Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Stroke is often the result of carotid atheroma, which may cause ischemia via progressive arterial narrowing or lead to superimposed thrombus formation and subsequent atheroembolism to the intracerebral vasculature. Revascularization through carotid endarterectomy or carotid artery stenting with embolic protection devices has produced favorable results in appropriately selected patients. In planning the percutaneous approach, an arch aortogram is first acquired to determine arch type and identify the presence of any anatomic variants which may affect the approach to the procedure and catheter selection. ⋯ Although Doppler ultrasound, computed tomography (CT), and magnetic resonance angiography (MRA) may be useful in evaluating the presence of carotid or cerebrovascular disease, digital subtraction angiography is required prior to performance of a percutaneous intervention in order to create a procedural "roadmap". Additionally, the comprehensive management of cerebrovascular disease requires a detailed knowledge of the specific clinical syndromes that result from ischemia in each vascular territory. This methodical review of cerebrovascular anatomy and stroke syndromes will provide the operator with the tools to conduct a thorough neurological assessment prior to revascularization, evaluate any periprocedural complications that may arise, and evaluate the patient with suspected stroke.
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Catheter Cardiovasc Interv · Mar 2010
Review Case ReportsThe utility of trans-catheter aortic valve replacement after commercialization: does the European experience provide a glimpse into the future use of this technology in the United States?
Treatment of aortic stenosis remains challenging in older individuals, as their perioperative mortality for open heart surgery is increased due to comorbidities. Transcatheter aortic valve implantation using the CoreValve ReValving System (Medtronic, Minneapolis, USA) and the Edwards SAPIEN transcatheter heart valve (THV; Edwards Lifescience, Irvine, California, USA) represents an alternative to conventional valve replacement in elderly patients that have a high risk for conventional surgery. This article summarizes the evidence-base from recent clinical trials. ⋯ Additionally, the lessons learned thus far from the European perspective and the potential impact on the future use in the US are discussed. Despite of the progress in this field, we are still lacking an optimal transcatheter heart valve. Once it is available, we can take the plunge to compare transcatheter valve implantation with convention surgery in severe aortic stenosis!
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Catheter Cardiovasc Interv · Mar 2010
Review Case ReportsEmergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest.
Long-term survival rates even after successful resuscitation from out-of-hospital cardiac arrest are dismal. Most of those initially resuscitated expired during their hospitalization. Recent reports have suggested that a more aggressive approach to postresuscitation care is the key to better outcome. ⋯ Most promising is combining these two postresuscitation therapies, namely immediate induction of hypothermia and early coronary angiography and PCI. Combining these therapies has resulted in long-term survival rates of 70% with more than 80% of all such survivors neurologically functional. Even those without ST elevation on their postresuscitation ECG can greatly benefit from timely induction of hypothermia and early angiography/PCI.
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Catheter Cardiovasc Interv · Jan 2010
ReviewAntithrombotic strategies in patients on oral anticoagulant therapy undergoing percutaneous coronary intervention: a proposed algorithm based on individual risk stratification.
An increasing number of patients on chronic oral anticoagulant therapy undergo percutaneous coronary intervention. There is a lack of evidence-based data and no practice guidelines are available about the optimal antithrombotic treatment of such patients after the procedure; thus, the adopted strategies are highly variable and are often left to the discretion of the attending physician. In this article, we review current evidence and propose an algorithm of antithrombotic strategies tailored to the individual patient, which takes into account the relative risks of bleeding, ischemic complications, and thromboembolism.
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Catheter Cardiovasc Interv · Aug 2009
ReviewIs the left atrial appendage more than a simple appendage?
The left atrial appendage (LAA) is a cardiac structure with unique anatomic and functional features. It is significantly more than a simple chamber appended to the left atrium (LA), differing from the LA in structure, function, and hormonal activity. ⋯ Benign healing of the appendage occurs without adverse hemodynamic effects, and with no residual surface thrombus or tissue damage. The feasibility of this treatment is now established, suggesting that percutaneous therapy is safe, practical and possibly effective to eliminate the need for anticoagulation and significantly reduce cardioembolic events.