Ebook Tarascon pocket cardiology: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Tarascon pocket cardiology: Part 2
Ebook Tarascon pocket cardiology: Part 2
SECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2(oxygen and nutrients) to the essential myocardium. The method of and indications for coronary revascularization are complex and often debated topics.The basic goals of coronary revascularization include the following three items:-1Improve clinical symptoms-2Improve long-term survival-3Attempt to de Ebook Tarascon pocket cardiology: Part 2crease the incidence of nonfatal outcomes such as myocardial infarction, congestive heart failure, and malignant arrhythmiasThere are three common metEbook Tarascon pocket cardiology: Part 2
hods for approaching coronary revascularization:•Percutaneous coronary intervention (PCI) is a generic term referring to any therapeutic procedure dirSECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2herectomy, or thrombectomy.•Coronary artery bypass surgery (CABG) is a surgical procedure directed at bypassing lhe stenotic coronary artery segments using vessels harvested from other places in the body (lower extremity veins or thoracic/ abdominal arterial grafts).•Fibrinolysis in the setting of S Ebook Tarascon pocket cardiology: Part 2T-Elevation myocardial infarction (STEMI).PERCUTANEOUS CORONARY INTERVENTION•PCI involves repair of the artery by advancing equipment over a coronaryEbook Tarascon pocket cardiology: Part 2
guide wire that has been advanced past a blockage in the artery.•PTCA (percutanous transluminal coronary intervention) angioplasty is when balloon infSECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2are utilized for specific clinical scenarios and lesions subsets. Such devices include:•Rotational (diamond tipped drill) or laser atherectomy for calcified, noncompliant vessels•Manual or mechanical thrombectomy for large thrombus burden•Protection devices, utilized in saphenous vein grafts, to cap Ebook Tarascon pocket cardiology: Part 2ture debris liberated during PCI, avoiding embolization downstreamo No benefit demonstrated in native coronary arteries234Coronary Revascularization•PEbook Tarascon pocket cardiology: Part 2
TCA is now almost always accompanied by the implantation of a coronary stent.•Coronary stents are small (2.0-5.0 mm) metallic tubes that are mounted oSECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2 of the vessel.•The stent creates a larger lumen, avoids abrupt closure related to vessel dissection and acts as a mechanical scaffold to prop open the vessel.•Compared with angioplasty alone, stents reduce restenosis, recurrent narrowing of the artery, abrupt closure, and early thrombosis of the ve Ebook Tarascon pocket cardiology: Part 2ssel due to vessel dissection after angioplasty.•Restenosis still occurs with stents and is due to slow neointimal proliferation causing reblockage wiEbook Tarascon pocket cardiology: Part 2
th scar tissue.•Stent thrombosis is an entity distinct from restenosis where there is abrupt clot formation within the stent. The latter most often prSECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2sociated mortality•Uncoated bare-metal stents (BMS) were the first stents.•Restenosis rates were 10-30% or more with these.•Stents coated with antiproliferative drugs (everolimus, sirolimus, paclitaxel, biolimus A9, and zotarolimus) were developed and reduced restenosis by approximately 60% or more. Ebook Tarascon pocket cardiology: Part 2•Drug-eluting stents (DES) suppress restenosis by retarding neointimal proliferation by locally modulating healing, immune, and inflammatory responsesEbook Tarascon pocket cardiology: Part 2
to the stent.•Though DES have reduced restenosis and the need for repeat revascularization, one drawback has been the infrequent occurrence (M/400) oSECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow ( Ebook Tarascon pocket cardiology: Part 2mediate lesions can be characterized with intravascular ultrasound (IVUS) or optical coherence tomography (OCT).•The hemodynamic significance of angiographicaIly obscured or intermediate lesions can be assessed by measuring the fractional flow reserve (FFR). Ebook Tarascon pocket cardiology: Part 2SECTION IIICARDIOVASCULAR THERAPEUTICS27 ■ CORONARY REVASCULARIZATION60INTRODUCTIONCoronary revascularization is the process of restoring blood flow (Gọi ngay
Chat zalo
Facebook