Angioplasty procedure, percutaneous transluminal coronary

Anticoagulant in patients with unstable angina who are undergoing percutaneous transluminal coronary angioplasty (PTCA) in conjunction with aspirin IV 0 75 mg/kg as IV bolus followed by IV infusion at rate of 1.75 mg/kg/hr for duration of procedure. After initial 4-hr infusion is completed, may give additional IV infusion at rate of 0.2 mg/ kg/hr for 20 hr or less, if necessary. 

Vascular stenting has become a common procedure during percutaneous transluminal angioplasty (PTA) and percutaneous transluminal coronary angioplasty (PTCA) procedures because it has been found to reduce restenosis (Narins et al., 1998). In both the STRESS (Stent Restenosis Study) and BENESTENT... 

Lesiak M, Grajek S, Pyda M, Skorupski W, Mitowski P, Cieslinski A. Percutaneous transluminal coronary angioplasty the influence of non-ionic and high osmolar ionic contrast media on the results and compheation of the procedure. Kardiol Pol 1999 50 311-21. 

Ryan TJ, Bauman WB, Kennedy JW, et al. Guidelines for percutaneous transluminal coronary angioplasty A report of the ACC/AHA Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 1993 22 2033-2054. 

The doses for the procedure during interventional radiology are generally very high, e.g., 7.5-57 mSv for PTCA (percutaneous transluminal coronary angioplasty), 2-40 mSv for TIPS (transjugular intrahepatic portosystemic shunt), 17-25 mSv for radiofrequncy ablation, 5.7-20 mSv for cerebral embolization, and 0.3-24 mSv for biliary procedure (O Table 55.20). 

Acute myocardial infarction can be limited by streptokinase which dissolves fresh clots and opens the artery, but muscle death and necrosis causes a mechanical defect. Subsequent infarcts cause further muscle death and ultimately lead to defective ventricular function and cardiac failure. There is the need for simple alarm systems to detect acute myocardial infarction and less traumatic invasive procedures to dissolve the clot and dilate the artery immediately. Coronary arteries ramify and branch in 3-dimensional space and the present generation of balloon catheters for percutaneous transluminal coronary angioplasty carries a small but definite risk. New, non-traumatic guidewires, low profile dilatation systems and more powerful dilatation balloons which will not rupture the artery are needed. 

Moreover, ECP using 8-MOP and UVA radiation has been evaluated during a clinical trial to analyze its efficacy for the treatment of clinical restenosis after percutaneous transluminal coronary angioplasty [260]. After this study, ECP has been shown to be effective in reducing restenosis in patients undergoing balloon percutaneous transluminal coronary angioplasty with and without stent deployment. However, the use of this procedure in this com-phcation needs further investigations. 

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