ADVANCES IN INTERVENTIONAL CARDIOLOGY-
PATIENT TREATMENT OPTIONS
Aftab Jan
Cardiologist
GRUENTZIG performed the first coronary BALLOON angioplasty in 1977
Transcatheter Intervention
toolbox
Patient with Left main stem disease and complex diffuse disease…
Diffuse disease not amenable to surgery/Hybrid revascularisation approach
Patient with ongoing angina, a chronically occluded artery and evidence of viability…
LITHOPLASTY USES SOUND WAVES TO DISRUPT VASCULAR CALCIUM FOR OPTIMAL
STENT DEPLOYMENT.
DISRUPT CAD, a multicentre single arm trial of the Shockwave system in patients with complex
calcified obstructive coronary artery disease prior to drug-eluting stent implantation showed 98
percent device success, an acute gain of 1.7 mm, and 13 percent residual stenosis post procedure.
CORONARY IMAGING TECHNOLOGY THAT ALLOWS VISUALIZATION
WITHIN ARTERY
INTRAVASCULAR ULTRASOUND (IVUS) OPTICAL COHERENCE TOMOGRAPHY (OCT)
LASER GUIDED ANGIOPLASTY IN PATIENT WITH AGGRESSIVE
NEOATHEROSCLEROSIS
Laser sheath delivers a ring of laser energy to vaporize the atheromatous tissue into
particles that are absorbed into the blood stream.
CT FRACTIONAL FLOW RESERVE (FFR) CUT-OFF 0.80
Patient with PFO and cryptogenic stroke…
Cryptogenic stroke i.e. stroke in the absence of classical vascular or cardioembolic sources, under the age of 55 years.
The mechanism has been attributed to paradoxical embolism through this residual embryologic intratrial communication
in some patients.
RA
LAIAS
RESPECT :The question of PFO closure efficacy has been a decades-long
question, but in final study findings, closure solidly beat medical
management for secondary stroke prevention in cryptogenic stroke.
Other studies
favouring closure
over medical
therapy alone
CLOSE
REDUCE
Amplatzer PFO Occluder
PATIENT WITH A.FIB, HIGH STROKE RISK AND UNFIT FOR
ANTICOAGULATION…?
(Minimally invasive) transcatheter aortic valve implantation (TAVI)
PARTNER 2A confirmed the noninferiority of Sapien XT implantation
to surgical aortic valve replacement (SAVR) in intermediate-risk
patients with symptomatic severe aortic stenosis. In those suitable for
transfemoral access, superiority was seen for the primary endpoint of
all-cause death and disabling stroke at two years.
Mitral valve is ready to stop playing second fiddle…?
RENAL DENERVATION MAKING A COMEBACK
The nerves that lead to the kidneys are a critical part of your patient's
sympathetic nervous system.
An overactive sympathetic nervous system can be one of the key
mechanisms that results in high blood pressure.
RDN works by interrupting the signalling coming from the nerves
SPYRAL HTN-OFF MED SPYRAL HTN-ON MED
PCSK9 inhibitors might be the “fluoride” of cardiology
.
PCSK9 inhibitors, should they be found to safely reduce cardiovascular events or stabilize
vulnerable plaques, could be a disrupter to interventional cardiology since, well, since the
invention of over-the-wire balloon angioplasty.
The success of transcatheter heart disease therapies has been the ability to do procedures that may have once required surgery, in a minimally invasive fashion.
A healthy respect for the complications of new and innovative therapy is critical for interventionalists.
In high-risk patients these therapies are readily accepted. However, in patients
of low operative risk we constantly re-examine transcatheter therapies with the
availability of excellent surgical therapies with long-term track records
Careful evaluation, monitoring and reporting of outcomes of these
new therapies are critical for further advancement and insight into
ideal patient selection.