Cath Lab Digest - October 2007 - (Page 28)

28 CASE REPORT OCTOBER 2007 continued from previous page Q A SCAI has been at the forefront of providing guidance to physicians regarding the use of drug-eluting stents (DES). When did SCAI issue its first position statement on DES? SCAI issued its first position statement on DES in 2003, in preparation for the approval of DES in the United States. Leading up to the approval, it was clear there were many concerns on how to best implement this technology, which was better but more expensive than existing technologies. The goal of issuing the statement was to give interventional cardiologists guidance on how to evaluate available data and integrate DES into their practices. We issued another position statement in January 2007 emphasizing the importance of keeping patients with DES on dual anti-platelet agents for a minimum of 12 months. The major independent predictor of latestent thrombosis, particularly in the first year, is premature cessation of dual anti-platelet agents. After one year, the protocol is not completely clear, because late thrombosis can occur despite a dual anti-platelet agent regimen. Q A Can cath lab technologists and nurses use guidelines? Absolutely. Although guidelines are aimed at the physicians who are actually performing procedures, cath lab staff and nurses are critically important to our success. These individuals often have more opportunities to pass along information from guidelines to patients, for example, about dual anti-platelet agents, which can make a huge difference in patient outcomes. Sponsored by Boston Scientific Corporation Figure 3. Final angiogram revealing excellent result and TIMI-3 flow. resulting in no residual stenosis (Figure 3). The artery continued into a posterior descending branch, without evidence of bifurcation into a posterolateral branch. The patient had an uneventful post-infarct course and was subsequently discharged after 2 days. Eighteen months later, she presented with complaints of substernal chest pressure and dyspnea on exertion, reminiscent of her prior symptoms. Although no objective evidence of ischemia or infarction were evident, decision was made to proceed directly to cardiac catheterization for Figure 4. Repeat angiogram revealing newly open posterolateral branch (double arrows) originating from middle of widely patent stent. The distal right coronary artery and posterior descending branch (single arrow) are also free of significant disease. Figure 2. Stent implantation after intracoronary nitroprusside pretreatment and Export catheter thrombectomy. a definitive diagnosis in light of her previous history. Again, no significant disease was seen in the left coronary system. Right coronary angiography revealed a widely patent stent with excellent TIMI grade 3 flow. However, a new patent posterolateral branch was now seen originating from the mid-section of the stent. It was then obvious that the stent had been deployed at the crux, across the previously occluded posterolateral branch (Figure 4). The patient was continued on longacting metoprolol, ramipril, aspirin, clopidogrel, and atorvastatin; pantoprazole was added for possible gastrointestinal symptoms. She was discharged the same day and has remained asymptomatic. Discussion Percutaneous treatment of coronary bifurcation lesions (BL) has been fraught with technical challenges. Many techniques, such as

Table of Contents Feed for the Digital Edition of Cath Lab Digest - October 2007

Saints Medical Center Fibromuscular Dysplasia in Children and Adolescents Cerebral Vascular Accident Following a Pulmonary Embolism: Search for the Hidden Patent Foramen Ovale Contents Clinical Editor’s Corner Meetings Calendar CEU Education Center Radiation Tracking in the Cardiac Catheterization Lab Letter to the Editor Carotid Stenting: An update Release from Stent-jail: Beneficial Snow-Plowing? Patient Management Guidelines Searching for a Cardiovascular Position? Tips for Creating a ‘Stand-Out’ Resume Long-Term Implications of Short-Term Closure Decisions – The Evolution to Vascular Access Management and the Boomerang Catalyst System The Ten-Minute Interview with… Angie Bowles, RN, CCRN CMS Issues Final FY 2008 IPPS Rule ACVP• Membership Page Experience with a New Workhorse Guidewire Ask the Clinical Instructor: Q&A for Those New to Cath Lab A Glimpse of the Future of Clinical Education: Boston Scientific’s SimSuite Bus Visits Carnegie Institute 2007 Educational Fair Held at the Washington Hospital Center Research Update: Original Contribution Abstracts from The Journal of Invasive Cardiology What Do You Think? A Virtual Cath Lab Viewer (VCL): The Development of an Online 3D C-arm Simulator and Coronary Anatomy Viewer Clinical & Industry News Cost-Effectiveness of the Radial versus Femoral Artery Approach to Diagnostic Cardiac Catheterization

Cath Lab Digest - October 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.