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
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
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