Sample : Interventional Cardiology
Interventional cardiology focuses on the treatment of cardiovascular diseases through catheter-based procedures rather than open-heart surgery. These techniques are minimally invasive and are commonly used to manage coronary artery disease, structural heart defects, and vascular diseases. Below are key aspects of interventional cardiology:
1. Percutaneous Coronary Intervention (PCI)
Definition: A non-surgical procedure used to treat narrowing (stenosis) of the coronary arteries of the heart, often caused by atherosclerosis.
Procedure:
A catheter is inserted through the femoral or radial artery and threaded into the coronary arteries.
A balloon is inflated at the site of the blockage to widen the artery (balloon angioplasty).
A stent (a metal mesh tube) is often placed to keep the artery open.
Indications:
Acute coronary syndromes (ACS), including ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI).
Chronic stable angina.
Stent Types:
Bare-metal stents (BMS): Earlier stents that are prone to restenosis.
Drug-eluting stents (DES): Coated with drugs to prevent restenosis, offering better long-term outcomes.
2. Coronary Angiography
Definition: A diagnostic imaging technique used to visualize the inside of coronary arteries.
Procedure:
A contrast dye is injected through a catheter into the coronary arteries.
X-ray imaging (fluoroscopy) is used to visualize the coronary anatomy.
Indications:
To assess the extent of coronary artery disease (CAD).
Prior to PCI or coronary artery bypass grafting (CABG).
In patients with chest pain (angina) or abnormal stress tests.
3. Transcatheter Aortic Valve Replacement (TAVR)
Definition: A minimally invasive procedure to replace a stenotic aortic valve without open-heart surgery.
Procedure:
A catheter is inserted into a large artery (usually femoral) and advanced to the heart.
A balloon-expandable or self-expanding valve is delivered via the catheter and positioned at the site of the diseased aortic valve.
The new valve is deployed, pushing aside the old valve and immediately improving blood flow.
Indications:
Severe aortic stenosis in patients at high risk or ineligible for surgical valve replacement.
4. Transcatheter Mitral Valve Repair (MitraClip)
Definition: A procedure to repair a leaking mitral valve (mitral regurgitation) using a catheter-based approach.
Procedure:
A catheter is inserted through the femoral vein and guided to the heart.
A clip is placed on the mitral valve leaflets to reduce the leak.
Indications:
Severe mitral regurgitation in patients who are not candidates for open-heart surgery.
5. Fractional Flow Reserve (FFR)
Definition: A guide to determine the functional significance of a coronary artery stenosis.
Procedure:
A pressure wire is passed through a stenosis during coronary angiography.
The pressure difference across the stenosis is measured before and after administering vasodilators.
Indications:
To assess whether a coronary stenosis is significant enough to require intervention.
In borderline cases of CAD where visual estimation from angiography is inconclusive.
6. Chronic Total Occlusion (CTO) Interventions
Definition: These are specialized procedures used to open completely blocked arteries that have been occluded for more than three months.
Procedure:
Special techniques, such as guidewire crossing and re-entry devices, are used to pass through the occluded segment.
Indications:
In patients with long-standing CAD and symptoms that are not relieved by medical management.
7. Peripheral Vascular Interventions
Definition: These procedures address blockages in arteries outside the heart, such as the carotid arteries, renal arteries, and leg arteries.
Common procedures include:
Carotid artery stenting.
Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.
Angioplasty and stenting for peripheral artery disease (PAD).
8. Intracoronary Imaging
Intravascular Ultrasound (IVUS):
Uses a catheter-based ultrasound probe to visualize the inside of coronary arteries.
Helps assess plaque characteristics and optimize stent deployment.
Optical Coherence Tomography (OCT):
Uses infrared light to create high-resolution images of the coronary artery walls.
Useful for precise evaluation of stent apposition and plaque morphology.
9. Complications of Interventional Cardiology Procedures
Bleeding and vascular complications at the access site (femoral or radial artery).
Coronary artery dissection or perforation during angioplasty or stent placement.
In-stent restenosis (narrowing of the artery within a previously placed stent).
Acute thrombosis of the stent, requiring immediate intervention.
Contrast-induced nephropathy due to the use of contrast agents.
10. Post-Procedural Care
Antiplatelet therapy: Dual antiplatelet therapy (DAPT) is commonly prescribed after stenting, usually with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor).
Lifestyle modification: Encouraging smoking cessation, a healthy diet, and exercise.
Monitoring for restenosis: Regular follow-up with non-invasive stress tests or repeat angiography if symptoms recur.
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Intervention Cardiology – Full Course
The Textbook of Interventional Cardiology covers a comprehensive array of topics essential for understanding and practicing interventional cardiology. The key areas include:
Cath Lab Basics and Safety: An introduction to coronary artery anatomy, vascular access, and radiation safety in the catheterization lab.
Core Procedures: In-depth discussion of coronary interventions such as percutaneous coronary interventions (PCI), chronic total occlusion management, and handling calcified coronary lesions.
Diagnostic Imaging: Detailed guidance on using techniques like intravascular ultrasound (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) for accurate diagnosis and treatment planning.
Device and Procedure-Specific Techniques: Covers the use of guidewires, stents, and hemodynamic support tools, along with guidelines for high-risk PCI.
Specialized Interventions: Treatment approaches for specific conditions, including left main disease, vulnerable plaque imaging, and device therapy for heart failure and hypertension.
Peripheral and Structural Interventions: Discusses interventions for lower extremity disease, renal and mesenteric arteries, and structural heart interventions such as valve repair and atrial appendage closure.
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