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Posts Tagged ‘time is muscle stent money’

Dear Cardiologist , can you spare a minute  extra  in cath  lab   . . . and give many happy years for your patients !

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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.

cci journal ptca pci balooln inflation time

Highlights

  • 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 %

balloon inflation time pci ptca

 

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 ?

Final message

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.

Reference

http://onlinelibrary.wiley.com/doi/10.1002/ccd.23343/abstract

Further questions ?

  1. Can post dilatation be as  efficacious   as that of  stent- balloon  dilatation ?
  2. 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  ?

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