Advances in interventional cardiology

Minh VoUniversity of ManitobaApril 30, 2009

Claude Bernard (1813-1878)

Werner Forssman (1904-1979)

Mason Sones (1919-1985)

Andreas Gruentzig (1939-1985)

1987 - first report of stents used in humans

2003 – approval for drug-eluting stents

Vascular access

Complications post percutaneous coronary intervention

• death 0.1%• stroke 0.05%• MI 0.05%• emergent CABG 0.1%• VF 0.5%• contrast agent reaction 0.23%• hematoma 1-3%• retroperitoneal hematoma• pseudo-aneurysm 1-3%• AV fistulas (<0.4%)• neuropathy• arterial thrombosis• distal emboli• infection 0.2%

Major complications are rare (<1%)Minor complications are uncommon 1-3%

Taking care of patients after percutaneous coronary intervention

in-stent restenosis(BMS 20% vs. DES 5%)

(highest incidence 6-9 months)

in-stent thrombosis(~1%)

(highest incidence within 1yr)

platforms anti-platelet therapy

Anti-platelet therapy in patients with intracoronary stents

• BMS (bare metal stents):• ASA 162-325mg for 1month then 75-162mg daily indefinitely• plavix 75mg for at least 1 month (minimum of 2 weeks if bleeding risk1,2) and preferably up to 1 year

• DES (drug-eluting stents):• ASA 162-325mg for 3 months after SES* (Cypher) and for 6 months after PES* (Taxus) then 75-162mg daily indefinitely• plavix 75mg for at least 1 year

* SES indicates sirolimus eluting stents. PES indicates paclitaxel eluting stents

Conclusions

1. Continuing advances in interventional cardiology2. Procedure is very safe3. Dual antiplatelet therapy extremely important