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INTERVENTIONAL CARDIOLOGY AN OVERVIEW Timothy P. Morris, D.O., F.A.C.C.

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Presentation on theme: "INTERVENTIONAL CARDIOLOGY AN OVERVIEW Timothy P. Morris, D.O., F.A.C.C."— Presentation transcript:

1 INTERVENTIONAL CARDIOLOGY AN OVERVIEW Timothy P. Morris, D.O., F.A.C.C.

2 INTERVENTIONAL CARDIOLOGY DIAGNOSTIC CATHETERIZATION CORONARY ANGIOPLASTY AORTIC AND PERIPHERAL ANGIOPLASTY PERCUTANEOUS CLOSURE OF SHUNTS FOREIGN BODY REMOVAL STIMULATION OF COLLATERAL FORMATION

3 INTERVENTIONAL CARDIOLOGY UNITED STATES 1.2 MILLION DIAGNOSTIC CATHETERIZATIONS PER YEAR 480,000 CORONARY ANGIOPLASTIES PER YEAR 1 MILLION WORLDWIDE

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5 INTERVENTIONAL CARDIOLOGY HISTORY –FORSSMAN st RIGHT HEART CATH –ZIMMERMAN st LEFT HEART CATH –SELDINGER 1953 –SONES 1958 –GRUENTZIG 1977

6 INTERVENTIONAL CARDIOLOGY INDICATIONS ASYMPTOMATIC –POSITIVE STRESS TEST –SUDDEN CARDIAC DEATH –INDIVIDUALS IN HIGH RISK PROFFESIONS –PRIOR TO SURGERY WITH BORDERLINE POSITIVE NONINVASIVE STRESS TESTS AND RISK FACTORS

7 INTERVENTIONAL CARDIOLOGY SYMPTOMATIC –FAILED MEDICAL THERAPY –UNSTABLE ANGINA PECTORIS –PRINZMETALS ANGINA –ANGINA PECTORIS INTOLERANCE TO MEDS HIGH RISK OCCUPATION MARKEDLY ABNORMAL STRESS TEST –PRIOR TO VASCULAR SURGERY

8 INTERVENTIONAL CARDIOLOGY ATYPICAL CHEST PAIN –HIGH RISK NON-INVASIVE STUDIES –SUSPECTED CORONARY VASOSPASM –CONGESTIVE HEART FAILURE POST MYOCARDIAL INFARCTION –FAILED THROMBOLYTIC THERAPY –SUSPECTED COMPLICATIONS

9 INTERVENTIONAL CARDIOLOGY VALVULAR HEART DISEASE –POSITIVE NON-INVASIVE STRESS TEST –PRIOR TO VALVE REPLACEMENT MALES > 35 y.o. FEMALES > 40 y.o. CONGENITAL HEART DISEASE –SUSPECTED CORONARY ANOMALIES –MALES > 40 y.o., POST MENOPAUSAL FEMALES

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12 INTERVENTIONAL CARDIOLOGY PROCEDURE –ARTERIAL ACCESS –VENOUS ACCESS –LEFT HEART CATH –RIGHT HEART CATH –SELECTIVE CORONARY ANGIOGRAPHY

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14 INTERVENTIONAL CARDIOLOGY LIMITATIONS OF ANGIOGRAPHY

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18 INTERVENTIONAL CARDIOLOGY ULCERATED PLAQUE

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23 INTERVENTIONAL CARDIOLOGY INDICATIONS FOR PTCA ASYMPTOMATIC, MILD SYMPTOMS –SUDDEN CARDIAC DEATH –SEVERE MYOCARDIAL ISCHEMIA –FAILURE MEDICAL THERAPY –INTOLERANT OF MEDICAL THERAPY –PRIOR TO HIGH RISK SURGERY

24 INTERVENTIONAL CARDIOLOGY INDICATIONS FOR PTCA SYMPTOMATIC –UNSTABLE ANGINA PECTORIS –FAILED MEDICAL THERAPY –LARGE AREA VIABLE MYOCARDIUM –RESCUE PTCA –PRIMARY PTCA IN ACUTE MI –CARDIOGENIC SHOCK

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27 INTERVENTIONAL CARDIOLOGY PTCA PROCEDURE FEMORAL ARTERIAL/ VENOUS ACCESS PLACE GUIDE CATHETER WIRE LESION BALLOON ANGIOPLASTY STENT SEAL ARTERIOTOMY

28 INTERVENTIONAL CARDIOLOGY PHARMACOLOGIC THERAPY ASPIRIN HEPARIN GLYCOPROTEIN 2B-3A INHIBITORS TICLID PLAVIX TREATMENT OF RISK FACTORS

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30 INTERVENTIONAL CARDIOLOGY

31 INTERVENTIONAL CARDIOLOGY CONTRAINDICATIONS ABSOLUTE –UNPROTECTED LEFT MAIN –LESION LESS THEN 50% –NO SURGICAL BACKUP RELATIVE –DIFFUSELY DISEASED SVG –DIFFUSELY DISEASED NATIVE VESSELS WITH GOOD DISTAL TARGETS

32 INTERVENTIONAL CARDIOLOGY CONTRAINDICATIONS RELATIVE (continued) –BLEEDING DIASTHESIS –PTCA OF NON-INFARCT VESSEL DURING PRIMARY PTCA –HIGH RISK ANATOMY FOR ABRUPT CLOSURE –SOLE VESSEL SUPPLYING HEART –DIABETICS WITH MULTIVESSEL Dx

33 INTERVENTIONAL CARDIOLOGY MAJOR COMPLICATIONS DEATH (0.5%-1%) Q-WAVE MYOCARDIAL INFARCTION ( 1%-3%) EMERGENT SURGERY (1%)

34 INTERVENTIONAL CARDIOLOGY PROCEDURAL COMPLICATIONS ACUTE CLOSURE (4%-8%) –SPASM –THROMBUS –DISECTION –EMBOLISM –TREATABLE WITH STENTS PERFORATION

35 INTERVENTIONAL CARDIOLOGY

36 INTERVENTIONAL CARDIOLOGY SHORT TERM RESULTS SUCCESS RATES (90%-95%) RESTENOSIS –OCCURS IN 2-4 MONTHS,RARE AFTER 6 MONTHS –RATE (32%-57%) –STENTS ( 20%-30%)

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40 INTERVENTIONAL CARDIOLOGY LONG TERM RESULTS SURVIVAL –1 YEAR ( 97%) –5 YEARS (88%-97%) –10 YEARS (78%-90%) EVENT-FREE SURVIVAL –1 YEAR (81%-90%) –5 YEARS ( 79%) –10 YEARS ( 65%)

41 INTERVENTIONAL CARDIOLOGY NEW DEVICES STENTS DIRECTIONAL ATHERECTOMY ROTATIONAL ATHERECTOMY TRANSLUMINAL ATHERECTOMY ANGIOJET RADIATION PMR

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43 INTERVENTIONAL CARDIOLOGY NIR STENT

44 C:\WINDOWS\All Users\Application Data\Microsoft\Works\Portfolio\Sample.dir\ 70\Portfolio file 1.emfC:\WINDOWS\All Users\Application Data\Microsoft\Works\Portfolio\Sample.dir\ 70\Portfolio file 1.emf

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57 INTERVENTIONAL CARDIOLOGY MITRAL VALVULOPLASTY

58 INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS

59 INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS AFTER STENTING

60 INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS

61 INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS POST PTA

62 INTERVENTIONAL CARDIOLOGY PTMR

63 INTERVENTIONAL CARDIOLGY SUMMARY RAPIDLY GROWING FIELD PTCA IDEAL FOR SINGLE VESSEL AND 2-VESSEL DISEASE WITHOUT PROXIMAL LAD INVOLVEMENT STENTS USED IN 80% PTCA CASES RESTENOSIS A LIMITING FACTOR NON-CORONARY PTA EXPANDING


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