WordNet

the act of intervening (as to mediate a dispute, etc.); "it occurs without human intervention" (同)intercession
(law) a proceeding that permits a person to enter into a lawsuit already in progress; admission of person not an original party to the suit so that person can protect some right or interest that is allegedly affected by the proceedings; "the purpose of intervention is to prevent unnecessary duplication of lawsuits"
a policy of intervening in the affairs of other countries (同)interference
(botany) the trumpet-shaped or cup-shaped outgrowth of the corolla of a daffodil or narcissus flower
one or more circles of light seen around a luminous object
a long cigar with blunt ends
(anatomy) any structure that resembles a crown in shape
surrounding like a crown (especially of the blood vessels surrounding the heart); "coronary arteries"

PrepTutorEJDIC

(…が)間に入ること(…の)干渉;調停,仲裁《+『of』+『名』》
コロナ(皆既日食のときに見える光冠) / (太陽・月などの)かさ
冠状動脈の / 心臓の / 冠状動脈血栓(けっせん)症(coronary thrombosis)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/15 23:06:35」(JST)

wiki en

Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the buildup of the cholesterol-laden plaques that form due to atherosclerosis. PCI is usually performed by an interventional cardiologist, though it was developed and originally performed by interventional radiologists.

During PCI, a cardiologist feeds a deflated balloon or other device on a catheter from the inguinal femoral artery or radial artery up through blood vessels until they reach the site of blockage in the heart. X-ray imaging is used to guide the catheter threading. At the blockage, the balloon is inflated to open the artery, allowing blood to flow. A stent is often placed at the site of blockage to permanently open the artery.

Coronary artery bypass grafting (CABG), commonly known as Heart Bypass, which bypasses stenotic arteries by grafting vessels from elsewhere in the body, is an alternative treatment. However, the coronary revascularization by CABG is associated with an increased risk of stroke.^[1] Most studies have found that CABG is better than PCI for reducing death and myocardial infarction.^{[citation needed]} PCI has proven to be as effective and less costly than CABG in patients with medically refractory myocardial ischemia.^[2]

Medical uses

Coronary angiography and angioplasty in acute myocardial infarction (left: RCA closed, right: RCA successfully dilated)

Tight, critical stenosis (95%) of the proximal LAD in a patient with Wellens' warning

PCI does not have any benefit over taking appropriate medications for those with stable coronary artery disease.^[3] In those with unstable disease, however, it is beneficial.^[3]

Bare-metal stents (BMSs) and drug-eluting stents (DESs) result in an equivalent chance of death when used for primary angioplasty of ST elevation myocardial infarction.^[4] Cobalt-chromium stents which elute everolimus appear to clot off less often than other types of stents, including bare metal stents.^[5]

In those who have had a stent more than 12 months of clopidogrel plus aspirin does not affect the risk of death.^[6]

Adverse events

Coronary angioplasty is widely practiced and has a number of risks;^[7] however, major procedural complications are uncommon. Coronary angioplasty is usually performed using invasive catheter-based procedures by an interventional cardiologist, a medical doctor with special training in the treatment of the heart.^[8]

The patient is usually awake during angioplasty, and chest discomfort may be experienced during the procedure. The patient remains awake in order to monitor the patients symptoms. If symptoms indicate the procedure is causing ischemia the cardiologist may alter or abort part of the procedure. Bleeding from the insertion point in the groin (femoral artery) or wrist (radial artery) is common, in part due to the use of antiplatelet drugs. Some bruising is therefore to be expected, but occasionally a hematoma may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires surgical repair. Infection at the skin puncture site is rare and dissection (tearing) of the access blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery.^[9]

The most serious risks are death, stroke, ventricular fibrillation (non-sustained ventricular tachycardia is common), myocardial infarction (heart attack, MI), and aortic dissection. A heart attack during or shortly after the procedure occurs in 0.3% of cases; this may require emergency coronary artery bypass surgery.^[10] Heart muscle injury characterized by elevated levels of CK-MB, troponin I, and troponin T may occur in up to 30% of all PCI procedures. Elevated enzymes have been associated with later clinical outcomes such as higher risk of death, subsequent MI, and need for repeat revascularization procedures.^[11]^[12] Angioplasty carried out shortly after an MI has a risk of causing a stroke, but this is less than the risk of a stroke following thrombolytic drug therapy.^[13]

As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than 2% of people die during angioplasty. Sometimes chest pain can occur during angioplasty because the balloon briefly blocks off the blood supply to the heart. The risk of complications is higher in:^[14]

People aged 65 and older
People who have kidney disease or diabetes
Women
People who have poor pumping function in their hearts
People who have extensive heart disease and blockages

Controversy

The value of angioplasty in rescuing someone having a heart attack (by immediately alleviating an obstruction) is clearly defined in multiple studies, but studies have failed to find reduction in hard endpoints for angioplasty vs. medical therapy in stable angina patients. The artery-opening procedure alleviates chest pain far more quickly than medical therapy; studies confirming reduction of mortality are still under discussion.

Procedures

The term balloon angioplasty is commonly used to describe percutaneous coronary intervention, which describes the inflation of a balloon within the coronary artery to crush the plaque into the walls of the artery. While balloon angioplasty is still done as a part of nearly all percutaneous coronary interventions, it is rarely the only procedure performed.

Other procedures done during a percutaneous coronary intervention include:

Implantation of stents
Rotational or laser atherectomy
Brachytherapy (use of radioactive source to inhibit restenosis)

Sometimes, a small mesh tube, or "stent", is introduced into the blood vessel or artery to prop it open using percutaneous methods. Angioplasty with stenting is a viable alternative to heart surgery for some forms of non-severe coronary artery disease.^[15] It has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac ischemia, but has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). In acute cases, a small but definite reduction of mortality occurs with this form of treatment compared with medical therapy, which usually consists of the administration of thrombolytic ("clot busting") medication.^[16]^[17]

Technique

The angioplasty procedure usually consists of most of the following steps and is performed by a team made up of physicians, physician assistants, nurse practitioners, nurses, radiographers, and cardiac invasive specialists; all of whom have extensive and specialized training in these types of procedures.

Access into the femoral artery in the leg (or, less commonly, into the radial artery or brachial artery in the arm) is created by a device called an "introducer needle". This procedure is often termed percutaneous access.
Once access into the artery is gained, a "sheath introducer" is placed in the opening to keep the artery open and control bleeding.
Through this sheath, a long, flexible, soft plastic tube called a "guiding catheter" is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radio-opaque dyes (usually iodine-based) to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time X-ray visualization.
During the X-ray visualization, the cardiologist estimates the size of the coronary artery and selects the type of balloon catheter and coronary guidewire that will be used during the case. Heparin (a "blood thinner" or medicine used to prevent the formation of clots) is given to maintain blood flow. Bivalirudin when used instead of heparin has a higher rate of myocardial infarction but lower rates of bleeding.^[18]
The coronary guidewire, which is an extremely thin wire with a radio-opaque flexible tip, is inserted through the guiding catheter and into the coronary artery. While visualizing again by real-time X-ray imaging, the cardiologist guides the wire through the coronary artery to the site of the stenosis or blockage. The tip of the wire is then passed across the blockage. The cardiologist controls the movement and direction of the guidewire by gently manipulating the end that sits outside the patient through twisting of the guidewire.
While the guidewire is in place, it now acts as the pathway to the stenosis. The tip of the angioplasty or balloon catheter is hollow and is then inserted at the back of the guidewire—thus the guidewire is now inside of the angioplasty catheter. The angioplasty catheter is gently pushed forward, until the deflated balloon is inside of the blockage.
The balloon is then inflated, and it compresses the atheromatous plaque and stretches the artery wall to expand.
If an expandable wire mesh tube (stent) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the artery from the inside.^[19]

Coronary stenting

A coronary stent placed by percutaneous coronary intervention.

Traditional ("bare-metal stent", BMS) coronary stents provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of coronary arteries. In normal patients in the usual case, stenting during PCI for an ST elevation myocardial infarction (STEMI) in a hemodynamically stable patient is not recommended because evidence does not show a likelihood of positive outcome for this and does show increased mortality and complications.^[20]^[21] Medical societies therefore recommend against stent placement into a noninfarct artery during PCI.^[20] Percutaneous transluminal coronary angioplasty with stenting, when indicated, has been shown to be superior to angioplasty alone in patient outcome by keeping arteries patent for a longer period of time.^[22]

Newer drug-eluting stents (DES) are traditional stents coated with drugs, which, when placed in the artery, release certain drugs over time. These types of stents have been shown to help prevent restenosis of the artery through several different physiological mechanisms, which rely upon the suppression of tissue growth at the stent site and local modulation of the body's inflammatory and immune responses. Five drugs, umirolimus,^[23] zotarolimus, sirolimus, everolimus, and paclitaxel, have demonstrated safety and efficacy in this application in controlled clinical trials by stent device manufacturers.^{[citation needed]} However, in 2006, three broad European trials seem to indicate that drug-eluting stents may be susceptible to an event known as "late stent thrombosis", where the blood-clotting inside the stent can occur one or more years after stent implantation. Late stent thrombosis occurs in 0.9% of patients, and is extremely dangerous and is fatal in about one-third of cases when the thrombosis occurs.^[24]^[25] Newer generation DES products market a biodegradable coating which aims to reduce this risk. A more recent study proposes that, in the case of population with diabetes mellitus that are particularly at risk, a treatment with paclitaxel-eluting balloon followed by BMS may reduce the incidence of coronary restenosis or myocardial infarction compared with BMS administered alone.^[26]

Preventive angioplasty

When performing emergency PCI in a patient with an acute ST-elevation myocardial infarction, in addition to the arterial occlusion that caused the MI, multiple complex atherosclerotic plaques are commonly found in other coronary arteries.^[27] The PRAMI trial showed, in patients having emergency PCI for acute STEMI who also had significant multiple vessel disease, performing preventive PCI on non-infarct arteries reduced the risk of a composite endpoint of death from cardiac causes, nonfatal myocardial infarction and refractory angina significantly (relative risk 0.35).^[28]

Epidemiology

PTCA is one of the most common procedures performed during U.S. hospital stays; it accounted for 3.6% of all operating room procedures performed in 2011.^[29] Between 2001 and 2011, however, its volume decreased by 28%, from 773,900 operating procedures performed in 2001 to 560,500 procedures in 2011.^[30]

History

Coronary angioplasty, also known as percutaneous transluminal coronary angioplasty (PTCA), because it is done through the skin and through the lumen of the artery, was first developed in 1977 by Andreas Gruentzig. The first procedure took place Friday Sept 16, 1977, at Zurich, Switzerland.^[31] Adoption of the procedure accelerated subsequent to Gruentzig's move to Emory University in the United States. Gruentzig's first fellow at Emory was Merril Knudtson, who, by 1981, had already introduced it to Calgary, Alberta, Canada.^[32] By the mid-1980s, many leading medical centers throughout the world were adopting the procedure as a treatment for coronary artery disease.

Angioplasty is sometimes erroneously referred to as "Dottering", after Interventional Radiologist, Dr Charles Theodore Dotter, who, together with Dr Melvin P. Judkins, first described angioplasty in 1964.^[33] As the range of procedures performed upon coronary artery lumens has widened, the name of the procedure has changed to percutaneous coronary intervention.

References

^ Tullio Palmerini; Giuseppe Biondi-Zoccai; Letizia Bacchi Reggiani; Diego Sangiorgi; Laura Alessi; Stefano De Servi; Angelo Branzi; Gregg W. Stone,; Biondi-Zoccai; Reggiani; Sangiorgi; Alessi; De Servi; Branzi; Stone (August 2012). "Risk of Stroke With Coronary Artery Bypass Graft Surgery Compared With Percutaneous Coronary Intervention". Journal of the American College of Cardiology 60 (9): 798–805. doi:10.1016/j.jacc.2011.10.912. PMID 22917004.
^ Stroupe KT, Morrison DA, Hlatky MA, Barnett PG, Cao L, Lyttle C, Hynes DM, Henderson WG (September 2006). "Cost-effectiveness of coronary artery bypass grafts versus percutaneous coronary intervention for revascularization of high-risk patients". Circulation 114 (12): 1251–1257. doi:10.1161/CIRCULATIONAHA.105.570838. PMID 16966588.
^ ^a ^b Kones, R (Sep 7, 2010). "Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization.". Vascular health and risk management 6: 749–74. doi:10.2147/vhrm.s11100. PMC 2941787. PMID 20859545.
^ "JAMA Network | Archives of Internal Medicine | Drug-Eluting vs Bare-Metal Stents in Primary AngioplastyA Pooled Patient-Level Meta-analysis of Randomized Trials". Archinte.ama-assn.org. 2012-04-23. Retrieved 2012-11-08.
^ Palmerini, T; Biondi-Zoccai, G, Riva, DD, Stettler, C, Sangiorgi, D, D'Ascenzo, F, Kimura, T, Briguori, C, Sabatè, M, Kim, HS, De Waha, A, Kedhi, E, Smits, PC, Kaiser, C, Sardella, G, Marullo, A, Kirtane, AJ, Leon, MB, Stone, GW (Mar 22, 2012). "Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis.". Lancet 379 (9824): 1393–402. doi:10.1016/S0140-6736(12)60324-9. PMID 22445239.
^ Elmariah, Sammy; Mauri, Laura; Doros, Gheorghe; Galper, Benjamin Z; O'Neill, Kelly E; Steg, Philippe Gabriel; Kereiakes, Dean J; Yeh, Robert W (November 2014). "Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis". The Lancet. doi:10.1016/S0140-6736(14)62052-3.
^ UK's NHS endorsed 'Best Treatments' advice on 'clinical evidence for patients from the BMJ' on Coronary angioplasty and its [1]
^ Harold JG; Bass TA; Bashore TM et al. (May 2013). "ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures)". Circulation 128 (4): 436–72. doi:10.1161/CIR.0b013e318299cd8a. PMID 23658439.
^ Jang JS; Jin HY; Seo JS et al. (August 2012). "The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis". EuroIntervention 8 (4): 501–10. doi:10.4244/EIJV8I4A78. PMID 22581470.
^ Yang EH, Gumina RJ, Lennon RJ, Holmes DR, Rihal CS, Singh (2005). "to 2003". Journal of the American College of Cardiology 46 (11): 2004–2009. doi:10.1016/j.jacc.2005.06.083. PMID 16325032.
^ Califf R. M.; Abdelmeguid A. E. et al. (1998). "Myonecrosis after revascularization procedures". J Am Coll Cardiol 31 (2): 241–51. doi:10.1016/S0735-1097(97)00506-8. PMID 9462562.
^ Tardiff B. E.; Califf R. M. et al. (1999). "Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous intervention. IMPACT-II Investigators. Integrilin (eptifibatide) to Minimize Platelet Aggregation and Coronary Thrombosis-II". J Am Coll Cardiol 33 (1): 88–96. doi:10.1016/S0735-1097(98)00551-8. PMID 9935014.
^ Cucherat M, Bonnefoy E, Tremeau G (2003). "Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction". Cochrane Database Syst Rev (3): CD001560. doi:10.1002/14651858.CD001560. PMID 12917910.
^ "What Is Coronary Angioplasty? - NHLBI, NIH". Nhlbi.nih.gov. Retrieved 2012-11-08.
^ Michaels AD, Chatterjee K (December 2002). "Cardiology patient pages. Angioplasty versus bypass surgery for coronary artery disease". Circulation 106 (23): e187–90. doi:10.1161/01.CIR.0000044747.37349.64. PMID 12460885. Retrieved 2009-07-13.
^ Mercado, N, Flather, MD, Boersna, E, et al., on Behalf of the Trial Investigators CABG vs Stenting for Multivessel Disease: a Meta-analysis of ARTS-1, SoS, ERACI-2, and MASS-2, Presentation at European Society of Cardiology Congress 2003
^ Weaver WD; Simes RJ; Betriu A et al. (December 1997). "Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review". JAMA 278 (23): 2093–8. doi:10.1001/jama.278.23.2093. PMID 9403425.
^ Cavender, MA; Sabatine, MS (Aug 16, 2014). "Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials.". Lancet 384 (9943): 599–606. doi:10.1016/s0140-6736(14)61216-2. PMID 25131979.
^ PTCA or Balloon Angioplasty
^ ^a ^b American College of Cardiology. "Five Things Physicians and Patients Should Question". Choosing Wisely: an initiative of the ABIM Foundation (American College of Cardiology). Retrieved August 17, 2012
^ Patel, M. R.; Dehmer, G. J.; Hirshfeld, J. W.; Smith, P. K.; Spertus, J. A. (2009). "ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization". Journal of the American College of Cardiology 53 (6): 530–553. doi:10.1016/j.jacc.2008.10.005. PMID 19195618. edit
^ Gandhi MM, Dawkins KD (March 1999). "Fortnightly review: Intracoronary stents". BMJ (Clinical Research Ed.) 318 (7184): 650–3. doi:10.1136/bmj.318.7184.650. PMC 1115094. PMID 10066211.
^ Windecker, Stephan; Serruys, Patrick W; Wandel, Simon; Buszman, Pawel; Trznadel, Stanislaw; Linke, Axel; Lenk, Karsten; Ischinger, Thomas; Klauss, Volker (2008). "Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial". The Lancet 372 (9644): 1163–1173. doi:10.1016/S0140-6736(08)61244-1.
^ Mauri L, Hsieh WH, Massaro JM, Ho KK, D'Agostino R, Cutlip DE (March 2007). "Stent thrombosis in randomized clinical trials of drug-eluting stents". The New England Journal of Medicine 356 (10): 1020–9. doi:10.1056/NEJMoa067731. PMID 17296821.
^ European Society of Cardiology Science News, 2007 Thrombosis is the price for the success of drug-eluting stents
^ Juan Mieres; Carlos Fernandez-Pereira; Gustavo Risau; Leonardo Solorzano; Ricardo Pauletto; Alfredo Matías Rodríguez-Granillo; Bibiana Rubilar; Pieter Stella; Alfredo E. Rodríguez (Sep–Oct 2012). "One-year outcome of patients with diabetes mellitus after percutaneous coronary intervention with three different revascularization strategies: Results from the DiabEtic Argentina Registry (DEAR)". Cardiovascular Revascularization Medicine 13 (5): 265–271. doi:10.1016/j.carrev.2012.06.001. PMID 22796496.
^ Goldstein, J. A.; Demetriou, D.; Grines, C. L.; Pica, M.; Shoukfeh, M.; O'Neill, W. W. (2000). "Multiple Complex Coronary Plaques in Patients with Acute Myocardial Infarction". New England Journal of Medicine 343 (13): 915–922. doi:10.1056/NEJM200009283431303. PMID 11006367. edit
^ Wald, D. S.; Morris, J. K.; Wald, N. J.; Chase, A. J.; Edwards, R. J.; Hughes, L. O.; Berry, C.; Oldroyd, K. G.; Prami, I. (2013). "Randomized Trial of Preventive Angioplasty in Myocardial Infarction". New England Journal of Medicine 369 (12): 1115–1123. doi:10.1056/NEJMoa1305520. PMID 23991625. edit
^ Weiss AJ, Elixhauser A, Andrews RM. (February 2014). "Characteristics of Operating Room Procedures in U.S. Hospitals, 2011.". HCUP Statistical Brief #170. Rockville, MD: Agency for Healthcare Research and Quality.
^ Weiss AJ, Elixhauser A. (March 2014). "Trends in Operating Room Procedures in U.S. Hospitals, 2001—2011.". HCUP Statistical Brief #171. Rockville, MD: Agency for Healthcare Research and Quality.
^ Meier B, Bachmann D, Lüscher T (February 2003). "25 years of coronary angioplasty: almost a fairy tale". Lancet 361 (9356): 527. doi:10.1016/S0140-6736(03)12470-1. PMID 12583964.
^ "Foothills Interventional Cardiology Service". Retrieved 2008-12-31.
^ Dotter CT, Judkins MP (November 1964). "Transluminal treatment of arteriosclerotic obstruction". Circulation 30 (5): 654–70. doi:10.1161/01.CIR.30.5.654. PMID 14226164. Retrieved 2009-07-13.

Steve Stiles. Survey says: Most cardiologists support elective PCI sans on-site CABG. . . with caveats. theheart.org; Dec 13, 2011

External links

Angioplasty.Org news and education
European Association of Percutaneous Cardiovascular Interventions (EAPCI)
Q&A: Primary angioplasty, 18 Oct 2008
Percutaneous Coronary Intervention - Patient UK
Percutaneous Coronary Intervention - Medscape

UpToDate Contents

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1. 急性ST上昇型心筋梗塞における緊急経皮的冠動脈インターベンション（Primary PCI）：周術期マネージメント primary percutaneous coronary intervention in acute st elevation myocardial infarction periprocedural management
2. 経皮的冠動脈形成術の周術期合併症 periprocedural complications of percutaneous coronary intervention
3. ST上昇型心筋梗塞に対する血栓溶解後の経皮的冠動脈インターベンション percutaneous coronary intervention after fibrinolysis for acute st elevation myocardial infarction
4. 安定冠動脈疾患患者ににおける血行再建術：冠動脈バイパス移植術と経皮的冠動脈形成術の比較 revascularization in patients with stable coronary artery disease coronary artery bypass graft surgery versus percutaneous coronary intervention
5. ST上昇型心筋梗塞におけるプライマリ経皮的冠動脈インターベンション：転帰の決定因子 primary percutaneous coronary intervention in acute st elevation myocardial infarction determinants of outcome

English Journal

Platelet function testing in contemporary clinical and interventional practice.

Franchi F1, Rollini F, Cho JR, Ferrante E, Angiolillo DJ.Author information 1University of Florida College of Medicine-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA, francesco.franchi@jax.ufl.edu.AbstractOPINION STATEMENT: Dual antiplatelet therapy with a combination of aspirin and an inhibitor of the ADP P2Y12 receptor is the recommended treatment for patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention (PCI). However, patients may continue to have ischemic recurrences, including stent thrombosis, which have been linked with the well-known variability in individual response to antiplatelet therapy, and clopidogrel in particular. There are currently several assays available to measure platelet reactivity, and platelet function testing has been shown to be a valuable tool to assess the pharmacodynamic efficacy of antiplatelet drugs. Moreover, platelet reactivity has important prognostic implications, as several studies have shown an association with thrombotic and bleeding events in patients with high and low platelet reactivity, respectively. Consequently, over the past years there has been a plethora of studies investigating the optimal range of platelet reactivity associated with the highest protection against ischemic complications and the lowest risk of bleeding. Given the correlation between on-treatment platelet reactivity and outcomes, the use of platelet function testing has also been advocated to create personalized antiplatelet therapy. Several studies have been conducted in this field, but major clinical trials have failed to demonstrate a benefit of such a strategy in improving clinical outcomes. Indeed, inherent limitations of these trials may have contributed to their failure. The present manuscript provides an overview on the role of platelet function testing in contemporary clinical and interventional practice.
Current treatment options in cardiovascular medicine.Curr Treat Options Cardiovasc Med.2014 May;16(5):300. doi: 10.1007/s11936-014-0300-y.
OPINION STATEMENT: Dual antiplatelet therapy with a combination of aspirin and an inhibitor of the ADP P2Y12 receptor is the recommended treatment for patients with acute coronary syndrome or who are undergoing percutaneous coronary intervention (PCI). However, patients may continue to have ischemic
PMID 24652579

Saphenous vein graft interventions.

Brilakis ES1, Lee M, Mehilli J, Marmagkiolis K, Rodes-Cabau J, Sachdeva R, Kotsia A, Christopoulos G, Rangan BV, Mohammed A, Banerjee S.Author information 1VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, TX, 75216, USA, esbrilakis@gmail.com.AbstractOPINION STATEMENT: Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) currently accounts for approximately 6 % of all PCIs and is associated with increased risk for distal embolization and subsequent SVG failure compared with native coronary artery PCI. To minimize the risk for distal embolization, embolic protection devices should be used during SVG PCI when technically feasible. To minimize the risk for in-stent restenosis and the need for repeat PCI, drug eluting stents should be utilized in patients without contraindications to long-term antiplatelet therapy. Treating native coronary artery lesions is preferable to SVG PCI when technically feasible.
Current treatment options in cardiovascular medicine.Curr Treat Options Cardiovasc Med.2014 May;16(5):301. doi: 10.1007/s11936-014-0301-x.
OPINION STATEMENT: Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) currently accounts for approximately 6 % of all PCIs and is associated with increased risk for distal embolization and subsequent SVG failure compared with native coronary artery PCI. To minimize the risk for dis
PMID 24643432

Characteristics and Outcomes in Patients Undergoing Percutaneous Coronary Intervention Following Cardiac Arrest (from the NCDR).

Gupta N1, Kontos MC2, Gupta A3, Dai D4, Vetrovec GW2, Roe MT4, Messenger J5.Author information 1Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: ngupta@mcw.edu.2Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virgina.3Department of Internal Medicine, Rosalind Franklin University of Medicine and Science, Chicago, Illinois.4Duke Clinical Research Institute, Durham, North Carolina.5Department of Internal Medicine, University of Colorado, Aurora, Colorado.AbstractOutcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry with those without CA. Patients with ST elevation were classified as ST-elevation myocardial infarction (STEMI); all other patients having PCI were classified as without STEMI. Patients with CA in each group were compared with the corresponding non-CA groups for baseline characteristics, angiographic findings, and outcomes. A total of 594,734 patients underwent PCI, of whom 114,768 had STEMI, including 9,375 (8.2%) had CA, and 479,966 had without STEMI, including 2,775 (0.6%) had CA. Patients with CA were similar in age to patients with non-CA, with a lower frequency of coronary disease risk factors and known coronary disease. On angiography, patients with CA were significantly more likely to have more complex lesions with worse baseline thrombolysis in myocardial infarction flow. Patients with CA were significantly more likely to have cardiogenic shock, both for patients with STEMI (51% vs 7.2%, respectively) and for patients without STEMI (38% vs 0.8%, respectively, both p <0.001). In-hospital mortality was substantially worse in patients with CA, for both patients with STEMI (24.9% vs 3.1%, respectively) and patients without STEMI (18.7% vs 0.4%, respectively). In conclusion, patients who underwent PCI after CA had more complex anatomy, more shock, and higher mortality. The substantially increased mortality in patients with CA has important implications for the development and regionalization of centers for CA.
The American journal of cardiology.Am J Cardiol.2014 Apr 1;113(7):1087-92. doi: 10.1016/j.amjcard.2013.12.014. Epub 2014 Jan 14.
Outcomes in patients with out-of-hospital cardiac arrest (CA) who undergo percutaneous coronary intervention (PCI) have been limited to small, mostly single-center studies. We compared patients who underwent PCI after CA included in the CathPCI Registry with those without CA. Patients with ST elevat
PMID 24513475

Japanese Journal

症例 High risk PCIを実施後,重症後腹膜出血を来したが保存的治療に成功した1例

板橋裕史,原田裕久,吉澤彰宏 [他]
呼吸と循環 60(7), 775-778, 2012-07
NAID 40019366853

臨床技術 MDCTを用いた左冠動脈起始部の分岐形態に基づく最適な血管造影角度の検討

佐保辰典,大西英雄,中村義隆 [他]
日本放射線技術学会雑誌 68(6), 704-710, 2012-06
NAID 40019377274

Related Pictures

★リンクテーブル★

リンク元	「経皮的冠動脈インターベンション」「経皮的冠動脈形成」「percutaneous coronary transluminal angioplasty」「PCI」
関連記事	「intervention」「percutaneous」「coronary」「coronary intervention」「corona」

「経皮的冠動脈インターベンション」

Percutaneous coronary intervention
	Intervention
	A coronary angiogram (an X-ray with radio-opaque contrast in the coronary arteries) that shows the left coronary circulation. The distal left main coronary artery (LMCA) is in the left upper quadrant of the image. Its main branches (also visible) are the left circumflex artery (LCX), which courses top-to-bottom initially and then toward the centre/bottom, and the left anterior descending (LAD) artery, which courses from left-to-right on the image and then courses down the middle of the image to project underneath of the distal LCX. The LAD, as is usual, has two large diagonal branches, which arise at the centre-top of the image and course toward the centre/right of the image.
ICD-9-CM	36.09, 00.66

　　[★]

英: percutaneous coronary intervention、PCI
同: 経皮的冠インターベンション
関: 経皮的冠動脈形成術 percutaneous coronary transluminal angioplasty、percutaneous transluminal coronary angioplasty、PTCA

禁忌

左冠動脈本幹病変
冠動脈2枝が完全閉塞している場合の第3枝病変

→CABGの適応(冠動脈バイパス術#適応

CABGが選択される場合

多枝にわたる高度石灰化病変、びまん性狭窄病変ではCABGの方が成績がよい。

「経皮的冠動脈形成」

　　[★]

英: percutaneous coronary intervention、percutaneous transluminal coronary angioplasty、percutaneous coronary transluminal angioplasty
関: 経皮的冠動脈形成術、経皮的冠動脈インターベンション、経皮経管冠動脈形成術、経皮的冠インターベンション、経皮経管冠動脈形成

「percutaneous coronary transluminal angioplasty」

　　[★]

経皮的冠動脈形成術、経皮的冠動脈形成、経皮経管冠動脈形成術、経皮経管冠動脈形成

関: PCI、percutaneous coronary intervention、percutaneous transluminal coronary angioplasty、PTCA

「PCI」

　　[★]

「intervention」

　　[★]

n.

介入、治療介入、介入治療、処置、(カテーテルを用いた治療法)インターベンション

関: intervene、interventional、involvement、manipulate、manipulation、measure、therapeutic intervention、transaction、treat、treatment

「percutaneous」

　　[★]

adj.

経皮的な、経皮の

関: dermal、dermally、percutaneously、transcutaneous、transcutaneously、transdermal、transdermally、transepidermal

「coronary」

　　[★]

adj.

冠血管の、冠状動脈の

関: coronary artery、coronary vessel

「coronary intervention」

　　[★]

冠動脈インターベンション

「corona」

　　[★] コロナ帯　　　　　

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[19] PTCA or Balloon Angioplasty

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匿名

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案内

案内

percutaneous coronary intervention