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Interventional Cardiology Clinics

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https://www.readbyqxmd.com/read/28257776/endovascular-treatment-of-peripheral-artery-disease-and-critical-limb-ischemia
#1
EDITORIAL
Ehrin J Armstrong
No abstract text is available yet for this article.
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257775/emerging-and-future-therapeutic-options-for-femoropopliteal-and-infrapopliteal-endovascular-intervention
#2
REVIEW
Damianos G Kokkinidis, Ehrin J Armstrong
Despite recent advances in endovascular therapy for peripheral artery disease, current technologies remain limited by rates of long-term restenosis and application to complex lesion subsets. This article presents data on upcoming therapies, including novel drug-coated balloons, drug-eluting stents, bioresorbable scaffolds, novel drug delivery therapies to target arteries, techniques to limit postangioplasty dissection, and treatment of severely calcified lesions.
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257774/angiosome-guided-intervention-in-critical-limb-ischemia
#3
REVIEW
Matthew C Bunte, Mehdi H Shishehbor
The goals of treatment for critical limb ischemia (CLI) are alleviation of ischemic rest pain, healing of arterial insufficiency ulcers, and improving quality of life, thereby preventing limb loss and CLI-related mortality. Arterial revascularization is the foundation of a contemporary approach to promote amputation-free survival. Angiosome-directed revascularization has become a popular theory of reperfusion, whereby anatomically directed arterial flow is restored straight to the wound bed. Innovations in endovascular revascularization combined with a multidisciplinary strategy of wound care accelerate progress in CLI management...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257773/inframalleolar-intervention-for-limb-preservation
#4
REVIEW
Javier A Valle, Andrew F Prouse, Robert K Rogers
Critical limb ischemia (CLI) is a relatively prevalent and highly morbid condition. Patients with CLI have a poor prognosis, especially in the setting of incomplete revascularization. Traditionally, achieving optimal revascularization has been limited by the high prevalence of small-vessel disease in this population. More recently, advanced endovascular techniques, increased operator experience, and new technologies have enabled complete revascularization of inframalleolar disease with encouraging clinical results...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257772/contemporary-outcomes-of-endovascular-intervention-for-critical-limb-ischemia
#5
REVIEW
Pratik K Dalal, Anand Prasad
Critical limb ischemia (CLI) remains a significant cause of morbidity and mortality in patients with peripheral arterial disease. Optimal treatment strategies for CLI remain controversial. The only randomized trial comparing surgical with endovascular revascularization suggests no significant difference in limb salvage between open surgical bypass and angioplasty. Although novel endovascular strategies are now available, their efficacies remain largely untested in a randomized fashion. This review provides an overview of the data surrounding contemporary outcomes of endovascular therapy with an emphasis on current knowledge gaps...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257771/current-role-of-atherectomy-for-treatment-of-femoropopliteal-and-infrapopliteal-disease
#6
REVIEW
Nicolas W Shammas
Atherectomy improves the acute procedural success of a procedure whether treating de novo or restenotic (including in-stent) disease. Intermediate follow-up results seem to be in favor of atherectomy in delaying and reducing the need for repeat revascularization in patients with femoropopliteal in-stent restenosis. Recent data suggest that avoiding cutting into the external elastic lamina is an important factor in reducing restenosis. The interplay between directional atherectomy and drug-coated balloons is unclear...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257770/nitinol-self-expanding-stents-for-the-superficial-femoral-artery
#7
REVIEW
Ashwin Nathan, Taisei Kobayashi, Jay Giri
The superficial femoral artery is a complex artery subject to a unique set of biomechanical loading conditions in its course through the leg. Plain balloon angioplasty and balloon-expandable stents had unacceptably high rates of restenosis, necessitating target vessel revascularization. Nitinol alloy is well suited to provide the strength and flexibility needed of stents to withstand the external forces posed by the environment of the superficial femoral artery. Advances in stent technology with the addition of a slow-releasing antiproliferative agent and changes in scaffold design have shown promise in reducing the rates of stent fracture and in-stent restenosis...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257769/drug-coated-balloons-current-outcomes-and-future-directions
#8
REVIEW
Ananya Kondapalli, Barbara A Danek, Houman Khalili, Haekyung Jeon-Slaughter, Subhash Banerjee
Paclitaxel-coated drug-coated balloons have significantly improved short-term and mid-term clinical outcomes in patients with symptomatic femoropopliteal peripheral artery disease. However, long-term results are awaited. Furthermore, the clinical success of drug-coated balloons in the infrapopliteal peripheral arteries has been more modest and overall similar to traditional balloon angioplasty, and remains an area of unmet clinical need. This article provides an overview of the clinical evidence for paclitaxel-coated balloons in the femoropopliteal and infrapopliteal peripheral artery distributions and future directions in this area...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257768/mechanisms-underlying-drug-delivery-to-peripheral-arteries
#9
REVIEW
Jun Li, Rami Tzafriri, Sandeep M Patel, Sahil A Parikh
Delivery of drugs onto arterial targets via endovascular devices commands several principles: dissolution, diffusion, convection, drug binding, barriers to absorption, and interaction between the drug, delivery vehicle, and accepting arterial wall. The understanding of drug delivery in the coronary vasculature is vast; there is ongoing work needed in the peripheral arteries. There are differences that account for some failures of application of coronary technology into the peripheral vascular space. Breakthroughs in peripheral vascular interventional techniques building on current technologies require investigators willing to acknowledge the similarities and differences between these different vascular territories, while developing technologies adapted for peripheral arteries...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257767/current-endovascular-management-of-acute-limb-ischemia
#10
REVIEW
Javier A Valle, Stephen W Waldo
Acute limb ischemia is a vascular emergency, threatening the viability of the affected limb and requiring immediate recognition and treatment. Even with revascularization of the affected extremity, acute limb ischemia is associated with significant morbidity and mortality resulting in up to a 15% risk of amputation during the initial hospitalization and a 1 in 5 risk of mortality within 1 year of the index event. This review summarizes the current management of acute limb ischemia. Understanding the diagnosis and therapeutic options will aid clinicians in treating these critically ill patients...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257766/is-common-femoral-artery-stenosis-still-a-surgical-disease
#11
REVIEW
Stephan Heo, Peter Soukas, Herbert D Aronow
Surgical endarterectomy has long been the standard approach for treating atherosclerotic stenosis in the common femoral artery. Its major advantage is the associated long-term patency, which approaches 95% at 5 years. Nevertheless, recent studies have suggested that percutaneous treatment may be a valid alternative to surgery.
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/28257765/current-status-and-outcomes-of-iliac-artery-endovascular-intervention
#12
REVIEW
Vladimir Lakhter, Vikas Aggarwal
Aortoiliac occlusive disease (AIOD) is widely prevalent and leads to significant limitations in patient quality of life. All patients with aortoiliac occlusive disease should be managed with approved medical therapies in addition to a supervised exercise program. Persistence of significant symptoms despite noninvasive therapy should prompt further management with endovascular revascularization. Although patients with the most complex cases of AIOD anatomy may ultimately require surgery, advances in endovascular techniques have made it possible to treat most of these patients with AIOD using an endovascular-first approach...
April 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886826/antiplatelet-and-anticoagulation-therapy-in-percutaneous-coronary-intervention
#13
EDITORIAL
Dominick J Angiolillo, Matthew J Price
No abstract text is available yet for this article.
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886825/antiplatelet-and-antithrombotic-therapy-in-patients-with-atrial-fibrillation-undergoing-coronary-stenting
#14
REVIEW
Mikhail S Dzeshka, Richard A Brown, Davide Capodanno, Gregory Y H Lip
Stroke prevention is the main priority in the management cascade of atrial fibrillation. Most patients require long-term oral anticoagulation (OAC) and may require percutaneous coronary intervention. Prevention of recurrent cardiac ischemia and stent thrombosis necessitate dual antiplatelet therapy (DAPT) for up to 12 months. Triple antithrombotic therapy with OAC plus DAPT of shortest feasible duration is warranted, followed by dual antithrombotic therapy of OAC and antiplatelet agent, and OAC alone after 12 months...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886824/switching-p2y12-receptor-inhibiting-therapies
#15
REVIEW
Fabiana Rollini, Francesco Franchi, Dominick J Angiolillo
Antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor is the cornerstone of treatment of patients with atherothrombotic disease manifestations. Switching between P2Y12 inhibitors occurs commonly in clinical practice for a variety of reasons, including safety, efficacy, adherence, and economic considerations. There are concerns about the optimal approach for switching because of potential drug interactions, which may lead to ineffective platelet inhibition and thrombotic complications, or potential overdosing due to overlap in drug therapy, which might cause excessive platelet inhibition and increased bleeding...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886823/protease-activated-receptor-1-antagonists-post-percutaneous-coronary-intervention
#16
REVIEW
Pierluigi Tricoci
Thrombin is a potent platelet agonist, and protease-activated receptor-1 (PAR-1) is the main thrombin receptor in human platelets and thrombin. PAR-1 antagonism has attracted interest as a potential therapeutic target to reduce atherothrombotic events in patients with atherosclerotic disease, especially coronary artery disease. In this review, the author describes the rationale of PAR-1 antagonism for the reduction of atherothrombotic events and reviews the key phase 3 trial results, with special attention to analyses in percutaneous coronary intervention patients...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886822/ticagrelor-effects-beyond-the-p2y12-receptor
#17
REVIEW
Wael Sumaya, Robert F Storey
Platelet P2Y12 receptor inhibitors are crucial in the treatment of patients with acute coronary syndrome or undergoing percutaneous coronary intervention. Ticagrelor is a reversibly binding, potent oral P2Y12 inhibitor that also is a weak inhibitor of the equilibrative nucleoside transporter-1 pathway for cellular adenosine uptake. It is hypothesized that ticagrelor has clinically relevant "off-target" effects, independent of its effect on platelet aggregation and thrombosis. This review considers the pleiotropic effects of ticagrelor and some of the possible mechanisms related to these effects...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886821/cangrelor-pharmacology-clinical-data-and-role-in-percutaneous-coronary-intervention
#18
REVIEW
Matthew J Price
In clinical trials that assessed the safety and efficacy of cangrelor during percutaneous coronary intervention (PCI), cangrelor was administered as a 30-μg/kg bolus followed by a 4-μg/kg/min infusion for at least 2 hours or the duration of the PCI, whichever was longer. Cangrelor is currently indicated as an adjunct to PCI to reduce the risk of myocardial infarction, repeat coronary revascularization, and stent thrombosis in patients who have not been treated with a P2Y12 platelet inhibitor and are not being given a glycoprotein IIb/IIIa inhibitor...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886820/optimal-duration-of-dual-antiplatelet-therapy-after-percutaneous-coronary-intervention
#19
REVIEW
Arjun Majithia, Deepak L Bhatt
Dual antiplatelet therapy (DAPT) is an essential component of treatment in patients with coronary artery disease treated with percutaneous coronary intervention (PCI). Recommendations for duration of DAPT after PCI should consider patient-specific risk, clinical presentation, stent characteristics, and procedural factors. Prolonged DAPT results in a reduction of stent thrombosis (ST) and myocardial infarction (MI) at the cost of increased bleeding. Studies of shorter-duration DAPT demonstrate similar mortality, MI, ST, and less bleeding when compared with longer DAPT duration...
January 2017: Interventional cardiology clinics
https://www.readbyqxmd.com/read/27886819/current-role-of-platelet-function-testing-in-percutaneous-coronary-intervention-and-coronary-artery-bypass-grafting
#20
REVIEW
Lisa Gross, Dirk Sibbing
There is interindividual variability in the pharmacodynamic response to antiplatelet medications. High on-treatment platelet reactivity, reflecting a failure to achieve adequate platelet inhibition, is associated with a higher risk for thrombotic events. Low on-treatment platelet reactivity, or an enhanced response to antiplatelet medications, has been linked to a higher risk for bleeding. There is evidence for the prognostic value of platelet function testing for risk prediction. This review presents the current evidence regarding platelet function testing in patients undergoing percutaneous cardiac intervention and coronary artery bypass grafting...
January 2017: Interventional cardiology clinics
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