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Cardiology
PCI in Special Settings Acute Myocardial Infarction, Cardiogenic Shock, Saphenous Vein Graft
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
8 sections · 84 slides
Overview
- Scope of this topic
- Why PCI is offered at all
Acute myocardial infarction
- Spectrum of acute myocardial infarction
- Pathophysiology of STEMI
- Anterior ST-segment elevation on the 12-lead ECG
- Primary PCI of an occluded left anterior descending artery
- Falling mortality from STEMI
- Unstable angina and NSTEMI
Vascular access
- Shift from femoral to radial access
- RIVAL trial: radial versus femoral access
- RIVAL STEMI subgroup
- RIFLE-STEACS and MATRIX
- Left coronary angiogram showing stenoses
- Identifying the culprit lesion
- Culprit-only versus complete revascularization
- PRAMI trial
- CvLPRIT trial
- Current recommendations for non-culprit lesions
- Rationale for aspiration thrombectomy
- TASTE, TOTAL and the current recommendation
Reperfusion timing
- Experimental basis for door-to-balloon time
- Primary PCI versus fibrinolysis
- Management strategy for STEMI
- Risk stratification in NSTE-ACS
- Immediate invasive strategy in NSTE-ACS
- Early versus delayed invasive strategy
Cardiogenic shock
- Cardiogenic shock complicating myocardial infarction
- The cardiogenic shock spiral
- SHOCK trial design
- SHOCK trial results
- CULPRIT-SHOCK trial
- Single-access PCI through an Impella sheath in cardiogenic shock
- Mechanical circulatory support in cardiogenic shock
- Percutaneous mechanical circulatory support devices
- DanGer Shock trial design
- DanGer Shock results and their consequences
- Systems of care in cardiogenic shock
Saphenous vein graft intervention
- Saphenous vein grafts to the coronary arteries
- Burden of saphenous vein graft disease
- PCI versus redo CABG for graft disease
- Distal embolization and no-reflow
- Distal embolic protection devices
- Vein graft PCI with distal embolic protection
- Timing of vein graft PCI after surgery
- Lesion age and stent choice in vein grafts
Left main stenting
- Significance of left main coronary artery disease
- Natural history of untreated left main disease
- Anatomy of the left main coronary artery
- Assessment of left main stenosis severity
- Technique for aorto-ostial left main lesions
- Ostial strut protrusion and the Ostial Flash System
- Complexity of left main bifurcation lesions
- Choice of bifurcation stenting strategy
- DK-CRUSH III trial
- Roles of intravascular imaging in PCI
- Minimal stent area targets in the left main
- Ostial left main stenting after transcatheter aortic valve replacement
- LE MANS trial
- SYNTAX left main subgroup
- PRECOMBAT and EXCEL
- Guideline classes for left main revascularization
Summary
- Key points: acute myocardial infarction and shock
- Key points: vein grafts and left main
- Conclusion
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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