LATEST DEVELOPMENTS IN INTERVENTIONAL

CARDIOLOGYGP Superclinic@Midland Railway Workshops Heart Week Event

Dr Chris Judkins MBBS MClinRes FRACP

Interventional CardiologistWA Cardiology

Fiona Stanley Hospital

www.perthheart.com

Topics to cover

What is Coronary Intervention ?

What are the latest developments?

Aftercare post Stenting

Percutaneous Coronary InterventionPCI – “stenting”

What is it?

How does it work?

What happens after stenting?

A short history of Percutaneous Coronary Angioplasty

Angiography 1960 -Mason Sones accidentally catheterised the LM – cardiac arrest

POBA Sept 16 1977, Switzerland, Andreas Gruentzig Limited by dissections, recoil, acute closure (5%), restenosis

BMS Introduced 1986 – Palmaz Schatz – approved FDA 1994 Better than POBA (Stress and Benestent-1 trials) Neointimal hyperplasia 20-30%

DES Introduced to overcome NIH Issue of late thrombosis (drug prevents endothelialisation)

DEB 2 available – Useful where a stent is not desirable, ISR etc

Bioabsorbable scaffolds Polymer of L-lactic acid (PLLA) (others magnesium etc) Abbott Vascular – ”Absorb” TGA 2014

Scaffold vs Stent

Radial Angiography

Patients prefer Radial (wrist) Access Back pain BMI Unable to lie flat

Less bleeding Less Mortality

Same day stenting

Access site Bleeding Complications Major and MinorCase Complication Treatment Required

FEMORAL1 Pseudoaneurysm

and retroperitoneal bleed

US compression + transfusion 2 units

2 Haematoma >5cm -Transfusion

Prolonged digital comp (3hr) and transfusion 2units

3 Haematoma >5cm - No transfusion

Digital compression 90mins

4 Haematoma >5cm - No transfusion

Digital compression 40mins

5 Retroperitoneal bleed

Wait and watch

6-20 Haematoma <5cm Digital compression <30mins

RADIAL21 Haematoma <2cm 2nd TR band

What is important after stenting?

Lifestyle: Diet Exercise

Risk Factors: Diabetes Hypertension Cholesterol Smoking

• Other Considerations:• Work/Driving• Medications• Comorbidities• Obstructive sleep apnea

Immediate post care

Arterial access site Driving

Diet Exercise Work

Personal vehicle

Commercial vehicle

after a heart attack 2 weeks 4 weeks

After a stent 2 days 4 weeks

After bypass grafts 4 weeks 3 months

Aftercare post stenting

Medications1. Aspirin2. Clopidogrel (Plavix), Ticagrelor (Brilinta)3. Statin (eg Atorvastatin)4. Beta Blocker (eg Metoprolol)5. ACE Inhibitor (eg ramipril)

Drug eluting stent (DES): 12 months Bare Metal Stent (BMS): 3 months After a heart attack: 12 months Bioresorbable stent: ?12 months

Aftercare post stenting

Medications1. Aspirin2. Clopidogrel (Plavix), Ticagrelor (Brilinta)3. Statin (eg Atorvastatin)4. Beta Blocker (eg Metoprolol)5. ACE Inhibitor (eg ramipril)

Drug eluting stent (DES): 12 months Bare Metal Stent (BMS): 3 months After a heart attack: 12 months Bioresorbable stent: ?12 months

Secnario One:65yo maleNot diabeticNormal high blood pressureSmokerBorderline high cholesterol

Scenario Two:Lower SBP by 10mmHgLower cholesterol to targetQuit smoking

Absolute Risk

28% down to 8%

Examples of post heart attack help programs

Tertiary Hospitals Rehabilitation programs HeartBeat (Armadale/Kelmscott)

www.baml.com.au/HB Heart Foundation

My Heart My Life App/Book Cardiovascular care WA (aka CPRwa)

Hollywood hospital www.cprwa.com.au

Perth Heart www.perthheart.com

THANK YOU

www.perthheart.com