scholarly journals How Fibrinolysis was Defeated by PCI

2021 ◽  
Vol 3 (4) ◽  
pp. 01-01
Author(s):  
Victor Gurewich
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Treatment ◽  
Blood Clot ◽  
Coronary Intervention ◽  
Catheter Removal ◽  
Enzymatic System ◽  
Heart Attacks ◽  
Percutaneous Coronary ◽  
Almost All ◽  
Medical Interest

Fibrinolysis refers to the natural enzymatic system responsible for dissolving a blood clot or thrombus. Since an intravascular thrombus is responsible for almost all heart attacks and most strokes, interest in fibrinolysis, the only medical treatment, dominated medical interest in the 60’s-90’s. Since that time, the incidence of heart attacks and strokes has not changed much, but interest in fibrinolysis has faded. Instead, interest has shifted to catheter removal of clots, called percutaneous coronary intervention (PCI) which is a time-consuming that delays reperfusion considerably, and is much more costly than fibrinolysis. It is also a cruder treatment that can only remove clots larger than the catheter, but it is very well reimbursed.

The ‘golden rules’ of percutaneous coronary intervention

2010 ◽  
pp. 81-87
Author(s):  
Rod H. Stables
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Adverse Events ◽  
Clinical Setting ◽  
Coronary Intervention ◽  
Therapeutic Options ◽  
Case Selection ◽  
Percutaneous Coronary ◽  
Core Concepts ◽  
Almost All ◽  
Educational Meetings

In the practice of percutaneous coronary intervention (PCI), the usual aim is to deliver maximum clinical gain—at the lowest possible risk—achievable in that specific clinical setting. Most interventionists will accept that PCI has established limitations. The enthusiasm to recommend and perform this form of therapy should be tempered in the light of this reality. Clinical gain can be real but is often modest. Performance can be associated with morbidity and mortality. Alternative therapeutic options exist and are effective. Other chapters in this textbook will seek to guide on case selection, to refine technique, and to provide an appreciation of available technologies and pharmacotherapy. I believe, however, that substantial improvements in both elements of the ‘risk:benefit’ ratio can be achieved with a re-examination and more universal application of some core, fundamental principles underpinning optimal PCI practice. A talk describing my ‘golden rules of PCI’ has been well-received, by trainees and experienced operators alike, at educational meetings over the last decade and most recipients come to accept my assertion that almost all procedure-related adverse events or suboptimal outcomes can be traced back to a breach of these core concepts.

scholarly journals Sinus Node Dysfunction due to Occlusion of the Sinus Node Artery during Percutaneous Coronary Intervention

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ofir Koren ◽  
Dante Antonelli ◽  
Ranya Khamaise ◽  
Scot Ehrenberg ◽  
Ehud Rozner ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Treatment ◽  
Sinus Node ◽  
Coronary Intervention ◽  
Sinus Node Dysfunction ◽  
Proximal Segment ◽  
Coronary Syndrome ◽  
Sinus Node Artery ◽  
Percutaneous Coronary

Background. Sinus node artery occlusion (SNO) is a rare complication of percutaneous coronary intervention (PCI). We analyze both the short- and long-term consequences of SNO. Methods. We retrospectively reviewed 1379 consecutive PCI’s involving RCA and Cx arteries performed in our heart institute from 2016 to 2019. Median follow-up was 44 ± 5 months. Results. Among the 4844 PCIs performed during the study period, 284 involved the RCA and the circumflex’s proximal segment. Periprocedural SNO was estimated by angiography observed in 15 patients (5.3%), all originated from RCA. The majority of SNO occurred during urgent and primary PCIs following acute coronary syndrome (ACS). Sinus node dysfunction (SND) appeared in 12 (80%) of patients. Four (26.6%) patients had sinus bradycardia, which resolved spontaneously, and 8 (53.3%) patients had sinus arrest with an escaped nodal rhythm, which mostly responded to medical treatment during the first 24 hours. There was no association between PCI technique and outcome. Three patients (20%) required urgent temporary ventricular pacing. One patient had permanent pacemaker implantation. Pacemaker interrogation during follow-up revealed a recovery of the sinus node function after one month. Conclusion. SNO is rare and seen mostly during angioplasty to the proximal segment of the RCA during ACS. The risk of developing sinus node dysfunction following SNO is high. SND usually appears during the first 24 h of PCI. The majority of SND patients responded to medical treatment, and only in rare cases were permanent pacemakers required.

scholarly journals Case Report of Korean Medical Treatment of Chest Pain After Percutaneous Coronary Intervention

2021 ◽  
Vol 42 (2) ◽  
pp. 184-196
Author(s):  
Seon-woo Min ◽  
Hak-kyeom Kim ◽  
Ji-seong Moon ◽  
Ye-seul Kim ◽  
Ji-yoon Park ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Case Report ◽  
Chest Pain ◽  
Medical Treatment ◽  
Coronary Intervention ◽  
Percutaneous Coronary
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