18.12)
Subclavian Loops and Tortuosities
COMPLICATIONS AND MANAGEMENT
Radial Artery Occlusion
Radial Artery Spasm
Forearm Hematoma and Compartment Syndrome
Radial Artery Perforation
Pseudoaneurysm
Arteriovenous Fistula Formation
Catheter Entrapment
LEARNING CURVE IN TRANSRADIAL PROCEDURES
CONCLUSION
CHAPTER 19:
Radial and Groin Care after Percutaneous Coronary Intervention
INTRODUCTION
SITE-RELATED COMPLICATIONS
Femoral Access Site-related Complications (Tables 19.1, 19.2 and Figs 19.2A and B)3
Radial Access Site-related Complications
VASCULAR CLOSURE DEVICES
Active Approximators
Passive Approximators
Radial Approach
SUMMARY OF RECOMMENDATIONS18
Discharge Instructions
CHAPTER 20:
Bioresorbable Vascular Scaffold
IGAKI-TAMAI SCAFFOLD
ABSORB BIORESORBALE VASCULAR SCAFFOLD
DESOLVE, NOVOLIMUS-ELUTING CORONARY SCAFFOLD
FANTOM, SIROLIMUS-ELUTING BIORESORBABLE SCAFFOLD
IDEAL BIOSTENT
MAGNESIUM METALLIC STENTS
BIORESORBABLE VASCULAR SCAFFOLD RATIONALE AND CLINICAL INDICATIONS
ABSORB BIORESORBABLE VASCULAR SCOFFOLD CLINICAL STUDIES
ABSORB BIORESORBABLE VASCULAR SCAFFOLD IMPLANTATION TECHNIQUE
SPECIAL LESION SUBSETS
DUAL ANTIPLATELET THERAPY AFTER BIORESORBABLE VASCULAR SCAFFOLD IMPLANTATION
DEVICE LIMITATIONS
FUTURE DIRECTIONS
CHAPTER 21:
Hybrid Coronary Revascularization
INTRODUCTION
PROCEDURE STRATEGY: TIMING AND STAGING
Staged MIDCAB Prior to PCI
Staged PCI before MIDCAB
Simultaneous PCI and MIDCAB
INDICATIONS AND CONTRAINDICATIONS FOR THE HYBRID CORONARY REVASCULARIZATION PROCEDURE
Indications
Multimorbid or High-risk Patients
Primary PCI of Circumflex/RCA
Patient Preference
Contraindications
SURGICAL TECHNIQUES
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Total Endoscopic Coronary Artery Bypass Grafting (TECAB)
Minimally Invasive Coronary Artery Surgery (MICAS)
RESULTS
MIDCAB
TECAB
MICAS
PCI
HCR
CONCLUSION
CHAPTER 22:
Difficult Situations in Coronary Angioplasty
INTRODUCTION
DEFINITION
CLASSIFICATION
EPIDEMIOLOGY
DIAGNOSIS
ANGIOGRAPHIC PROFILING OF ANOMALOUS CORONARIES
Angiographic Profiling of AORCA
Anomalous Circumflex
Anomalous LAD (Dual LAD Type IV to VI)
Anomalous Origin of Left Main Coronary Artery from Right Sinus
PERCUTANEOUS INTERVENTION IN AOCA: TECHNICAL CHALLENGES
GUIDE CATHETER SELECTION
Guide Catheter Selection for AORCA3–5
Guide Catheter Selection for AOLCA
Single Coronary Artery
Anomalous Origin of the Right Coronary Artery from the Left Anterior Descending Coronary Artery
Word of Caution
ANCILLARY HARDWARE AND TECHNIQUES
Access
Guidewire
Tips and Tricks
CONCLUSION
REFERENCES
BACKGROUND
DEFINITION OF CAC
EPIDEMIOLOGY
PATHOPHYSIOLOGY AND RISK FACTORS
DETECTION OF CORONARY CALCIFICATION
PERCUTANEOUS INTERVENTION IN CALCIFIED ARTERIES
Optimal Assessment of Lesion
Vascular Access and Arterial Sheath
Guide Catheter
Active Backup Maneuvers
Guidewire
Preparation of Lesion
CUTTING BALLOON ANGIOPLASTY
Mechanism of Action
Procedural Tips
Efficacy
Indications
Present Role in Treatment of Calcific Coronaries
The FX MiniRail
The Angiosculpt
Present Role
PLAIN BALLOON ANGIOPLASTY
Present Role in Calcific Lesion Angioplasty
Bare Metal Stents or Drug-eluting Stents
Atherectomy Devices
DIRECTIONAL ATHERECTOMY
Description of Device
Mechanism of Action
Present Role
ROTATIONAL ATHERECTOMY
Mechanism of Action
Indication
Contraindication
Bare Metal Stents or Drug-eluting Stents
Present Role
EXCIMER LASER CORONARY ATHERECTOMY
Mechanism of Action
Procedural Details
Clinical Studies
Present Role of ELCA
Future Role
ORBITAL ATHERECTOMY SYSTEM
Mechanism of Action
Device Description
Procedural Details
Indication
Clinical Studies
Contraindications
Tips and Tricks
Present Role
Strategy for Intervention in Calcified Lesions
Vessel Size <2.5 mm
Vessel Size >2.5 mm
SUCCESSFUL ROTA (FIGS 22.32 TO 22.34)
FAILED ROTA (FIGS 22.35 AND 22.36)
CONCLUSION
CHAPTER 23:
Contrast-induced Nephropathy
INTRODUCTION AND DIAGNOSTIC CRITERIA
CLINICAL FEATURES, MANAGEMENT AND PROGNOSIS
INCIDENCE AND PREDISPOSING FACTORS
DEVELOPMENT OF CLINICAL SCORES FOR RISK STRATIFICATION
PATHOPHYSIOLOGY OF CONTRAST-INDUCED NEPHROPATHY
PREVENTION STRATEGIES
Risk Assessment
Hydration
Issues Related to Contrast
Dose
Contrast Types (Table 23.2)
Other Measures with Unproven Benefit
N-acetylcysteine
WITHHOLDING VARIOUS DRUGS
CONCLUSION
CHAPTER 24:
Rehabilitation after Percutaneous Transluminal Coronary Angioplasty
INTRODUCTION
CARDIAC REHABILITATION DEFINITION
EVIDENCE BASE
Benefits of Cardiac Rehabilitation
Importance
Indication
Components of Cardiac Rehabilitation
EDUCATION AND COUNSELING
OBJECTIVES
Tobacco Cessation
Hypertension Management
Diabetes Management
Lipid Control
Weight Management
Nutritional Counseling
Physical Inactivity
Physical Activity
EXERCISE TRAINING
EXERCISE PRESCRIPTION
INTENSITY OF EXERCISE TRAINING
Frequency and Duration of Exercise Session
Risk Stratification
Conducting Exercise Program
Content of Exercise Classes
Home Exercise Programs
ALCOHOL CONSUMPTION
SEXUAL COUNSELING
MANAGEMENT OF PSYCHOSOCIAL AND PROFESSIONAL ISSUES/STRESS
SUMMARY
CHAPTER 25:
Outcomes of Coronary Angioplasty
STABLE CORONARY ARTERY DISEASE PCI VERSUS MEDICAL TREATMENT
STABLE CORONARY ARTERY DISEASE PCI VERSUS CABG
NON-ST ELEVATION ACUTE CORONARY SYNDROME
ST ELEVATION MYOCARDIAL INFARCTION
POST-CABG PATIENTS
SPECIAL SITUATIONS: STENT THROMBOSIS AND RESTENOSIS
BIORESORBABLE STENTS
DRUG-COATED BALLOONS
CHAPTER 26:
Future of Angioplasty
LUMINOGRAM TO PLAQUE CHARACTER
INTEGRATED IMAGING
MINIATURIZATION
HYBRID PROCEDURES
ROBOTICS AND NAVIGATION
HARDWARE
PRINTABLE HARDWARE
CLOSURE DEVICE
ECONOMICS AND COST
LOCATING HARDWARE IN THE LAB
RADIATION SAFETY
MYOCARDIAL VIABILITY
DATA NETWORK
CONCLUSION
CHAPTER 27:
Rotablation in Coronary Artery Disease
INTRODUCTION
NEED FOR ROTABLATION
Benefits
Principles
Differential Cutting (Fig. 27.1)
Example
Orthogonal Displacement of Friction
Example (Fig. 27.3)
Fundamental Elements of Optimal RA Technique
INDICATIONS
OTHER FREQUENT USES
CONTRAINDICATIONS
ROTABLATOR PRODUCTS AND SYSTEM COMPONENTS (FIGS 27.5 TO 27.10)
Burr
Irrigating the Rota Burr
Air Supply Set Up
Dual Gauge Regulator
FIRST-GENERATION GUIDEWIRES (FIG. 27.11)
SECOND-GENERATION WIRES: FLOPPY AND EXTRA SUPPORT (FIG. 27.12)
WIRE CLIP TORQUER FEATURES (FIG. 27.13)
PROCEDURE
Preprocedural Evaluation
Preprocedure Checklist (DRAW)
Guide Catheter Selection
Guidewire Selection
Our Technique
Burr Speed and Burr Advancement
Pecking Method
Use of Temporary Pacemaker
Use of GP2B3A Inhibitors
Rotaglide Solution
Sources of Heat
Postprocedural Evaluation
Complications (Tables 27.2 to 27.4)
Others, Like–
Mechanism of Burr Entrapment
Retrieval Techniques
IVUS IN ROTABLATION
OCT IN ROTABLATION
CHAPTER 28:
Hardware for Chronic Total Occlusion
SHEATHS
GUIDE CATHETERS
Diameter, Length and Shape
Diameter
Length
Shapes
Shortening of Guiding Catheter
Side Holes
Y Connector with Hemostatic Valves
MICROCATHETERS (TABLE 28.1)
Corsair
Finecross
Venture
GUIDEWIRES
GAIA Wires
Description of Coronary Guide Wires Commonly Utilized in CTO PCI
DISSECTION/REENTRY EQUIPMENT
CrossBoss Catheter
Stingray Balloon and Guidewire
SNARES
UNCROSSABLE AND UNDILATABLE LESION EQUIPMENT
Guide Catheter Extension
Tips
INTRAVASCULAR ULTRASOUND
COMPLICATION MANAGEMENT EQUIPMENT
RADIATION PROTECTION
INDEX
TOC
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