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New technology in coronary intervention

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https://www.readbyqxmd.com/read/28228292/a-fresh-look-at-bioresorbable-scaffold-technology-intuition-pumps
#1
EDITORIAL
Sundeep Mishra
Bioresorbable scaffolds (BRS) are a new enticing treatment option in coronary interventions. Absorb BVS™ Is the most widely used and researched polymer based BRS, eluting everolimus. However currently it has several technical limitations; low radial support, larger strut size, poor visualization, poor deliverability and complex implantation technique. Magnesium based BRS are an alternate but they are also limited not only by lower radial support and poor visualization but also earlier bio-absorption. Material processing: blow-molding, annealing, polymer orientation, change in composition and use of higher molecular weight polymer, as well new polymers like tyrosine or salicyclate analogs and even hybrid (polymer and metallic) combined with intelligent cell design has led to evolution of BRS technology...
January 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28220461/new-generation-coronary-stents-current-data-and-future-directions
#2
REVIEW
Ankur Kalra, Hasan Rehman, Sahil Khera, Braghadheeswar Thyagarajan, Deepak L Bhatt, Neal S Kleiman, Robert W Yeh
PURPOSE OF REVIEW: Drug-eluting stents are the mainstay in the treatment of coronary artery disease using percutaneous coronary intervention. Innovations developed to overcome the limitations of prior generations of stents include biodegradable polymer stents, drug-eluting stents without a polymer, and bioabsorbable scaffolds. Our review briefly discusses the clinical profiles of first- and second-generation coronary stents, and provides an up-to-date overview of design, technology, and clinical safety and efficacy profiles of newer generation coronary stents discussing the relevant clinical trials in this rapidly evolving area of interventional cardiology...
March 2017: Current Atherosclerosis Reports
https://www.readbyqxmd.com/read/28183437/cardiac-3d-printing-and-its-future-directions
#3
REVIEW
Marija Vukicevic, Bobak Mosadegh, James K Min, Stephen H Little
Three-dimensional (3D) printing is at the crossroads of printer and materials engineering, noninvasive diagnostic imaging, computer-aided design, and structural heart intervention. Cardiovascular applications of this technology development include the use of patient-specific 3D models for medical teaching, exploration of valve and vessel function, surgical and catheter-based procedural planning, and early work in designing and refining the latest innovations in percutaneous structural devices. In this review, we discuss the methods and materials being used for 3D printing today...
February 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28164572/impact-of-the-cyp2c19-gene-polymorphism-on-clopidogrel-personalized-drug-regimen-and-the-clinical-outcomes
#4
Keguang Chen, Rui Zhang, Huanjun Liu, Xi Guo, Pingli Li, Xuehong Liu
BACKGROUND: Although the relationship between CYP2C19 genotype and clopidogrel metabolism has been studied clearly, we have not seen the report that clopidogrel was administered at a dose adjusted based on genotyping. The two main polymorphism loci of CYP2C19 gene were detected by the CYP2C19 genetic testing. ADP platelet aggregation technology was used to investigate the correlation between clinical effect and the clopidogrel dose, genetic metabolic type, physiological, pathological and other factors, to provide new ideas for clopidogrel therapy for percutaneous coronary intervention postoperation patients...
September 1, 2016: Clinical Laboratory
https://www.readbyqxmd.com/read/28144714/-new-and-established-aspects-of-cardiological-diagnostics-using-tee-do-we-need-3d-technology-in-clinical-routine
#5
A Hagendorff, S Stoebe, D Jurisch, M Neef, M Metze, D Pfeiffer
In comparison to transthoracic echocardiography (TTE) transesophageal echocardiography (TEE) enables an acquisition of images with better spatial resolution due to the use of higher ultrasound frequencies. Thus, the morphology and function of cardiac structures can principally be analyzed better and more accurately with TEE than with TTE. In addition, using three-dimensional (3D) TEE data sets standardized sectional planes can be constructed by post-processing, which enables quantitative assessment of the target structures...
January 31, 2017: Herz
https://www.readbyqxmd.com/read/28089778/image-noise-reduction-technology-reduces-radiation-in-a-radial-first-cardiac-catheterization-laboratory
#6
Ateka Gunja, Yagya Pandey, Hui Xie, Beata M Wolska, Adhir R Shroff, Amer K Ardati, Mladen I Vidovich
BACKGROUND: Transradial coronary angiography (TRA) has been associated with increased radiation doses. We hypothesized that contemporary image noise reduction technology would reduce radiation doses in the cardiac catheterization laboratory in a typical clinical setting. METHODS AND RESULTS: We performed a single-center, retrospective analysis of 400 consecutive patients who underwent diagnostic and interventional cardiac catheterizations in a predominantly TRA laboratory with traditional fluoroscopy (N=200) and a new image noise reduction fluoroscopy system (N=200)...
December 27, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28064551/fd-oct-and-ivus-intravascular-imaging-modalities-in-peripheral-vasculature
#7
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
https://www.readbyqxmd.com/read/27957249/physiology-of-in-situ-arterial-revascularization-in-coronary-artery-bypass-grafting-preoperative-intraoperative-and-postoperative-factors-and-influences
#8
REVIEW
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
https://www.readbyqxmd.com/read/27861114/bioresorbable-stents-the-future-of-interventional-cardiology
#9
REVIEW
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
https://www.readbyqxmd.com/read/27843185/drug-eluting-stents-to-evolve-or-dissolve
#10
REVIEW
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
https://www.readbyqxmd.com/read/27797462/paving-the-way-to-a-bioresorbable-technology-development-of-the-absorb-brs-program
#11
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
https://www.readbyqxmd.com/read/27714584/contemporary-management-of-st-segment-elevation-myocardial-infarction
#12
REVIEW
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...
December 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27619478/bioresorbable-vascular-scaffolds-what-does-the-future-bring
#13
COMMENT
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
https://www.readbyqxmd.com/read/27595692/rationale-and-design-of-a-randomized-trial-of-automated-hovering-for-post-myocardial-infarction-patients-the-heartstrong-program
#14
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
https://www.readbyqxmd.com/read/27550021/the-absorb-bioresorbable-vascular-scaffold-for-the-treatment-of-coronary-artery-disease
#15
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
https://www.readbyqxmd.com/read/27514608/lp-a-and-cardiovascular-risk-investigating-the-hidden-side-of-the-moon
#16
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
https://www.readbyqxmd.com/read/27500283/medicare-and-private-insurance-variations-in-new-medical-technology-the-case-of-drug-eluting-stents
#17
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
https://www.readbyqxmd.com/read/27468252/bioresorbable-vascular-scaffolds-technology-current-use-and-future-developments
#18
REVIEW
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
https://www.readbyqxmd.com/read/27400638/saphenous-vein-bypass-graft-intervention-and-embolic-protection-devices-time-for-reassessment-and-revision-of-percutaneous-coronary-intervention-guidelines
#19
EDITORIAL
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
https://www.readbyqxmd.com/read/27393032/is-ffr-ct-a%C3%A2-game-changer-in-the-diagnostic-management-of-stable-coronary-artery-disease
#20
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
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