Percutaneous transluminal coronary intervention

Percutaneous coronary intervention (PCI) is one of a host of techniques performed by using a catheter inserted via a major limb artery that aims to relieve nanowing of coronary arteries. For example, percutaneous transluminal coronary angioplasty (PTCA) is the classic PCI that uses a catheter-directed balloon to dilate a stenotic coronary artery, and more recent PCIs include stent implantation, rotational atherectomy, and laser angioplasty. 

Coronary interventions (coronary bypass, percutaneous transluminal coronary angioplasty, or stents)... 

Cardiac catheterization and coronary angiography are used in patients with suspected CAD to document the presence and severity of disease as well as for prognostic purposes. Interventional catheterization is used for thrombolytic therapy in patients with acute MI and for managing patients with significant CAD to relieve obstruction through percutaneous transluminal coronary angioplasty, atherectomy, laser treatment, or stent placement. 

The safety and efficacy of bivalirudin have not been established in patients with acute coronary syndromes who are not undergoing percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). 

NPV = negative predictive value PPV = positive predictive value ACS = acute coronary syndrome PTCA = percutaneous transluminal coronary angioplasty PCI = percutaneous coronary intervention DCCV = direct-current cardioversion A fib = atrial fibrillation NA = not applicable. 

Abbreviations BMS, bare-metal stents ICB, intracoronary brachytherapy N/A, results not published NS, not statistically significant (P > 0.05) PCI, percutaneous coronary intervention FTCA, percutaneous transluminal coronary angioplasty POBA, plain old balloon angioplasty. 

PCI, percutaneous coronary intervention PES, paclitaxel-eluting stent PTCA, percutaneous transluminal coronary angioplasty FTCA balloon angioplasty rotational atherectomy directional atherectomy, or excimer laser angioplasty SES, sirolimus-eluting stent. 

Oxygen deprivation follows when blood flow is compromised by a local, temporary circulatory blockade that may occur naturally as a result of stenosis, stroke, or a myocardial infarction (heart attack) or may accompany therapeutic interventions, such as percutaneous transluminal coronary angioplasty (PTCA). Packed RBCs are not useful for restoration of oxygen delivery in these situations, because they are too large to traverse the constricted vessels or too viscous and fragile to be pumped through a perfusion balloon catheter. A number of preclinical studies in this area are summarized below. 

Reductions in elevated total cholesterol and LDL cholesterol reduce coronary heast disease mortality and total mortality increasing HDL reduces coronary heart disease events as well. Aggressive treatment of hypercholesterolemia results in fewer patients progressing to myocardial infarction, angina, and stroke and reduces the need for interventions such as coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. 

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). 

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

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