Posted in Cardiology -Interventional -PCI, Cardiology -Therapeutic dilemma, Cardiology -unresolved questions, tagged aorto ostial lesion, aorto ostial stenting, coronary ostial stenting, merit medical ostio pro stent system, ostial dissection in rca, ostio pro coronary stent system, proximal left main disease, rca stent projecting to aorta, stent, stent lost in aortic root, stent migration, stent projection in aortic root, stenting, tips and tricks cath lab left main stenting, tips for aorto ostial stenting on November 2, 2014| 1 Comment »
Aorto ostial stenting requires extra caution and special technique. It always worry us what if few mm of metal might project into Aorta when we stent a RCA or left main ostium.
To prevent this ,Merit- medical has innovated a catheter that help us position the stent exactly at the ostial level .It is done with a help of an octopus like buttressing arm that support the aortic wall when the stent is deployed .
Watch the video.
Reference
Posted in Uncategorized, tagged acc aha guidelines, acs, cabg, cath lab, chronic stable angina, cleaveland clinic, coronay revascularisation, courage trial, cypher stent, des, euoropct, flow limiting lesion, gruentzig, jacc, jama, left main disese, mayo clinic, nejm, nstemis, paclitaxel, pci, primary pci, proximal lad, ptca, ravel, scai, sirius, sirolimus, stemi, stent, stenting, syntax score, taxus, tct md, triple vesseldisease, wisdom trial on May 4, 2009| 1 Comment »
Scientifically , the indication for coronary revascularisation should be based on following
Practically ,
A CAD patient may fulfill “Any of the above 5 “ or “None of the above 5” , but , if a coronary obstruction was revealed by coronary angiogram and if he fulfils The 6th criteria , he becomes eligible for revascualrisation
If the patient has enough monetary resources (by self ) or by an insurance company to take care of PCI /CABG *
*The sixth criteria overrides all other criteria in many of the cath labs .Of course , there are few genuine ones still fighting hard , to keep the commerce out , from contaminating cardiology !
Posted in Cardiology -Interventional -PCI, Infrequently asked questions in cardiology (iFAQs), tagged acc, acs, bifurcation angioplasty, cardiology, coronary, cypher, des, drsvenkatesan, drug eluting stent, europcr, jacc, medina, nejm, pci, primary pci, ptca, scai, side branch, stenting, taxus, tctmd, unstable angina, xience v on September 6, 2008| Leave a Comment »
There are numerous complex grading for bifurcation lesions available.
The one proposed by Medina is simple and most useful.
In this grading three segments
Are given a code 0, and 1 if lesion is present or absent .
This grading gives simple and fast method to label a bifurcatiuon lesion and to asssess the response to PCI. The only issue here is the individual lesions are not graded , for example branch vessel ostium just involved about 20 % is not addressed . Further TIMI flow in these vessels may also be incorporated
A patient with 1.1.1 after the treatment should revert back to 0.0.0. if converted into 0.0.(.5) may indicate a residual side branch lesion .5 shall indicate 50% residual lesion, .3 , 30% etc
The topic has been discussed extensively for over a decade in various forums.
Though the lesions and intervention techniques appear complex the basic concept is simple.
Following is the 8 point algorithm
1. Assess the bifurcation lesion accurately.
2. Apply the general rule and ask the first question whether PCI is neccessary at all ? if decided for PCI
3. Stent the main vessel.Protect the side branch.
4. Dilate the side branch with a balloon.(KIss or through the struts)
5. Very rarely, if the side vessel is more significant and large stent it and balloon the main vessel.
6. Use drug eluting stents with caution .
7. Resist the temptation of using two stents unless the situation demands and is absolutely required.
8. Never attempt to do bifurcation angioplasty during ACS as apart of primary angioplasty.( Unless you’re extremely competent, even then aim of primary PCI is to salvage myocarium quickly , not to provide TIMI 3 flow in non IRA vessel.)
Dr.S.Venkatesan.Madras medical college.Chennai.
Dr.S.Venkatesan MD 