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Posts Tagged ‘interventional cardiology’

What is Interventional cardiology ? I don’t know , . . I am in pursuit of a curious new definition !

Posted in Uncategorized, tagged , , , , on February 2, 2019|

Let me see how many find sense in this Nonsense !


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Learn the essence of Interventional coronary care in 180 seconds flat !

Posted in Cardiology -Therapeutic dilemma, cardiology -Therapeutics, Cardiology -unresolved questions, tagged , , , , , , on October 3, 2014| 1 Comment »

Your clock starts  now !

 

clock gif dr s venkatesan002

Chronic stable angina : Most can be effectively managed  by  optimal /intensive medicines and life style Interventions .About 10% will require PCI/CABG.

ACS – STEMI:  Primarily  managed  with  rapid and competent  pre-hospital care with prompt thrombolysis in or out of hospital .Patients  with  large STEMI who develop complications (Again about 10 %)   require PCI and few additional  lives can be saved.

ACS-NSTEMI : This is  the group that demand  an  important role for PCI . All true high risk UA/NSTEMI patients  should receive urgent coronary  angiogram and critical lesions  should either be stented or  sent for CABG  (If the lesions are multiple and complex ) The field of interventional  cardiology  is  expected  to play a major  role in  this category of  patients for the simple reason , we  not only give dramatic  relief from angina and also prevent a  potentially a huge MI that is waiting to happen !

* It is vital to emphasise  the “Aim and  objective” in  NSTEMI  management  is critically different from other two. We know ,  in CSA   the aim is to give relief  symptoms  and improve excercise capacity . Both PCI/CABG  are  unlikely  to prevent a future MI in CSA..In STEMI it has already occurred .The aim is to salvage myocardium  and prevent  future events. While PCI can do the former , it can’t do the later . In STEMI scenerio ,we have very good  alternate  modality called thrombolysis which can easily beat the  pPCI  in , cost , availability and time  (and  hence efficiency as well  in  most  countries !)

Counter thought

The above suggestion  is too simplified ,generalized , misleading , and  unscientific, should   strongly be disagreed. For those people who disagree , I provide an alternate scheme  .It is ultra short ,comes in  5 lines .Very practical  and  scientific too  !

In any  patient , who is  suspected to have either  acute or chronic  coronary syndromes ,take them to the cath lab in an  urgent or semi urgent fashion .Do an angiogram and stent all lesions  that you feel important . If  stenting is not possible  manage  with optimal medicines and /or send them to the surgeons.

Final message

The essence of catheter based coronary care is simple.We complicate it. To understand this concept  100’s of cardiology  journals  and as many conferences and infinite  number of books are churned out every year !

 

 

 

 

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What is double barrel stenting ?

Posted in Cardiology -Interventional -PCI, tagged , , , , , , , , , , , , , , , , , on February 13, 2011| Leave a Comment »

  • It is a complex PCI procedure meant for  high risk  bifurcation /Trifurcation lesions
  • Two stents are simultaneously  deployed.
  • It aims to prevent sudden acute occlusion of one of the major  branches .
  • It is not an easy procedure , and be used only in rare circumstances .
  • Distal left main and ostio proximal LAD/LCX  is a  classical  example.
  • Navigation can be difficult , only well experienced operators should attempt it.

*Is there a ready made two lumen stent available ?

The image is meant for concept purpose only !

 

It is one of the techniques available to stent unprotected left main

An excellent review  in  ACC intervention journal for unprotected left main .

Click on the Image to reach the article

 


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Unscientific quotes for the interventional cardiologists

Posted in Uncategorized, tagged , , , , on December 21, 2008| Leave a Comment »

A poorly deployed drug eluting stent is far inferior to a properly deployed bare metal stents

  • Doing a plain old balloon  angioplasty ( POBA)  is not a scientific crime , millions of coronary lesion just  need that! ( Click here -Why POBA is important ? )
  • PCI is most effective during an ACS than a chronic coronary syndrome
  • Primary PCI is a race against time and muscle , not a race against money ! Don’t do it  for a  evolved   MI
  • Recognise , from the patient point of view  the term no reflow is  generally  synonymous with   failed primary PCI( It is semantics !)
  • Side branch  can be more important than main branches , so don’t sacrifice it often
  • Attempting a trifurcation  angioplasty is generally not in  the interest of the patient but  to show interventional expertise
  • Make sure surgical back up means, a table is reserved with a surgeon fully informed and ready

When in  doubt , it is always  better to err on a longer stent than a shorter one

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Is plaque fissure or rupture painful ?

Posted in cardiology- coronary care, tagged , , , , , , , on July 19, 2008| Leave a Comment »

Plaque fissure ,rupture and subsequent thrombois is the hallmark of acute coronary syndrome . Are these events painful ? We always attribute any chest pain in an ACS patient to ischemia of myocardium.Is that always true? Coronary artery also has a rich vasa nervorum that could be activated by plaque disruption.

Why  we need an answer to this question ?

We are triaging patients for early invasive apporach based on chestpain .

Many patients may be subjected to revascularisation process for an non ischemic coronary pain !

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