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New technology in coronary intervention

S Spiliopoulos, P Kitrou, K Katsanos, D Karnabatidis
Intra-Vascular Ultra-Sound (IVUS) and Frequency Domain-Optical Coherence Tomography (FD-OCT), in vivo, intra-vascular, imaging modalities, widely used in the field of coronary disease, have been recently implemented in peripheral endovascular procedures, for procedural assessment, plaque characterization and determination of predictors of treatment outcomes. Their unique characteristics have also been used in order to provide additional features and improve the performance of re-entry devices and atherotomes...
January 13, 2017: Expert Review of Medical Devices
T Bruce Ferguson
Surgical revascularization with coronary artery bypass grafting (CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease (SIHD). This recommendation is based on traditional 5-year outcomes of mortality and avoidance of myocardial infarction leading to reintervention and/or cardiac death. However, these results are confounded in that they challenge the traditional CABG surgical tenets of completeness of anatomic revascularization, the impact of arterial revascularization on late survival, and the lesser impact of secondary prevention following CABG on late outcomes...
November 26, 2016: World Journal of Cardiology
Stephen G Ellis, Haris Riaz
The introduction of stents has drastically reduced target-lesion restenosis rates associated with percutaneous coronary angioplasty. Bare-metal stents were the first introduced, followed by drug-eluting stents, both of which had significant impacts on the complication rates. Stents, however, have resulted in the emergence of stent thrombosis and stent restenosis, which can cause life-threatening cardiac complications. Three new technological approaches are being investigated to overcome these complications: stents coated with bioresorbable polymers, stents without polymers, and completely bioresorbable stents...
November 2016: Cleveland Clinic Journal of Medicine
Prashant Bharadwaj, D S Chadha
Currently, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is the most commonly employed modality in the treatment of patients with coronary artery disease. PCI has come of age over the last four decades with enormous forays in the technology and drugs which have greatly enhanced its capability. Angioplasty and bare metal stents were plagued by high failure rates on account of restenosis leading to repeat revascularization procedures. Insights into pathophysiology of instent restenosis (ISR) and neointimal hyperplasia triggered the development of DES...
October 2016: Medical Journal, Armed Forces India
Laura E Leigh Perkins, Mary Beth Kossuth, Julia C Fox, Richard J Rapoza
Bioresorbable scaffolds (BRS) combine attributes of the preceding generations of percutaneous coronary intervention (PCI) devices with new technologies to result in a novel therapy promoted as being the fourth generation of PCI. By providing mechanical support and drug elution to suppress restenosis, BRS initially function similarly to drug eluting stents. Thereafter, through their degradation, BRS undergo a decline in radial strength, allowing a gradual transition of mechanical function from the scaffold back to the artery in order to provide long term effectiveness similar to balloon angioplasty...
November 2016: Catheterization and Cardiovascular Interventions
Ajay Yadlapati, Mark Gajjar, Daniel R Schimmel, Mark J Ricciardi, James D Flaherty
ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI...
October 6, 2016: Internal and Emergency Medicine
Jacek Bil, Robert J Gil
Bioresorbable vascular scaffolds (BVS) have emerged as an interesting alternative since the presence of the prosthesis in the coronary artery is transient. This technology enables to restore the normal vasomotor tone and allows positive remodeling, simultaneously reducing the trigger for persistent inflammation and facilitating further interventions by percutaneous or surgical means. Absorb BVS(®) is the first generation everolimus-eluting poly-L-lactide (PLLA) bioresorbable scaffold. In recent meta-analyses Absorb BVS(®) was definitely proved to be safe and effective device in the treatment of symptomatic coronary artery disease...
August 2016: Journal of Thoracic Disease
Andrea B Troxel, David A Asch, Shivan J Mehta, Laurie Norton, Devon Taylor, Tirza A Calderon, Raymond Lim, Jingsan Zhu, Daniel M Kolansky, Brian M Drachman, Kevin G Volpp
BACKGROUND: Coronary artery disease is the single leading cause of death in the United States, and medications can significantly reduce the rate of repeat cardiovascular events and treatment procedures. Adherence to these medications, however, is very low. METHODS: HeartStrong is a national randomized trial offering 3 innovations. First, the intervention is built on concepts from behavioral economics that we expect to enhance its effectiveness. Second, the implementation of the trial takes advantage of new technology, including wireless pill bottles and remote feedback, to substantially automate procedures...
September 2016: American Heart Journal
Carlos Collet, Robbert J de Winter, Yoshinobu Onuma, Patrick W Serruys
INTRODUCTION: Every decade the field of interventional cardiology is revolutionized by new technology. The fully bioresorbable everolimus-eluting scaffold (ABSORB BVS) technology would preserve the benefits of metallic stents by sealing balloon-induced dissections, avoiding elastic recoil and vessel occlusion. The polymeric scaffold would be resorbed to restore the natural integrity of the vessel, superseding the consequence of the permanent presence of a foreign body in the coronary artery...
October 2016: Expert Opinion on Drug Delivery
M Bucci, C Tana, M A Giamberardino, F Cipollone
AIMS: This article reports current evidence on the association between Lp(a) and cardiovascular (CV) disease and on pathophysiological mechanisms. The available information on therapy for reduction of lipoprotein(a) is also discussed. DATA SYNTHESIS: Although some evidence is conflicting, Lp(a) seems to increase CV risk through stimulation of platelet aggregation, inhibition of tissue factor pathway inhibitor, alteration of fibrin clot structure and promotion of endothelial dysfunction and phospholipid oxidation...
July 12, 2016: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
Esra Eren Bayindir, Pinar Karaca Mandic
IMPORTANCE: Little is known about the geographic and hospital variations of the new medical technologies in Medicare. Even less is known about these variations for the privately insured. OBJECTIVE: To examine geographic and hospital variations in the diffusion of drug eluting stents, comparing Medicare and privately insured populations. DESIGN: Retrospective analyses of discharges from the State Inpatient Databases for 11 states (2004-2005) supplemented with data on hospital characteristics from the American Hospital Association Annual Survey...
June 2016: Health Economics & Outcome Research: Open Access
Giuseppe Giacchi, Luis Ortega-Paz, Salvatore Brugaletta, Kohki Ishida, Manel Sabaté
Coronary bioresorbable vascular scaffolds are a new appealing therapeutic option in interventional cardiology. The most used and studied is currently the Absorb BVS™. Its backbone is made of poly-L-lactide and coated by a thin layer of poly-D,L-lactide, it releases everolimus and is fully degraded to H2O and CO2 in 2-3 years. Absorb BVS™ seems to offer several theoretical advantages over metallic stent, as it gives temporary mechanical support to vessel wall without permanently caging it. Therefore, long-term endothelial function and structure are not affected...
2016: Medical Devices: Evidence and Research
Robert D Safian
Professional societies recommend embolic protection devices (EPDs) during percutaneous intervention of saphenous vein bypass grafts (SVGs; class I, level of evidence B). Practice patterns indicate that 21% of SVG interventions are performed with EPDs. Despite a single randomized trial that demonstrated efficacy for EPDs, other studies suggest that the benefits of EPDs are controversial. Consideration should be given toward performing a contemporary EPD trial to incorporate new technologies and pharmacotherapies; in the meantime, guideline recommendations for use of EPDs should be downgraded...
July 2016: Catheterization and Cardiovascular Interventions
W A Leber
The introduction of fractional flow reserve computed tomography (FFR-CT) that is performed from static coronary CT angiography datasets may open new horizons in the diagnostic management of patients with suspected coronary artery disease. FFR-CT has a high sensitivity and moderate specificity in identifying ischemia in intermediate coronary stenoses. It has been demonstrated that this technology has the potential to significantly reduce the number of invasive coronary angiograms and the rate of normal coronary angiograms that are not followed by an intervention...
August 2016: Herz
Bernhard Meier
Evidence-based diagnosis, decision-making, and therapy appear a must these days. Generating and publishing evidence is a tedious job according to ever new and tightened research practice regulations. Rules will never prevent the typical human behaviour from showing the new thing to be shinier and the old thing dustier than they really are. The medical community is solicited to concoct a meal that is gullible for patients, authorities, and third-party payers out of the available evidence (after applying some conversion factors correcting the common bias of the researchers), anticipation of what will be the evidence tomorrow, common sense, and digested experience...
July 7, 2016: European Heart Journal
Mirlind Kastrati, Lukas Langenbrink, Michal Piatkowski, Jochen Michaelsen, Doris Reimann, Rainer Hoffmann
This study sought to quantitatively evaluate the reduction of radiation dose in coronary angiography and angioplasty with the use of image noise reduction technology in a routine clinical setting. Radiation dose data from consecutive 605 coronary procedures (397 consecutive coronary angiograms and 208 consecutive coronary interventions) performed from October 2014 to April 2015 on a coronary angiography system with noise reduction technology (Allura Clarity IQ) were collected. For comparison, radiation dose data from consecutive 695 coronary procedures (435 coronary angiograms and 260 coronary interventions) performed on a conventional coronary angiography system from October 2013 to April 2014 were evaluated...
August 1, 2016: American Journal of Cardiology
Javier Escaned, Adrian Banning, Vasim Farooq, Mauro Echavarria-Pinto, Yoshinobu Onuma, Nicola Ryan, Rafael Cavalcante, Carlos M Campos, Bojan M Stanetic, Yuki Ishibashi, Pannipa Suwannasom, Arie-Pieter Kappetein, David Taggart, Marie-Angèle Morel, Gerrit-Anne van Es, Patrick W Serruys
AIMS: The applicability of the results of the SYNTAX trial comparing percutaneous coronary intervention (PCI) using first-generation drug-eluting stents (DES) with coronary artery bypass graft (CABG) surgery for the treatment of patients with complex coronary artery disease (CAD) has been challenged by recent major technical and procedural developments in coronary revascularisation. Functional assessment of coronary lesions has contributed to marked improvements in both safety and efficacy of DES implantation...
June 12, 2016: EuroIntervention
Claire McCune, Peter McKavanagh, Ian B A Menown
INTRODUCTION: Multiple significant, potentially practice changing clinical trials in cardiology have been conducted and subsequently presented throughout the past year. METHODS: In this paper, the authors have reviewed and contextualized significant cardiovascular clinical trials presented at major international conferences of 2015 including American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, American Diabetes Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, Heart Rhythm Congress, and the American Heart Association Scientific Sessions...
December 2016: Cardiology and Therapy
J Li, X Li, S Hu, Y Yu, X F Yan, L X Jiang
OBJECTIVE: To assess trends in clinical characteristics, treatments, and outcomes for hospitalized patients with ST-segment elevation myocardial infarction(STEMI) in eastern urban China from 2001 to 2011. METHODS: The data were obtained from the China PEACE-retrospective acute myocardial infarction study. Patients admitted to hospital in the eastern urban China for STEMI were selected via two-stage random sampling. The first phase was to identify participating hospitals via a simple random-sampling procedure...
April 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
Daniel Brie, Peter Penson, Maria-Corina Serban, Peter P Toth, Charles Simonton, Patrick W Serruys, Maciej Banach
Today, drug-eluting metal stents are considered the gold standard for interventional treatment of coronary artery disease. While providing inhibition of neointimal hyperplasia, drug-eluting metal stents have many limitations such as the risk of late and very late stent thrombosis, restriction of vascular vasomotion and chronic local inflammatory reaction due to permanent implantation of a 'metallic cage', recognized as a foreign body. Bioresorbable scaffold stents (BRS) are a new solution, which is trying to overcome the limitation of the 'metallic cage'...
July 15, 2016: International Journal of Cardiology
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