Coronary Ct Angiography On Revascularized Patients : Coronary Stenting

The blood vessel that Dr. Eltahawy was concerned about was thin and looked as though it would collapse in on itself. First, Dr. Eltahawy tried a balloon catheter. At the top of the catheter was a small balloon that could inflate to maintain a shape or structure of a blood vessel. However, because the blood vessel was so thin, the balloon catheter was not very effective. Instead, Dr. Eltahawy installed a stent. A stent is a wire mesh tube. It is placed in a blood vessel permanently to maintain the shape of the vessel and to allow for the free flow of blood. Throughout this entire independent study, I realize that shadowing in the medical field is less about learning about medicine and more about discovering about whether becoming a doctor is the right step. This independent study has been a step in the right

1). Chest X-ray was normal. Initial laboratory studies were remarkable for white blood cells count of 12.1K, a creatine kinase MB fraction of < 3 mm was associated with significant reductions in restenosis and the rate of target vessel revascularization19. In SES-SMART trial patients were randomly assigned to receive a Sirolimus-eluting or bare-metal stent in small coronary artery. Sirolimus stent was associated with significant reductions in the rates of angiographic restenosis (primary outcome), target lesion revascularization and MI at 8 months20. The composite clinical endpoint ( death, non-fatal MI, ischemia- driven target lesion revascularization, and cerebrovascular accidents) was significantly lower with the sirolimus-eluting stent21. In the TAXUS V trial, in the subset of patients with small coronary arteries, the paclitaxel stent was associated with significant reductions in angiographic restenosis and target lesion revascularization at nine months compared to bare metal stents22. Although DES improves target lesion revascularization rates compared to bare-metal stents in small vessels, the absolute rates are still higher in small vessels than large

A coronary angiography provides information about the hearts blood pressure and functioning. This procedure can identify whether the coronary arteries are blocked or narrowing. A tube/camera is passed through an artery in the groin or arm; it is guided using x-rays up to the heart. A coronary angiogram is a safe procedure, but there are some small side affect. You may feel a slightly strange sensation when the dye is put down the catheter, a small amount of bleeding when the catheter is removed, a bruise in your groin or arm.

Stent devices were invented in the 1980s and refined in the 1990s. Stenting techniques have transformed and expanded the therapeutic capabilities of angioplasty. There are two classification for stents based on their mode of deployment balloon-expandable and self-expandable. Stents are small mesh tubes which inserted to keep arteries open after angioplasty procedure. Drug -eluting stents have a polymer coating over mesh. This Polymer coatings have been proven to be durable and deliver drug in a uniform and controlled way ( White, Hollier 2007).

Studies have shown that prescribing patients certain medications can aid in cardiac health and keeping coronary stents patent after discharge from the hospital post

Catheter angiography can accurately evaluate aortic pararenal patency. This is especially important when placing engrafts at the iliac bifurcation site. CTA is more sensitive to assessing endoleaks occurring after EVAR procedures, but digit subtraction angiography (DSA) is more accurate in classifying endoleaks. This is possible because the direction of flow in or out of the aneurysm site can be evaluated via DSA. Catheter angiography plays a role in imaging intraoperative EVAR patients for endoleak classification and for post-operative re-intervention (Francois et al., 2012). Figure 5 illustrates an arteriogram taken in preparation for an EVAR procedure, while Figure 6 was taken after the EVAR procedure was

A few of stents are the Leo, Enterprise, and the Solitaire AB Stent. Leo stents are retrievable but they are prone to shift when they are in mid release state (Cui, Y., Xu, H., Liu, H., & Wang, Y. (2015). Enterprise stents can only be recovered once, and it’s only when they haven’t been released over 70 percent. The Solitaire AB Stent can be recovered a number of times. This is the main advantage of the Solitaire AB stent over other stents. The release technique is also different with the Solitaire AB stent. The stent is released from distal end and only after the position is determined; it also has a single open end which is different than the Leo and

Angiography has so far been the gold stan- dard for identifying coronary artery lesions [19]. It provides the practitioners with in- formation about the severity of luminal narrowing and hence, enables the diagno- sis of atherosclerotic disease. Angiography may show severe lesions, plaque disrup- tion, luminal thrombosis,

By using ST changes in AVR can know culprit lesion of coronary arteries, Shakerian F et al were predict the location of the culprit lesion in most vessels such as the proximal RCA and the mid LAD by using AVR ST changes 4 , Nabat et al represent that ST elevated in AVR in ACS is associated with 3 vessel diseases and low LVEF. 2 Aygul N et al revealed ST elevation in AVR is good indicator of proximal LAD occlusion. 5

The study hoped to find an acceptable correlation with abnormal or normal Doppler ultrasound and venography. The results were not sufficient to determine that Doppler ultrasound alone was an adequate tool to determine stent malfunction consistently. Future objectives are for non-invasive Doppler testing to be sensitive and reproducible enough to detect early stent malfunction even before symptoms occur.29 Boyer,23 reports that Doppler ultrasound has sensitivity and specificity rates from 70%-100% in cases of stent stenosis, but it is still not ideal. Ultrasound requires a technologist and radiologist with experience and must be conducted with consistent parameters to obtain dependable results. Most of the trials recommend follow up studies including some or all of the following: venography, Doppler ultrasound combined with two-dimensional ultrasound, angiography, magnetic resonance imaging and computerized

Besides echocardiography, cardiac magnetic resonance (CMR) and Multi-slice computed tomography angiocardiography (MSCT) have gained particular importance. (8) The presence of image degrading artifacts from implanted metal, such as intravascular stents and embolization coils; higher cost; limited availability; contraindication in imaging of

Because the spatial resolution of MSCT is lower than that of CCA, detection of stenosis may be more difficult in thickened segments, because the artery lumen is already smaller in a diffuse fashion. Such findings in heart transplant patients should lead to careful analysis before excluding significant narrowing, and in some cases, CCA may be required for confirmation. Eight stenoses were correctly diagnosed by MSCT in 10 evaluable segments, but three were missed in non-evaluable vessels 1.5 mm. In addition, two cases of ISR were missed. Intrastent analysis was not reliable with 16-slice CT, because only three (33%) of nine of the stents could be correctly visualized. Our study clearly indicates that the only reliable tool for detection of ISR

The left anterior descending artery (LAD) was found to be the most commonly affected coronary artery among the 23 patients showing scar tissue on LGE being involved in 18 patients (78.3 %) table 10.

Enhancement on the currently accepted methods of stenting is continually in process, improving the success rate of coronary intervention without restenosis is the main target. New platforms are in development to incorporate the anti-proliferative drugs on, this is to enhance the efficacy of stenting and minimise the risk of side effects. Potentially the use of NO will reduce restenosis if it is delivered in the correct concentrations, and this can be controlled to prevent cytotoxicity. This can’t be administered systemically due to the short half-life of NO, as explained further on, therefore the use of NO donors has been investigated to see if they could be combined within stents (42).

Take over-the-counter and prescription medicines only as told by your health care provider. Blood thinners may be prescribed after your procedure to improve blood flow through the stent.