Cardiovascular Medicine Book

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AngioplastyAka: Percutaneous Coronary Intervention, PTCA

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  1. Indications
    1. Cardiac Ischemia
    2. Myocardial Infarction
  2. Timing: Perioperative Stent Implications
    1. Recent PTCA
      1. Balloon angioplasty
        1. Time since surgery <14 days: Delay non-urgent or elective surgery
        2. Time since surgery >14 days: Proceed to surgery with Aspirin
      2. Bare-metal stent
        1. Time since surgery <30-45 days: Delay non-urgent or elective surgery
        2. Time since surgery >45-90 days: Proceed to surgery with Aspirin
      3. Drug-eluting stent
        1. Time since surgery <365 days: Delay non-urgent or elective surgery
        2. Time since surgery >365 days: Proceed to surgery with Aspirin
    2. PTCA required to stabilize acute cardiovascular status prior to surgery
      1. Surgery with low risk of bleeding: Stent and continue dual-antiplatelet therapy
      2. Time to surgery 14 to 29 days: Balloon angioplasty
      3. Time to surgery 30 to 365 days: Bare-metal stent
      4. Time to surgery >365 days: Drug-eluting stent
  3. Efficacy
    1. Initial: 95% effective in coronary ischemia
    2. Angioplasty without stent: 35% re-stenosis at 6 months
    3. Angioplasty with stenting: 17% re-stenosis at one year
    4. Angioplasty with stenting and radiotherapy
      1. Lowers re-stenosis rate at 6 months
      2. Lowers need for revascularization at one year
      3. Does not alter mortality rate
      4. Does not alter Myocardial Infarction rate
      5. Waksman (2002) N Engl J Med 346:1194
    5. Angioplasty with drug eluting stent
      1. Overall restenosis rate: 10%
      2. Drug eluting stents have a higher rate of thrombus formation in first 6-12 months
        1. See adverse effects below
      3. Initial studies: 6.9% re-stenosis at 9 months
        1. Moses (2003) N Engl J Med 349:1315
  4. Trials
    1. START (Stent versus directional coronary atherectomy)
      1. Atherectomy superior to primary stenting
    2. References
      1. Tsuchikane (1999) J Am Coll Cardiol 34:1050
  5. Adverse Effects: Thrombosis at drug eluting stent site
    1. May be related to polymer used to bind the drugs to the stent
    2. Requires concurrent Aspirin 81 mg and Clopidogrel (Plavix) 75 mg for at least 12 months
      1. Minimizing Aspirin dose decreases serious bleeding events
      2. Significantly reduces cardiovascular events
    3. Peri-operative management within one year of drug eluting stent placement
      1. Delay elective surgeries for >1 year from PTCA placement
      2. Less invasive procedures (e.g. endoscopy) can be performed without stopping dual agents
      3. Protocol for more invasive urgent procedures
        1. Continue Aspirin 81 mg throughout perioperative period
        2. Stop Clopidogrel 5 days before surgery and restart on same day of surgery postoperatively
          1. First dose on restarting Clopidogrel should be loading dose of 300 mg
    4. References
      1. Kopacky (2008) Mayo Selected Topics in Internal Medicine, Lecture
      2. Mehta (2001) Lancet 358:527
  6. References
    1. Serruys (2001) N Engl J Med 344:1117

Angioplasty, Transluminal, Percutaneous Coronary (C0002997)

Definition (MSH)Dilatation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply.
Definition (NCI)A procedure to open an occluded coronary artery, performed by percutaneous introduction of a catheter into a peripheral (usually femoral) artery which is directed in a retrograde fashion to reach the diseased coronary artery.
ConceptsTherapeutic or Preventive Procedure (T061)
ICD900.66
MSHD015906
EnglishBalloon angioplasty of coronary artery, Coronary Balloon Angioplasties, Coronary Balloon Angioplasty, Percutaneous angioplasty of coronary artery, Percutaneous balloon angioplasty of coronary artery, Percutaneous transluminal coronary angioplasty, Percutaneous transluminal coronary balloon angioplasty, PTCA, PTCA - Percutaneous transluminal coronary angioplasty, Transluminal Coronary Balloon Dilatation
Spanishangioplastia coronaria con balon transluminal percutanea, angioplastia coronaria transluminal percutanea
Parent ConceptsCardiovascular Surgical Procedures (C0038897), Angioplasty, Balloon (C0002996), Myocardial Revascularization (C0027056), Angioplasty (C0162577), Coronary angioplasty (C0190211), Percutaneous transluminal balloon angioplasty (C0411287), Percutaneous balloon angioplasty of artery (C0456226), Duplicate concept (C1274013)
SourcesCCS, CSP, MSH, MTH, MTHICD9, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Angioplasty (C0162577)

Definition (MSH)Endovascular reconstruction of an artery, which may include the removal of atheromatous plaque and/or the endothelial lining as well as simple dilatation. These are procedures performed by catheterization. When reconstruction of an artery is performed surgically, it is called ENDARTERECTOMY.
Definition (CSP)diverse group of surgical procedures to remove or flatten constrictive deposits on the inner walls of blood vessels, thereby improving blood flow.
Definition (NCI)A procedure to repair a damaged blood vessel.
ConceptsTherapeutic or Preventive Procedure (T061)
MSHD017130
EnglishAngioplasties, Angioplasty, Angioplasty - action, Angioplasty of blood vessel, intraluminal angioplasty, Repair of blood vessel
Spanishangioplastia, reparacion de un vaso sanguineo
Parent ConceptsCardiovascular Surgical Procedures (C0038897), Catheterization (C0007430), Vascular Surgical Procedures (C0042381), Angioplasty (C0162577), Dilation procedure (C0392800), Catheter procedure (C0455760), Cardiovascular system repair (C1293374), Reason not stated concept (C1276325)
SourcesCSP, LNC, MEDLINEPLUS, MSH, MTH, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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