| Protected percutaneous coronary intervention | |
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 A coronary angiogram delineating the left coronary circulation. |
Protected percutaneous coronary intervention, abbreviated as Protected PCI, is a heart procedure that involves a ventricular assist device that is used to treat patients with cardiovascular disease, including advanced heart failure. [1] [2]
During a protected percutaneous coronary intervention (Protected PCI) procedure, "the Impella 2.5 heart pump helps maintain a stable heart function by pumping blood for the heart. This gives a weak heart muscle an opportunity to rest and reduces the heart’s workload, preventing the heart from being overstressed by the procedure as coronary artery blockages are repaired". [3] Deborah Moore, the Director of Interventional Cardiology at Florida Hospital Zephyrhills, stated that protected PCI is beneficial in patients who are "inoperable or non-candidates for stents and angioplasty." [3] The Impella 2.5, used in protected PCI, "received FDA approval for elective and urgent high-risk PCI procedures in March 2015, following its 510(k) clearance in 2008" and as a percutaneous hemodynamic support device, it was deemed "safe and effective for patients with complex coronary disease, depressed ejection fraction, other co-morbidities, and who have been refused for surgical treatment." [4] The PROTECT II Study, published in Circulation found that the "Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of −0.04±0.24 W in comparison with −0.14±0.27 W for IABP (P=0.001)." [5] Hospitals such as Detroit Medical Center, and organizations such as the Society of Cardiovascular Angiography and Interventions, have featured lectures including "The New Era of Protected PCI: Treating Elective and High-Risk PCI Patients with Impella 2.5", [6] and "Expanding your Patient Practice with Protected PCI: Treating the Most Complex Patients" in order to educate physicians on using protected percutaneous coronary intervention, respectively. [7]
Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive endovascular procedure used to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A deflated balloon attached to a catheter is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn. Angioplasty has come to include all manner of vascular interventions that are typically performed percutaneously.
A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional (treatment) purposes.
Interventional cardiology is a branch of cardiology that deals specifically with the catheter based treatment of structural heart diseases. Andreas Gruentzig is considered the father of interventional cardiology after the development of angioplasty by interventional radiologist Charles Dotter.
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done both for diagnostic and interventional purposes. A common example of cardiac catheterization is coronary catheterization that involves catheterization of the coronary arteries for coronary artery disease and myocardial infarctions. Catheterization is most often performed in special laboratories with fluoroscopy and highly maneuverable tables. These "cath labs" are often equipped with cabinets of catheters, stents, balloons, etc. of various sizes to increase efficiency. Monitors show the fluoroscopy imaging, EKG, pressure waves, and more.
Acute coronary syndrome (ACS) is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. The most common symptom is chest pain, often radiating to the left shoulder or angle of the jaw, crushing, central and associated with nausea and sweating. Many people with acute coronary syndromes present with symptoms other than chest pain, particularly, women, older patients, and patients with diabetes mellitus.
Percutaneous coronary intervention (PCI) is a non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The process involves combining coronary angioplasty with stenting, which is the insertion of a permanent wire-meshed tube that is either drug eluting (DES) or composed of bare metal (BMS). The stent delivery balloon from the angioplasty catheter is inflated with media to force contact between the struts of the stent and the vessel wall, thus widening the blood vessel diameter. After accessing the blood stream through the femoral or radial artery, the procedure uses coronary catheterization to visualise the blood vessels on X-ray imaging. After this, an interventional cardiologist can perform a coronary angioplasty, using a balloon catheter in which a deflated balloon is advanced into the obstructed artery and inflated to relieve the narrowing; certain devices such as stents can be deployed to keep the blood vessel open. Various other procedures can also be performed.
The intra-aortic balloon pump(IABP) is a mechanical device that increases myocardial oxygen perfusion and indirectly increases cardiac output through afterload reduction. It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery. The balloon inflates and deflates via counter pulsation, meaning it actively deflates in systole and inflates in diastole. Systolic deflation decreases afterload through a vacuum effect and indirectly increases forward flow from the heart. Diastolic inflation increases blood flow to the coronary arteries via retrograde flow. These actions combine to decrease myocardial oxygen demand and increase myocardial oxygen supply.
Bivalirudin is a direct thrombin inhibitor (DTI).
Myocardial rupture is a laceration of the ventricles or atria of the heart, of the interatrial or interventricular septum, or of the papillary muscles. It is most commonly seen as a serious sequela of an acute myocardial infarction.
The history of invasive and interventional cardiology is complex, with multiple groups working independently on similar technologies. Invasive and interventional cardiology is currently closely associated with cardiologists, though the development and most of its early research and procedures were performed by diagnostic and interventional radiologists.
A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in the treatment of coronary heart disease. It is used in a procedure called percutaneous coronary intervention (PCI). Coronary stents are now used in more than 90% of PCI procedures. Stents reduce angina and have been shown to improve survivability and decrease adverse events in an acute myocardial infarction.
A myocardial infarction (MI), also known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat or feeling tired. About 30% of people have atypical symptoms. Women more often present without chest pain and instead have neck pain, arm pain or feel tired. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock or cardiac arrest.
Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a heart attack. Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis. Surgeries performed may be minimally-invasive endovascular procedures such as a percutaneous coronary intervention (PCI), followed by a coronary angioplasty. The angioplasty uses the insertion of a balloon to open up the artery, with the possible additional use of one or more stents. Other surgeries performed are the more invasive bypass surgeries that graft arteries around blockages.
Transradial catheterization is an endovascular procedure or catheterization procedure performed to diagnose and treat arterial disease. Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery, brachial artery or radial artery in the wrist. The transfemoral approach to perform cardiac catheterization has typically been more prevalent in invasive cardiology. But radial access has gained popularity due to technical advances with catheters and lower complication rates than transfemoral access. The European Society of Cardiology and the American Heart Association both support a radial-first approach in acute coronary syndrome.
Management of acute coronary syndrome is targeted against the effects of reduced blood flow to the afflicted area of the heart muscle, usually because of a blood clot in one of the coronary arteries, the vessels that supply oxygenated blood to the myocardium. This is achieved with urgent hospitalization and medical therapy, including drugs that relieve chest pain and reduce the size of the infarct, and drugs that inhibit clot formation; for a subset of patients invasive measures are also employed. Basic principles of management are the same for all types of acute coronary syndrome. However, some important aspects of treatment depend on the presence or absence of elevation of the ST segment on the electrocardiogram, which classifies cases upon presentation to either ST segment elevation myocardial infarction (STEMI) or non-ST elevation acute coronary syndrome (NST-ACS); the latter includes unstable angina and non-ST elevation myocardial infarction (NSTEMI). Treatment is generally more aggressive for STEMI patients, and reperfusion therapy is more often reserved for them. Long-term therapy is necessary for prevention of recurrent events and complications.
Impella is a family of medical devices used for temporary ventricular support in patients with depressed heart function. Some versions of the device can provide right heart support during other forms of mechanical circulatory support including ECMO and Centrimag.
A hybrid cardiac surgical procedure in a narrow sense is defined as a procedure that combines a conventional surgical part with an interventional part, using some sort of catheter-based procedure guided by fluoroscopy imaging in a hybrid OR without interruption. A wider definition includes a clinically connected succession of a catheter intervention and a surgical procedure with a time gap.
Prof. Aly Saad, is a pioneer professor of cardiology at Zagazig University and a Member of higher committee of promotion of professors and Assistant professors of cardiovascular diseases and Critical care Subspecialty in Egypt.
Remote ischemic conditioning (RIC) is an experimental medical procedure that aims to reduce the severity of ischaemic injury to an organ such as the heart or the brain, most commonly in the situation of a heart attack or a stroke, or during procedures such as heart surgery when the heart may temporary suffer ischaemia during the operation, by triggering the body's natural protection against tissue injury. Although noted to have some benefits in experimental models in animals, this is still an experimental procedure in humans and initial evidence from small studies have not been replicated in larger clinical trials. Successive clinical trials have failed to identify evidence supporting a protective role in humans.
Acute cardiac unloading is any maneuver, therapy, or intervention that decreases the power expenditure of the ventricle and limits the hemodynamic forces that lead to ventricular remodeling after insult or injury to the heart. This technique is being investigated as a therapeutic to aid after damage has occurred to the heart, such as after a heart attack. The theory behind this approach is that by simultaneously limiting the oxygen demand and maximizing oxygen delivery to the heart after damage has occurred, the heart is more fully able to recover. This is primarily achieved by using temporary minimally invasive mechanical circulatory support to supplant the pumping of blood by the heart. Using mechanical support decreases the workload of the heart, or unloads it.
This is so because the group undergoing protected primary PCI presented unaltered CFI during the second as compared to the first coronary occlusion.
Distal embolism is one of the major complications during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). The Guard Wire system (GS) consists of an occlusion balloon which is inflated distally allowing protected PCI has recently become available.
|url= (help)Einstein’s Protected PCI program has operated from a position of strength, but expansion this spring broadened the patient mix to include elective and urgent high-risk PCI patients. At the center of the program is the Impella 2.5. The device received FDA approval for elective and urgent high-risk PCI procedures in March 2015, following its 510(k) clearance in 2008, making it the first percutaneous hemodynamic support device to get the regulatory nod as both safe and effective for patients with complex coronary disease, depressed ejection fraction, other co-morbidities, and who have been refused for surgical treatment.
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