ADVANCES IN INTERVENTIONAL CARDIOLOGY-

PATIENT TREATMENT OPTIONS

Aftab Jan

Cardiologist

GRUENTZIG performed the first coronary BALLOON angioplasty in 1977

Transcatheter Intervention

toolbox

Patient with Left main stem disease and complex diffuse disease…

Diffuse disease not amenable to surgery/Hybrid revascularisation approach

Patient with ongoing angina, a chronically occluded artery and evidence of viability…

LITHOPLASTY USES SOUND WAVES TO DISRUPT VASCULAR CALCIUM FOR OPTIMAL

STENT DEPLOYMENT.

DISRUPT CAD, a multicentre single arm trial of the Shockwave system in patients with complex

calcified obstructive coronary artery disease prior to drug-eluting stent implantation showed 98

percent device success, an acute gain of 1.7 mm, and 13 percent residual stenosis post procedure.

CORONARY IMAGING TECHNOLOGY THAT ALLOWS VISUALIZATION

WITHIN ARTERY

INTRAVASCULAR ULTRASOUND (IVUS) OPTICAL COHERENCE TOMOGRAPHY (OCT)

LASER GUIDED ANGIOPLASTY IN PATIENT WITH AGGRESSIVE

NEOATHEROSCLEROSIS

Laser sheath delivers a ring of laser energy to vaporize the atheromatous tissue into

particles that are absorbed into the blood stream.

CT FRACTIONAL FLOW RESERVE (FFR) CUT-OFF 0.80

Patient with PFO and cryptogenic stroke…

Cryptogenic stroke i.e. stroke in the absence of classical vascular or cardioembolic sources, under the age of 55 years.

The mechanism has been attributed to paradoxical embolism through this residual embryologic intratrial communication

in some patients.

RA

LAIAS

RESPECT :The question of PFO closure efficacy has been a decades-long

question, but in final study findings, closure solidly beat medical

management for secondary stroke prevention in cryptogenic stroke.

Other studies

favouring closure

over medical

therapy alone

CLOSE

REDUCE

Amplatzer PFO Occluder

PATIENT WITH A.FIB, HIGH STROKE RISK AND UNFIT FOR

ANTICOAGULATION…?

(Minimally invasive) transcatheter aortic valve implantation (TAVI)

PARTNER 2A confirmed the noninferiority of Sapien XT implantation

to surgical aortic valve replacement (SAVR) in intermediate-risk

patients with symptomatic severe aortic stenosis. In those suitable for

transfemoral access, superiority was seen for the primary endpoint of

all-cause death and disabling stroke at two years.

Mitral valve is ready to stop playing second fiddle…?

RENAL DENERVATION MAKING A COMEBACK

The nerves that lead to the kidneys are a critical part of your patient's

sympathetic nervous system.

An overactive sympathetic nervous system can be one of the key

mechanisms that results in high blood pressure.

RDN works by interrupting the signalling coming from the nerves

SPYRAL HTN-OFF MED SPYRAL HTN-ON MED

PCSK9 inhibitors might be the “fluoride” of cardiology

.

PCSK9 inhibitors, should they be found to safely reduce cardiovascular events or stabilize

vulnerable plaques, could be a disrupter to interventional cardiology since, well, since the

invention of over-the-wire balloon angioplasty.

The success of transcatheter heart disease therapies has been the ability to do procedures that may have once required surgery, in a minimally invasive fashion.

A healthy respect for the complications of new and innovative therapy is critical for interventionalists.

In high-risk patients these therapies are readily accepted. However, in patients

of low operative risk we constantly re-examine transcatheter therapies with the

availability of excellent surgical therapies with long-term track records

Careful evaluation, monitoring and reporting of outcomes of these

new therapies are critical for further advancement and insight into

ideal patient selection.