Further burring will only aggravate the situation and the procedure will have to be terminated before the endpoint is realized and hence prevention is key.
Steps to do this have been listed under hypotension and bradycardia. The use of glycoprotein GP IIb-IIIa inhibitors is of some benefit but is hazardous should a perforation occur and hence is not advisable as prophylactic treatment. Use of bivalirudin instead of unfractionated heparin has been described, though immediate reversal is not possible should a perforation occur. Intracoronary nitroglycerin, adenosine, verapamil, and nitroprusside boluses are used to improve flow. Other methods to correct ensuing ischemia and its consequences should be employed and may include the placement of an IABP.
The lesion should be adequately treated with stent placement to ensure adequate distal flow and to treat any underlying dissection, which may sometimes explain this slow flow. This phenomenon is associated with a high incidence of a postprocedural cardiac enzyme and troponin elevation, and patients should be managed as ACS patients. Catheter Cardiovasc Interv. This paper describes techniques that reduce complications based on newer methods that were tested in a large number of patients.
This is the basis for current practice.
Coronary Laser Angioplasty
J Am Coll Cardiol. This meta-analysis discusses the available techniques of plaque modification and their role in contemperory percutaneous coronary interventions. Am Heart J. Results from this trial suggests improved procedural outcome with debulking using rotational atherectomy for diffuse in-stent restenosis. As the practice of coronary interventions have evolved and the techniques of rotational atherectomy have been refined, the complication rates and early success rates are very favorable as compared to the early days of this technique.
This paper describes the role of plaque debulking in the current era and the niche role of this technique when drug-eluting stents are used. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Login Register. Read an unlimited amount by logging in or registering at no cost. General description of procedure, equipment, technique Introduction Following the introduction of balloon angioplasty as treatment for obstructive coronary artery disease, it became quickly evident that this procedure was associated with two major problems—acute closure of the vessel and chronic restenosis.
Indications and patient selection Indications for rotational atherectomy Calcified and "undilatable" lesions Heavily calcified lesions may not respond well to predilation and hence stents placed may be underexpanded in these lesion subsets. Undilatable lesions may be suspected in the following scenarios: Coronary calcification visible on fluoroscopy, computed tomography CT scan, or intravascular ultrasound IVUS Previous balloon angioplasty that failed to dilate the lesion adequately i.
Ostial lesions Aorto-ostial lesions and bifurcation lesions exhibit elastic recoil after predilation, inhibiting stent crossing and appropriate stent expansion.
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Other indications This procedure may be sometimes used in treating chronic total occlusions or resistant lesions when the stenosis cannot be crossed with a balloon after successful wire passage. Contraindications Contraindications Thrombotic lesion Rotational atherectomy will most likely result in embolization into the distal bed. Dissection in the lesion Dissections may have been caused by previous attempts at angioplasty or spontaneously due to plaque disruption. Tortuous vessel The presence of severe tortuosity proximal to the lesion may make it difficult to get close to the lesion and spinning the burr in tortuous segments may increase the chance of complications.
Poor flow in the distal bed Poor flow in the coronary branches distal to the bed either due to the severity of the lesion, diffuse disease, or embolization are relative contraindications since wash out of debulked debris would be limited resulting in a further decrease in coronary flow. Severe left ventricular dysfunction Patients with severe left ventricular dysfunction may be unable to tolerate somewhat prolonged ischemia that may result from this procedure.
Sole remaining vessel or large amount of myocardium in jeopardy This is a relative contraindication since prolonged ischemia in this situation may be associated with deterioration in clinical condition.
Cardiac Catheterization & Coronary Angioplasty and Stent (Interventional Procedures)
Details of how the procedure is performed Rotational atherectomy The procedure is performed by using a Rotablator catheter Boston Scientific , which consists of a spring coil shaft with a burr at the tip. Complications and their management Complications and management Hypotension and bradycardia These are very common complications, particularly while treating the right coronary artery. Powered By Decision Support in Medicine.
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Close more info about Rotational Atherectomy. Get the most out of Cardiology Advisor. Finally, contrast injection during ELCA was associated with multiple calcium fractures and fractures even in thicker calcium. Conclusions: ELCA is effective for treating ISR with underexpansion by disrupting peri-stent calcium, facilitating better expansion of the previously implanted stent. Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline. Coronary interventions.
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Haag 2 , RN; Ziad A. This part of the procedure is called a coronary angiogram or coronary angiography. The digital photographs of the contrast material are used to identify the site of the narrowing or blockage in the coronary artery. Additional imaging procedures, called intra-vascular ultrasound IVUS and fractional flow reserve FFR , may be performed along with cardiac catheterization in some cases to obtain detailed images of the walls of the blood vessels.
Both of these imaging procedures are currently only available in specialized hospitals and research centers. With IVUS, a miniature sound-probe transducer is positioned on the tip of a coronary catheter. The catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the inside walls of the arteries. IVUS produces an accurate picture of the location and extent of plaque.
With FFR, a special wire is threaded through the artery and a vasodilator medication is given. This test is functionally performing a very high quality stress test for a short segment of the artery. What is an interventional procedure? An interventional procedure is a non-surgical treatment used to open narrowed coronary arteries to improve blood flow to the heart.
An interventional procedure can be performed during a diagnostic cardiac catheterization when a blockage is identified, or it may be scheduled after a catheterization has confirmed the presence of coronary artery disease. An interventional procedure starts out the same way as a cardiac catheterization. Once the catheter is in place, one of these interventional procedures is performed to open the artery: balloon angioplasty, stent placement, rotablation or cutting balloon. Balloon angioplasty: A procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery.
The technical name for balloon angioplasty is percutaneous transluminal coronary angioplasty PTCA or percutaneous coronary intervention PCI. When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened dilated to increase blood flow to the heart. This procedure is sometimes complicated by vessel recoil and restenosis. Balloon angioplasty with stenting: In most cases, balloon angioplasty is performed in combination with the stenting procedure.
Laser angioplasty : Coronary Artery Disease
A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open.
The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent. In this way, restenosis is somewhat diminished.