Attenuated coronary collateral function after drug-eluting stent implantation: a new downside of drug-eluting stents?
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Biomedical subjects
Publications and source records attributed to Morton J Kern.
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With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.
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This report describes a technique for correct positioning of a stent in an ostial stenosis by using a second wire passed through the last cell of a stent. The anchor wire technique, first described by Szabo et al. [Szabo S, Abramowitz B, Vaitkus PT. Am J Cardiol 2005;96:212H], will facilitate precise ostial stent placement and eliminate errors of positioning inside or outside the ostial narrowing.
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This report describes a technique for correct positioning of a stent proximal to a bifurcation lesion treated with V-stents. A second wire passed through the first cell of a stent, the opposite end of the anchor wire technique as first described by Szabo et al, facilitated precise stent placement and eliminated erroneous positioning inside or outside the treated bifurcation lesion.
While Coronary angiography remains the standard for the diagnosis and treatment of coronary artery disease within the cardiac catheterization lab, many lesion subsets require further investigation to determine their overall significance in causing symptoms. Direct measurement coronary flow and subsequently the ability to measure coronary pressure changes at maximal hyperemia have been developed to provide physiologic data to the catheterization operator which reveal the significance of coronary artery lesions in question and guide treatment. These measures, coronary flow reserve (CFR) and fractional flow reserve (FFR) have been validated against non-invasive tests for myocardial ischemia. Furthermore, FFR has also been studied in its ability to guide percutaneous coronary interventions in single vessel disease, multi-vessel disease, ostial side-branch lesions, and left main lesions.
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More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women.
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