Download or read book Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-07 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: Coronary artery disease (CAD), is a narrowing (stenosis) of one or more of the epicardial coronary arteries. It is most commonly due to the buildup of plaque (atherosclerosis), which impedes the ability of these blood vessels to deliver oxygenated blood to the heart muscle (myocardium). Revascularization of the stenotic vessel either by dilatation using a balloon (also known as angioplasty) or by using a bypass venous graft (also known as coronary bypass) are the most common methods to restore blood supply. Percutaneous coronary intervention (PCI) or angioplasty with stent deployment is currently the most commonly performed revascularization procedure for CAD. PCI has traditionally been based on qualitative and quantitative coronary angiography (visual inspection of the radiocontrast lumenogram and computer-based quantification, respectively), an imaging technique for visualizing the interior of blood vessels. While angiography is the standard technique for anatomic visualization of coronary arteries, it is not without limitations as it does not provide information about what is causing the narrowing or whether the narrowing seriously impedes blood flow. Several adjunctive intravascular diagnostic procedures and imaging techniques have been developed for the purpose of providing more detailed anatomic and hemodynamic information about lesions in coronary arteries. However, whether this additional information improves patient outcomes and whether this improvement outweighs any risks introduced by the additional procedure needs to be considered. Using criteria based on the AHRQ CER Methods Guide, we assessed the strength of evidence for major comparisons of interest, as follows: • There is a moderate strength of evidence (drawn from one randomized controlled trial [RCT] and one nonrandomized study) that the adjunctive use of FFR during stenting, as compared with angiography alone, to decide whether an intermediate coronary lesion (50 to 70% stenosis) requires stenting, can confer a lower risk of composite endpoint of death or myocardial infarction (MI) or of major adverse cardiac event (MACE), decrease procedural costs, and lead to fewer stent implantations. However, these FFR studies also included patients with low risk lesions and lower grades of angina, and excluded left main coronary artery disease and acute MI. • There is a moderate strength of evidence (drawn from 9 RCTs and 22 nonrandomized studies) that supports no significant difference in mortality and MI, but a significant reduction in restenosis and repeat revascularizations with IVUS-guided stenting compared with stent placement guided by angiography alone. This significant reduction was observed in RCTs, but not observed in nonrandomized comparative studies. Notably, most of the RCTs were conducted before 2000 using previous generation bare-metal stents. • There is insufficient evidence concerning the use of any intravascular diagnostic techniques immediately after PCI to evaluate the success of stent placement as compared with angiography, or for direct comparisons between intravascular diagnostic techniques. • There is a moderate strength of evidence (on the basis of one large-sample-size nonrandomized study) that sex, diabetes mellitus status, lesion length and reference diameter, and interaction with IVUS- and angiography-guided stent placement did not show any significant association with individual components of death or MI or the composite outcome of MACE. • There is insufficient evidence to evaluate the comparative effect of techniques other than FFR and IVUS on outcomes. The present report describes the development of a stakeholder-prioritized list of research needs for that topic, along with a measured consideration of the advantages and disadvantages of various potential research designs, in order to help researchers and funders develop future research proposals or solicitations.

Download or read book Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Artery Stenting written by Gowri Raman and published by . This book was released on 2013 with total page 171 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Several intravascular diagnostic techniques provide detailed information regarding the narrowing (stenosis) of the lumen of coronary arteries. They are increasingly used in addition to angiography during coronary artery stenting. PURPOSE: To systematically review the comparative effectiveness of intravascular diagnostic techniques versus angiography alone in patients with coronary artery disease who are undergoing percutaneous coronary interventions for the following objectives: (a) to decide whether a coronary lesion needs to be stented; (b) to guide and optimize stent deployment; (c) to assess whether stent placement was successful; and (d) to evaluate the factors influencing the diagnostic techniques' effect on outcomes. DATA SOURCES: MEDLINE(r), Cochrane Central Register of Controlled Trials, recent conference proceedings, and ClinicalTrials.gov. STUDY SELECTION: We included studies of any design and duration of followup, without any language or sample size restriction. We excluded studies that did not directly compare the use of an intravascular diagnostic technique with angiography alone or another intravascular diagnostic technique to decide whether to stent or to guide coronary artery stenting. DATA EXTRACTION: We extracted details on study population characteristics and results, and assessed studies for risk of bias. We evaluated therapeutic decisionmaking outcomes, intermediate outcomes, and patient-centered outcomes. We appraised strength of evidence primarily based on studies rated as having a low or medium risk of bias. DATA SYNTHESIS: In total, 37 eligible studies evaluated two of the intravascular diagnostic techniques, namely fractional flow reserve (FFR) and intravascular ultrasound (IVUS). There is a moderate strength of evidence (drawn from one randomized controlled trial [RCT] and one nonrandomized study) that the use of FFR, as compared with angiography alone, supports the following: (a) FFR is effective in helping to decide whether intermediate coronary lesions (defined as 50% to 70% stenosis) require stenting; (b) FFR confers a lower risk of the composite endpoint of death or myocardial infarction (MI) or of major adverse cardiac events; and (c) FFR leads to fewer stents implanted and reduces the cost of the procedure. Regarding the comparison of IVUS-guided stenting and stent placement guided by angiography alone, there is a moderate strength of evidence (drawn from 9 RCTs and 22 nonrandomized studies) that supports no significant difference between the two approaches in mortality or MI, but a significant reduction in repeat revascularizations and restenosis with IVUS-guided stenting. There is insufficient evidence concerning the use of intravascular diagnostic techniques immediately after percutaneous coronary interventions to evaluate the success of stenting compared with angiography or for direct comparisons between intravascular diagnostic techniques. There is a moderate strength of evidence (on the basis of one large nonrandomized study) that sex, diabetes mellitus status, lesion length, and reference diameter among those undergoing IVUS- and angiography-guided stent placement had no significant association with major adverse cardiac events or its individual components. There is insufficient evidence to evaluate the comparative effect of intravascular diagnostic techniques other than FFR and IVUS. LIMITATIONS: Studies evaluating FFR and IVUS were limited by incomplete outcome reporting, heterogeneity in outcome definitions, infrequent enrollment of women, and a lack of data on patients with left main coronary artery disease or acute MI. The evidence for FFR was derived from trials that focused on patients with lower grade angina or those with nonischemic intermediate coronary stenosis. The majority of the IVUS trials were conducted before 2000, a particularly important limitation given the rapid pace of technological advancement in this domain. CONCLUSIONS: There is a moderate strength of evidence that the use of FFR (as compared with angiography alone) to decide whether or not to stent an intermediate coronary lesion confers a lower risk of composite endpoint of death or MI, or of major adverse cardiac events; leads to fewer stents being implanted; and reduces procedural costs. There is a moderate strength of evidence that the use of IVUS (as compared with angiography alone) to guide optimal stent placement reduces repeat revascularization and restenosis, but does not affect mortality or MI. Future studies will need to focus on women and on patients with more severe coronary artery disease, and to evaluate longer term (on the order of years) patient outcomes to better appreciate real world effectiveness. Stenting low-risk lesions may lead to additional invasive tests or treatments that could adversely impact long-term outcomes. Further research is also needed to evaluate the use of hybrid and novel intravascular diagnostic techniques.

Download or read book Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting written by Stanley Ip and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: The optimal use of intravascular diagnostic techniques in patients with coronary artery diseases who are being considered for stenting remains to be defined. PURPOSE: Generate prioritized topics for future research on the use of intravascular diagnostic techniques, building on evidence gaps identified in a prior comparative effectiveness review (CER) and following an explicit stakeholder-driven nomination and prioritization process. METHODS: Building on evidence gaps identified in a previous CER on intravascular diagnostic techniques, a preliminary list of future research needs (FRN) was supplemented and refined through input from stakeholders. Stakeholders were asked to rate each proposed priority topic considering the following dimensions in prioritization: (1) importance, (2) desirability of research/avoidance of unnecessary duplication, (3) feasibility, and (4) potential impact. The three topics with the highest number of stakeholder endorsements were identified as the prioritized FRN topics. FUTURE RESEARCH NEEDS TOPICS: Two topics (one on the use of intravascular physiologic measurements like fractional flow reserve in treatment decisionmaking before stenting and one on the impact of the use of intravascular imaging diagnostics on stenting) are based directly on evidence gaps identified in the CER. One topic on the added value of intravascular diagnostic techniques in patients for whom there is already a clear clinical and other noninvasive diagnostic indication suggesting the need for revascularization was raised by the stakeholders. CONCLUSIONS: This report identifies three high priority future research needs with regards to intravascular diagnostic techniques, as determined by a stakeholder panel. Both data from pragmatic randomized controlled trials and properly adjusted observational studies could be used to fill the gaps and help address the important clinical questions.

Download or read book Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting Future Research Needs Identification of Future Research Needs From Comparative Effectiveness written by and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting written by and published by . This book was released on 2013 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Primary Angioplasty written by Timothy J Watson and published by Springer. This book was released on 2018-07-13 with total page 338 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is open access under a CC BY 4.0 license. This quick-reference handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology. Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

Download or read book Imaging Coronary Arteries written by David A. Dowe and published by Springer Science & Business Media. This book was released on 2013-11-26 with total page 265 pages. Available in PDF, EPUB and Kindle. Book excerpt: In non-fatal cases, cardiovascular diseases are associated with a decreased quality of life as well as a substantial economic burden to society. Most sudden cardiac events are related to the complications of a non-stenosing marginal plaque. For this reason, the ability to properly identify the atherosclerotic plaque with rapid, non-invasive techniques is of utmost clinical interest in diagnostic workup and therapeutic planning of symptomatic patient. Nowadays CT produces high-quality images of the coronary arteries, in addition to defining their location and the extent of the atherosclerotic involvement. This new edition is enriched with two important additions. Firstly, dedicated chapters on intravascular ultrasound (IVUS), catheter angiography, and nuclear imaging have been included, with some discussions on theoretical techniques such as optical coherence tomography (OCT) and magnetic resonance imaging (MRI). Secondly, a completely new section comprising more than 70 clinical cases remarkably expands the horizons reached by the previous edition. This volume provides general practitioners and cardiologists with a basic understanding of the imaging techniques. For radiologists with no direct experience in cardiac imaging, the book serves as an important source of information on coronary pathophysiology and anatomy.

Download or read book Coronary Imaging and Physiology written by Myeong-Ki Hong and published by Springer. This book was released on 2017-10-31 with total page 323 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book is intended as a guide for all cardiologists who are interested in coronary imaging and physiology, a sound understanding of which is vital for the optimal performance of appropriate coronary interventions. The basics of each relevant modality are presented, with clear explanation of clinical utility and evaluation of the evidence regarding clinical outcomes. All technical methods are described in detail, and the text is complemented by numerous helpful tables and illustrations. The effectiveness of intravascular coronary imaging in improving clinical outcomes is proven, and it is widely used for this purpose. Two modalities for intravascular coronary imaging are available in clinical practice: intravascular ultrasound (IVUS) and optical coherence tomography (OCT). For coronary physiology, the pressure wire-derived fractional flow reserve (FFR) provides information on the functional status of coronary trees. This technique and its clinical applications receive particular attention in the book, which also looks beyond FFR to FFR-CT, a method using computational fluid dynamics, and to invasive assessment of the microcirculation.

Download or read book Practical Manual of Interventional Cardiology written by Annapoorna Kini and published by Springer. This book was released on 2014-11-26 with total page 297 pages. Available in PDF, EPUB and Kindle. Book excerpt: This practical handbook is based on an internal working manual developed by staff and fellows at Mount Sinai Heart Cardiovascular Catheterization Laboratory, renowned for its high-volume and low complication complex coronary procedures. The Practical Handbook of Interventional Cardiology captures the knowledge and methodological know-how from leaders in interventional cardiology, it intends to guide users in a stepwise, methodical and practical approach through various cardiac interventional procedures in order to achieve maximum patient safety and improved outcomes. From patient selection, preoperative work-up, setting up equipment to step-by-step illustrations of various procedural details and troubleshooting, this handbook captures all the details necessary to perform the simplest to the most complex cardiac interventions. The book is designed for cardiologists and trainees who desire an efficient way to review the steps of various cardiac interventional procedures and a quick, reliable reference for everyday use.

Download or read book Bioresorbable Scaffolds written by Yoshinobu Onuma and published by CRC Press. This book was released on 2017-10-02 with total page 533 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book focuses on the coronary bioresorbable scaffold, a new interventional treatment for coronary artery disease, differentiated from a permanent metallic stent. The book provides an overview of the technology including non-clinical studies and clinical evidences in order to help clinicians understand the appropriate application of the technology and the optimal techniques of implantation. It covers the basics of bioresorbable scaffolds; bench test results; preclinical studies; clinical evidences; and tips and tricks of implantation.

Download or read book PanVascular Medicine written by Peter Lanzer and published by Springer. This book was released on 2015-03-30 with total page 5004 pages. Available in PDF, EPUB and Kindle. Book excerpt: ​Vascular management and care has become a truly multidisciplinary enterprise as the number of specialists involved in the treatment of patients with vascular diseases has steadily increased. While in the past, treatments were delivered by individual specialists, in the twenty-first century a team approach is without doubt the most effective strategy. In order to promote professional excellence in this dynamic and rapidly evolving field, a shared knowledge base and interdisciplinary standards need to be established. Pan Vascular Medicine, 2nd edition has been designed to offer such an interdisciplinary platform, providing vascular specialists with state-of-the art descriptive and procedural knowledge. Basic science, diagnostics, and therapy are all comprehensively covered. In a series of succinct, clearly written chapters, renowned specialists introduce and comment on the current international guidelines and present up-to-date reviews of all aspects of vascular care.

Download or read book Cardiovascular Computed Tomography written by James Stirrup and published by Oxford University Press, USA. This book was released on 2020-01-02 with total page 577 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent years have seen a marked increase in cardiovascular computed tomography (CT) imaging, with the technique now integrated into many imaging guidelines, such as those published by ESC and NICE. Rapid clinical and technological progress has created a need for guidance on the practical aspects of CT image acquisition, analysis and interpretation. The Oxford Specialist Handbook of Cardiovascular CT, now revised for the second edition by practising international experts with many years of hands-on experience, is designed to fulfil this need. The Handbook is a practical guide on performing, analysing and interpreting cardiovascular CT scans, covering all aspects from patient safety to optimal image acquisition to differential diagnoses of tricky images. It takes an international approach to both accreditation and certification, highlighting British, European, and American examinations and courses. The format is designed to be accessible and is laid out in easy to navigate sections. It is meant as a quick-reference guide, to live near the CT scanner, workstation, or on the office shelf. The Handbook is aimed at all cardiovascular CT users (Cardiologists, Radiologists and Radiographers), particularly those new to cardiovascular CT, although even the advanced user should find useful tips and tricks within.

Download or read book Coronary Pressure written by N.H. Pijls and published by Springer Science & Business Media. This book was released on 2013-06-29 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiologists must answer three important questions when evaluating and treating patients with a coronary artery stenosis. As a physiologist: "What is the effect of this stenosis on coronary blood flow and myocardial function?"; as a clinician: " Is this lesion responsible for the patient's symptoms?"; and finally as an interventionalist: "Will revascularization of this artery improve the patient?" Fundamentally, the answer to these questions can be given to a large extent by measuring coronary pressure. That is the rationale of writing this book. 1. 1 Historical overview. Andreas Gruentzig and most interventional cardiologists in the early days of PTCA, had the intuitive feeling that pressure measurements could help to establish the severity of a coronary stenosis and to monitor the progress and result of a coronary intervention. At that time, measuring coronary pressure by the balloon catheter was part of a standard procedure. A residual transstenotic gradient of less than 15 mmHg was generally considered as a good result. Later, however, it turned out that measuring these (resting) gradients with balloon catheters was inaccurate an only had a limited prognostic value. Moreover, because there was no consistent theory to correlate pressure measurements to blood flow, the interest in measuring coronary pressures faded and disappeared almost completely with the introduction of new balloon catheters not intended for pressure measurement.

Download or read book Chronic Total Occlusions written by Ron Waksman and published by John Wiley & Sons. This book was released on 2011-08-31 with total page 373 pages. Available in PDF, EPUB and Kindle. Book excerpt: Chronic total occlusions (CTO) are common, and found in approximately one third of patients with significant coronary artery disease who undergo angiography. Over the past 20 years, CTO lesions have represented the most difficult anatomy for treatment — with lower success rates and higher complication rates. Chronic Total Occlusions provides interventionalists insight into the world of CTOs with introductory chapters that describe the pathology and indications of CTOs along with a review of clinical trials. Imaging modalities including CT angiography, magnetic navigation wire, and IVUS guided recanalization of CTO are also introduced, together with information on new wires technology and devices for CTOs. With numerous illustrations of these devices, technologies, and strategies to improve the CTO success rate, this clinical guide, headed up by Ron Waksman, will prove to be the ideal companion for interventional cardiologists and cardiac surgeons who are required to perform angioplasty and coronary stenting.

Download or read book Practical Textbook of Cardiac CT and MRI written by Tae-Hwan Lim and published by Springer. This book was released on 2015-02-09 with total page 330 pages. Available in PDF, EPUB and Kindle. Book excerpt: This up-to-date textbook comprehensively reviews all aspects of cardiac CT and MRI and demonstrates the value of these techniques in clinical practice. A wide range of applications are considered, including imaging of atherosclerotic and non-atherosclerotic coronary artery disease, coronary revascularization, ischemic heart disease, non-ischemic cardiomyopathy, valvular heart disease, cardiac tumors, and pericardial disease. The numerous high-quality images illustrate how to interpret cardiac CT and MRI correctly for the purposes of diagnosis, treatment planning, and follow-up. Helpful summarizing sections in every chapter will facilitate rapid retrieval of information. This book will be of great value to radiologists and cardiologists seeking a reliable guide to the optimal use of cardiac CT and MRI in real clinical situations.​ An additional feature is the provision of QR codes allowing internet access to references, further figures, and motion pictures. The reader will be able to enjoy this book using a smartphone or tablet PC.

Download or read book An Atlas and Manual of Coronary Intravascular Ultrasound Imaging written by Paul Schoenhagen and published by CRC Press. This book was released on 2003-11-19 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt: Intravascular ultrasound (IVUS) is an imaging technique used during coronary angiography. This book provides a systematic introduction to coronary imaging with (IVUS). It is divided into two integrated and extensively cross-referenced parts, the Atlas and the Manual. The Manual describes the rationale, method, and interpretation of IVUS imaging for

Download or read book Oxford Textbook of Interventional Cardiology written by Simon Redwood and published by Oxford University Press. This book was released on 2018-09-13 with total page 808 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiac catheterization and coronary angiography remain key tools in the management of patients with coronary heart disease. Although this is the most frequently used method of coronary revascularization, general training in cardiology rarely offers more than the opportunity to assist a more senior operator to perform angioplasty procedures. This textbook, covering key procedures and fully revised and updated to include the latest trials, technology, and new techniques, is essential reading. The Oxford Textbook of Interventional Cardiology, 2nd edition spans the whole spectrum of interventional cardiology procedures, including a novel section on the future of interventional cardiology, and multiple new chapters covering special devices in percutaneous coronary intervention. Written by an expert team of international authors, this book offers guidance on all aspects of interventional cardiology according the European curriculum, and covers the evidence-based guidelines for a comprehensive view of the field.