Dear Cardiologist , can you spare a minute extra in cath lab . . . and give many happy years for your patients !
PCI (Fondly called PTCA) made a humble beginning from a Zürich hospital in 1977 . In 4 decades it has become the staple diet of most cardiologists , of course bulk of our patients benefit from that . When Gruentzig introduced the concept stent was never in the picture .Now stents have become mandatory in all most all PCI (We have gone one stop ahead (probably in the wrong direction !) and given a cult status to drug electing stent .
Now we enjoy our work with countless tools and techniques in our coronary automobile shop .
Suddenly . . . 0ne primitive , common sense based question is asked !
How many seconds are required to optimally dilate and deploy the coronary stent ?
This debate is thrown out live into cath lab . . . by this simple and elegant study from the prestigious CCI journal.
- 105 patients, 150 lesions , Three different stents were used
- Cypher Select (55%) , Xience V (30.%), Taxus Liberté (15.%)
- Three balloon inflation timing
- 5, 15, 25 seconds
- Complex lesion (B2) formed 26 %
This paper concludes , duration of stent balloon inflation has a significant impact on stent expansion. Stent deployment for >25 sec is recommended.
It again keeps the vital answer to our guess ! Can we inflate it for 60 seconds ? After all 60 /120 seconds both are greater than 25 sec is isn’t ?
This seemingly simple paper conveys a strong message .
Time is every thing , . . . we have to be fast . . . where we need to (Time is muscle) and we have to be slow where we need to* . It has rekindled the basic senses of our supposedly advanced brains !
I agree . . . every minute of cardiologist’s life is precious as “Time is also Wealth” , still few minutes of caution and patience in cath lab can make world of good for our patients !
* The most important determinant of cath lab complications , is lack of patience on the part of cardiologist .Next only comes , expertise , adequacy of hardware etc . Surprisingly , patient factors come in the bottom of the list in most non emergency interventions.
Further questions ?
- Can post dilatation be as efficacious as that of stent- balloon dilatation ?
- In difficult lesions , the sum of “Pre / Per / Post” balloon dilatation gives us net inflation time(NIT) Does it add any sense to our understanding of optimal stent deployment ?