Stenting

Coronary stenting improves blood supply to the heart muscle using stents to widen the coronary arteries. Visit Radcliffe Cardiology’s website for more articles.

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Coronary stenting improves blood supply to the heart muscle using stents to widen the coronary arteries. Visit Radcliffe Cardiology’s website for more articles.

Common and Uncommon CTO complications

Chronic total occlusions (CTO) are a common finding at angiography in patients with coronary artery disease (CAD); they are present in ~20 % of cases at angiography (excluding those with acute MI or prior coronary artery bypass graft (CABG).1 Data from the same Canadian registry showed that only 10 % of CTO patients had had a percutaneous coronary intervention (PCI) attempted to treat CTO, with only 7 % successfully revascularised by this procedure.

The Newest Generation of Drug-eluting Stents and Beyond

When Andreas Grüntzig introduced balloon coronary angioplasty in 1977 it represented the first alternative to coronary artery bypass graft surgery. However, balloon dilatation had inherent limitations – including elastic recoil and vessel closure in the acute phase, as well as negative remodelling and restenosis in the late phase – which limited its applicability and further expansion. In the 1980s, bare metal stents (BMS) rapidly demonstrated superiority over balloon angioplasty, improving angiographic results and clinical outcomes.

Challenges in Patients with Diabetes: Improving Clinical Outcomes After Percutaneous Coronary Intervention Through EVOlving Stent Technology

Newer generation polymeric metallic drug-eluting stents (DES) have shown improved efficacy and safety compared with bare-metal stents and first-generation DES, improving patient outcomes after percutaneous coronary intervention (PCI) and facilitating the treatment of more complex coronary disease.1 However, clinical outcomes in certain lesion and patient subsets remain suboptimal. Procedural and/or technological refinements may improve success rates in such scenarios.

Current State of the Art in Approaches to Saphenous Vein Graft Interventions

Saphenous vein grafts (SVGs) are commonly used during coronary artery bypass graft surgery (CABG) for severe coronary artery disease. However, SVGs are prone to both degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. Previous reports suggest rates of SVG failure in the first 12–18 months may be as high as 25 %.1–4 SVG neointimal hyperplasia and accelerated atherosclerosis diminish the long-term benefits of CABG, while subsequent SVG interventions are plagued by plaque embolisation and no-reflow phenomenon.

The Proximal Optimisation Technique for Intervention of Coronary Bifurcations

The coronary tree is comprised of arteries which divide into ever smaller branches to supply the myocardium. This means that the diameter of the vessel proximal to a bifurcation is always larger than the diameter of the main vessel distal to the bifurcation. The proximal optimisation technique (POT) was proposed by Dr Olivier Darremont as a technique to compensate for this difference in diameters when bifurcation lesions are stented.

Optimising Stent Deployment in Contemporary Practice: The Role of Intracoronary Imaging and Non-compliant Balloons

In 1995, stent implantation became the second revolution in interventional cardiology when Colombo et al. demonstrated that intravascular ultrasound (IVUS)-guided post-dilatation of stents to achieve optimal expansion and larger lumens led to reduced restenosis and stent thrombosis (ST).1 This ‘bigger is better’ hypothesis became the technical cornerstone of all stent implantation in the bare metal stent (BMS) era.