GP SuperclinicMidland Railway Workshops Heart Week Event Dr Chris Judkins MBBS MClinRes FRACP Interventional Cardiologist WA Cardiology Fiona Stanley Hospital wwwperthheartcom ID: 935920
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Slide1
LATEST DEVELOPMENTS IN INTERVENTIONAL CARDIOLOGY
GP
Superclinic@Midland
Railway Workshops Heart Week Event
Dr
Chris
Judkins
MBBS
MClinRes
FRACP
Interventional Cardiologist
WA Cardiology
Fiona Stanley Hospital
www.perthheart.com
Slide2Topics to cover
What is Coronary Intervention
?
What are the latest developments?
Aftercare post Stenting
Slide3Percutaneous Coronary Intervention
PCI – “stenting”
What is it?
How does it work?
What happens after stenting?
Slide4Slide5Slide6A short history of Percutaneous Coronary Angioplasty
Angiography
1960 -Mason
Sones
accidentally
catheterised the LM – cardiac arrest POBASept 16 1977, Switzerland, Andreas GruentzigLimited by dissections, recoil, acute closure (5%), restenosisBMS
Introduced 1986 – Palmaz Schatz – approved FDA 1994Better than POBA (Stress and Benestent-1 trials)Neointimal hyperplasia 20-30%DESIntroduced to overcome NIHIssue of late thrombosis (drug prevents endothelialisation
)DEB2 available – Useful where a stent is not desirable, ISR etcBioabsorbable scaffoldsPolymer of L-lactic acid (PLLA) (others magnesium etc)Abbott Vascular – ”Absorb” TGA 2014
Slide7Scaffold vs Stent
Slide8Radial AngiographyPatients prefer Radial (wrist) Access
Back pain
BMI
Unable to lie flat
Less bleeding
Less MortalitySame day stenting
Slide9Access
site Bleeding Complications
Major
and Minor
Case
Complication
Treatment Required
FEMORAL
1
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 RADIAL21Haematoma <2cm2nd TR band
Slide10What i
s important after stenting?
Lifestyle:
Diet
Exercise
Risk Factors:
DiabetesHypertensionCholesterolSmoking
Other Considerations:Work/DrivingMedicationsComorbidities
Obstructive sleep
apnea
Slide11Immediate post care
Arterial access site
Driving
Diet
Exercise
Work
Personal vehicleCommercial vehicleafter a heart attack
2 weeks4 weeksAfter a stent2 days4 weeks
After bypass grafts
4 weeks
3 months
Slide12Aftercare post stenting
Medications
Aspirin
Clopidogrel
(
Plavix), Ticagrelor (Brilinta
)Statin (eg Atorvastatin)Beta Blocker (eg Metoprolol)
ACE Inhibitor (eg ramipril)Drug eluting stent (DES): 12 monthsBare Metal Stent (BMS): 3 monthsAfter a heart attack: 12 monthsBioresorbable stent: ?12 months
Slide13Aftercare post stenting
Medications
Aspirin
Clopidogrel
(
P
lavix), Ticagrelor (Brilinta)Statin (eg Atorvastatin)
Beta Blocker (eg Metoprolol)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
Slide14Secnario
One:
65yo male
Not diabetic
Normal high blood pressure
SmokerBorderline high cholesterolScenario Two:Lower SBP by 10mmHgLower cholesterol to targetQuit smoking
Absolute Risk28% down to 8%
Slide15Examples of post heart attack help
programs
Tertiary
Hospitals
Rehabilitation programs
HeartBeat (Armadale/Kelmscott)www.baml.com.au/HB
Heart FoundationMy Heart My Life App/BookCardiovascular care WA (aka CPRwa)Hollywood hospital www.cprwa.com.auPerth Heartwww.perthheart.com
Slide16THANK YOU
www.perthheart.com