How Will New Bioabsorbable Polymer Drug Eluting Stents Impact Dapt Duration?

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

Such contraindications could be an intolerance to long-term antiplatelet therapy or significant conditions leading to a reduced lifespan in the patient. If there is a lack of cardiac surgical support or the artery has suffered less than 50% or complete occlusion, the procedure may be voided. The patient also must not have received a bypass graft to the left anterior descending artery. (http://www.merckmanuals.com/professional/cardiovascular-disorders/cardiovascular-tests-and-procedures/percutaneous-coronary-interventions). Careful approach should be used in cases where patients suffer from diabetes and coronary artery disease or have left main disease without collateral flow and a high Syntax score. (http://emedicine.medscape.com/article/ 161446-overview).

After an acute coronary syndrome (ACS) event, patients are potentially at risk of further ischemic events for a considerable period time. These events may include unstable angina, non-ST elevation myocardial infarction (NSTEMI), acute MI (STEMI) or percutaneous coronary intervention (PCI). The use of dual anti-platelet therapy (DAPT) along with aspirin significantly lowers the risk of complications such as platelet-mediated thrombosis with ACS (Wiviott & Steg, 2015). For patients that participate in cardiac

Mr. Harry Bright has undergone a procedure called percutaneous transluminal coronary intervention (PTCI) via a femoral approach for the treatment of his progressive unstable angina. Femoral artery is the most common access site used for PTCI because of its size and its direct passageway to the heart (Young, 2014 p.431; Cosman, Arthur, Bryant-Lukosius, Strachan, 2015 p.180). In this procedure, a cardiac catheter followed by a stent is inserted into the artery to dilate the occluded blood vessel and improve blood flow (Young, 2014 p.430). The occlusive atherosclerotic plaque is usually associated with Mr. Bright’s diabetes, hypertension and smoking history. Contrary to the positive effect of PTCI, bleeding and hematoma formation are the most

A STEMI is caused by an acute interruption of blood supply to an area of the heart that develops into full thickness cardiac muscle damage to the area that the vessel supplies blood to (Wadud, A; 2014). It is defined by having ST-segment elevation with pathological Q-wave formation and is condition under the umbrella term Acute Coronary Syndrome (ACS) (Wadud, A; 2014). The lack of oxygenation to the myocardium also causes the cardiac markers troponin T, troponin I and creatinine kinase myocardial brand (CK-MB) start to rise in the blood. Troponin rises within 4-6 hours and remains raised for up to two weeks whilst CK-MB starts to rise within 4-6 hours and returns to normal within 48-72 hours (Wadud, A; 2014). Nice guidance identifies that “nearly half of potentially salvageable myocardium is lost within 1 hour of the coronary artery being occluded and two thirds are lost within 3 hours” (NICE; 2013). The end of the 20th century showed the best way to re-perfuse and improve oxygenation was using a fibrinolytic drug however in recent years the use of Coronary Angioplasty, thrombus extraction catheters and stenting which are under the umbrella term Percutaneous Coronary Intervention (primary PCI) (NICE; 2013). The National Infarct Angioplasty Project (NIAP) interim report found that primary PCI will be feasible in a variety of geographical settings, will be most effective and cost-effective if delivered within 120-150 minutes from a patient’s initial call for

DAPT had to have long enough time after implanting the stent into arteries to prevent stent thrombosis.Premature discontinuation of anticoagulation therapy, also known as premature discontinuation of DAPT, means discontinuation of DAPT for less than three months for sirolimus-eluting stents (SES) and shorter than six months for paclitaxel-eluting stents (PES). The outcome of the premature discontinuation of DAPT can increase the risk of stent thrombosis, myocardial infarction, and death. Bare-metal stents (BMS) do not relate to blood clotting issues after stent implantation such as stent thrombosis. Therefore, it can be said that BMS do not need anti-clotting therapies. On the contrary, drug-eluting stents have been involved with late stent thrombosis. To prevent this issue, optimal conditions of several factors should be considered. Those factors can be stent position and expansion, the number of stents, stent size, stent design, patient and lesion, and premature discontinuation of antiplatelet medicines. Revascularization can be defined that produce the healthy blood circulation to a body part again under the situation carrying depletion of oxygen to an organ. The terminology, revascularization, is usually used by surgical

Vascular complications are the leading cause of morbidity and mortality amongst diabetic patients which represent a major proportion of patients undergoing coronary artery revascularization. Major advances in drug eluting stent technologies have reduced the overall rates of restenosis in general however diabetic patients still remain at a high risk thus requiring target lesion revascularization more commonly as compared to non-diabetic cohort. Phenotypic modulation demonstrated by smooth

Manipulating the transducer to obtain an optimal angle of incidence is important. Sub-xiphoid, subcostal and intercostal views are all potentially used to align the beam with the vessel of interest. Stent material is easily seen using two-dimensional ultrasound. “Shadowing is only a problem when stents covered with fabric such as polytetrafluoroethylene are used. In these cases, gas that is embedded in the fabric will cause shadowing for several days, but eventually the gas is absorbed and the covered stents then appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler criteria has not been established as of yet, although some physicians and facilities have developed

Diabetic patients with ACS derive a greater benefit from established therapies, particularly platelet-inhibiting therapies, including clopidogrel pretreatment, and glycoprotein IIb/IIIa inhibitor use. Recent data show intense ADP-P2Y12 platelet receptor inhibition with prasugrel is of particular clinical value in the diabetic patient with ACS, without excessive bleeding. Diabetic patients with ACS also benefit more from aggressive revascularization strategies. Recent data show the benefit of drug-eluting stents in the setting of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in decreasing target vessel revascularization up to 2 years, particularly in patients at highest risk for restenosis with bare metal stents (likely diabetic patients). This review summarizes the data supporting the key pharmacologic and revascularization management strategies to guide the clinician in taking care of diabetic patients who present with an ACS event.

Primary stent placement may minimize vessel recoiland prevent abrupt occlusion, but there is debate overthe relative benefit

Coronary angioplasty is a nonsurgical method to treat obstructive coronary artery disease; it is performed by inserting a thin, inflatable balloon into the clogged artery before being inflated. This pushes the plaque to the artery wall, and results in the reversing of artery narrowing, allowing easier blood flow. The balloon enters the body through a cut, often from the pelvic bone, being steered by the doctor before being inflated. The surgery is usually combined with the permanent placement of a wire, mesh tube called a stent to keep open artery in hopes to decrease the chance of arterial narrowing. These stents can be drug-eluting stents, which is covered with a pharmacologic agent that prevent scar tissue from growing within or into the

There are several ways to overcome aortic valve stenosis. The first method being a minimally invasive procedure, the insertion of a transcatheter aortic valve replacement where the new tissue valve is inflated over the calcified one. The second method is open heart surgery where the calcified valve is completely replaced with a tissue valve or with a metal mechanical valve. The mechanical valve, though very effective at restoring normal flow and withstanding the test of time, can still use improvement. The St. Jude Regent mechanical valve, despite advantages over other mechanical valves, still has its flaws. Simple improvements such as covering the valve with artificial tissue using nanospring biomaterial adhesive can remove problems

Percutaneous coronary intervention (PCI) is an invasive approach that improves clinical outcomes in clients with ST-segment elevation myocardial infarction (STEMI) and in clients with non-ST-segment elevation acute coronary syndromes (NSTEACS) (Mehta et al., 2012). Periprocedural major bleeding is a strong autonomous predictor of early and late major adverse cardiovascular events and mortality (Bernat et al., 2014). In an investigation of more than three million PCIs from the U. S. national registry, post-procedural bleeding events were linked with an increased chance of in-hospital mortality and an approximated 12.1% death rate related to bleeding complications (Bernat et al., 2014). In clients with acute coronary syndrome (ACS), access

With a lifelong passion for the sciences, I became interested in adult nurse practitioner cardiologist. Before pursing my education as NP, I lost two important people in my life for heart disease, my father and my fifteen year old daughter. I realized that I enjoyed making a difference in people’s lives and empowering patients to be active participants in his/her own healthcare through education and strong patient –healthcare provider relationship. I feel that I can lead patient to achieving his/her health goals by provide support for the patient at the same time focuses on myocardial infraction (MI) prevention through health promotion by emphasizing lifestyle modifications to enhance overall quality of life.

By the mid 1980’s, bare metal stents (BMS) were developed to overcome the limitations of balloon angioplasty [1]. Coronary stents are metal lattices that hold the vessel open, which prevents recoil following angioplasty [2]. They are delivered using a catheter-mounted balloon inserted either in the brachial or femoral artery, which is then threaded to the site of blockage in the coronary artery. The balloon is inflated, and the stent is released covering the stenosed lesion