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SPEC - Textbook of Interventional Cardiology E-Book 12 month Subscription
Eric J. Topol | Paul S. Teirstein
(2011)
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Book Details
Abstract
The 6th Edition of the indispensable Textbook of Interventional Cardiology, by Drs. Eric Topol and Paul S. Teirstein, offers you comprehensive, seasoned clinical advice on all aspects of this rapidly evolving subspecialty. You’ll find balanced, expert perspectives on the scientific and clinical advances established over the last few decades so you can better decide which procedures deliver optimal results in any given situation. You’ll also get an updated look at promising new techniques like transcatheter aortic valve implantation; new interventional approaches for left mainstem disease and thrombus-containing lesions; transradial intervention; and optical coherence tomography (OCT). At www.expertconsult.com you can access the complete contents of the book, plus additional case discussions and procedural videos to enhance your knowledge and skills.
- Rely on Dr. Topol’s premier text to provide unmatched leadership in the ever-evolving practice of interventional cardiology.
- Achieve the best outcomes for your patients with dependable, objective advice on both proven and emerging procedures and devices.
- Perform effective interventions for heart disorders with the expert guidance of leading authorities who offer a fresh and balanced perspective on all aspects of interventional cardiology.
- Keep up with emerging procedures including transcatheter aortic valve implantation (TAVI), transradial intervention, and optical coherence tomography (OCT), as well as new interventional approaches for left mainstem disease and thrombus-containing lesions.
- Stay current with the latest genetic information and clinical trials.
Search the complete text plus additional case discussions, download all the images, and watch procedural videos online at www.expertconsult.com.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Textbook of Interventional Cardiology | i | ||
| Copyright page | iv | ||
| Dedication | v | ||
| Contributors | vii | ||
| Preface | xiii | ||
| Table of Contents | xv | ||
| VIDEO TABLE OF CONTENTS | xvii | ||
| 1 Patient Selection | 1 | ||
| 1 Individualized Assessment for Percutaneous or Surgical Revascularization | 3 | ||
| Key Points | 3 | ||
| Introduction | 3 | ||
| The Need for Individualized Patient Assessment | 3 | ||
| Patient Comorbidities | 3 | ||
| Technological Advances | 3 | ||
| Clinical Trial Results | 4 | ||
| The SYNTAX Trial | 5 | ||
| Individual Assessment—From a Physician’s Perspective | 6 | ||
| Qualitative Versus Quantitative Risk Assessment | 7 | ||
| Risk Models in Contemporary Practice | 8 | ||
| Clinically Based Scores | 8 | ||
| euroSCORE | 8 | ||
| Mayo Clinic Risk Score | 9 | ||
| Age, Creatinine, Ejection Fraction Score | 9 | ||
| National Cardiovascular Database Registry CathPCI Risk Prediction Score | 10 | ||
| Angiography-Based Scores | 10 | ||
| ACC/AHA Lesion Classification | 10 | ||
| Syntax Score | 10 | ||
| Combined Risk Scores | 11 | ||
| Society of Thoracic Surgery Score | 12 | ||
| euroSCORE-SYNTAX | 12 | ||
| Clinical Syntax Score | 12 | ||
| Individual Assessment—From a Patient’s Perspective | 12 | ||
| Conclusions | 13 | ||
| References | 14 | ||
| 2 Evidence-Based Interventional Practice | 16 | ||
| Key Points | 16 | ||
| Introduction | 16 | ||
| Changing Paradigms of Coronary Revascularization | 16 | ||
| The Scope of this Chapter | 16 | ||
| Prognostic Indications for Coronary Revascularization | 17 | ||
| Clinical Presentation | 17 | ||
| Myocardial Infarction with ST-Segment Elevation | 17 | ||
| Acute Coronary Syndromes without ST-Segment Elevation | 17 | ||
| Stable Angina—Severe Angina or Large Ischemic Area | 18 | ||
| Coronary Anatomy | 18 | ||
| Technical Feasibility | 19 | ||
| Prognostic Indication for Revascularization: PCI Versus CABG | 20 | ||
| Multivessel Disease | 20 | ||
| Lessons from Studies with Bare Metal Stents | 20 | ||
| Randomized Studies. | 20 | ||
| 2 Pharmacologic Intervention | 95 | ||
| 8 Platelet Inhibitor Agents | 97 | ||
| Key Points | 97 | ||
| Basic Principles of Anti-Platelet Therapy | 97 | ||
| Aspirin | 98 | ||
| Mechanism of Action | 98 | ||
| Pharmacokinetics and Pharmacodynamics | 98 | ||
| Aspirin Dose after Percutaneous Coronary Intervention | 98 | ||
| P2Y12 Inhibitors | 100 | ||
| Basic Principles | 100 | ||
| Thienopyridines | 100 | ||
| Ticlopidine | 100 | ||
| Clopidogrel | 100 | ||
| Metabolism. | 100 | ||
| Pharmacodynamics. | 100 | ||
| Clinical Studies | 100 | ||
| Non–ST Elevation Acute Coronary Syndrome. | 100 | ||
| ST Elevation Myocardial Infarction. | 101 | ||
| Pretreatment for Percutaneous Coronary Intervention. | 101 | ||
| Dosing Strategies. | 102 | ||
| Duration of Therapy. | 102 | ||
| Role of CYP2C19. | 102 | ||
| Predicted Metabolic Phenotype. | 102 | ||
| CYP2C19 and Clinical Outcomes. | 103 | ||
| U.S. Food and Drug Administration’s Boxed Warning. | 104 | ||
| Other Genetic Polymorphisms | 104 | ||
| PON1. | 104 | ||
| ABCB1. | 104 | ||
| Proton Pump Inhibitors | 104 | ||
| Prasugrel | 105 | ||
| Metabolism | 105 | ||
| Pharmacodynamics | 105 | ||
| Clinical Studies | 105 | ||
| Non-Thienopyridines | 105 | ||
| Ticagrelor | 105 | ||
| Pharmacology and Metabolism. | 106 | ||
| Pharmacodynamics. | 106 | ||
| Clinical Studies. | 106 | ||
| Adverse Effects. | 106 | ||
| Cangrelor. | 106 | ||
| Thrombin Receptor Antagonists | 107 | ||
| Basic Principles | 107 | ||
| Vorapaxar | 107 | ||
| Atopaxar | 108 | ||
| Phosphodiesterase Inhibitors | 108 | ||
| Cilostazol | 108 | ||
| Glycoprotein IIb/IIIa Inhibitors | 108 | ||
| Pharmacology | 108 | ||
| Clinical Trials with Glycoprotein IIb/IIIa Inhibitors | 109 | ||
| Timing of Glycoprotein IIb/IIIa Administration | 110 | ||
| Glycoprotein IIb/IIIa Inhibitors in Primary Percutaneous Coronary Intervention | 110 | ||
| Platelet Function Testing | 110 | ||
| Conclusion | 111 | ||
| References | 111 | ||
| 9 Anticoagulation in Percutaneous Coronary Intervention | 113 | ||
| Key Points | 113 | ||
| Introduction | 113 | ||
| The Biology of Coagulation: Therapeutic Targets | 113 | ||
| The Central Role of Thrombin | 113 | ||
| Adverse Events Following Percutaneous Coronary Intervention | 113 | ||
| Monitoring of Anticoagulation | 115 | ||
| Unfractionated Heparin | 116 | ||
| Heparin Pharmacology | 116 | ||
| Clinical Data with Unfractionated Heparin | 117 | ||
| Low-Molecular-Weight Heparin | 117 | ||
| Pharmacology | 117 | ||
| Clinical Data with Enoxaparin | 117 | ||
| Clinical Data with Dalteparin | 119 | ||
| Pentasaccharide and Hexadecasaccharide | 119 | ||
| Direct Thrombin Inhibitors | 119 | ||
| Pharmacology | 119 | ||
| Clinical Data With Direct Thrombin INHIBITORS | 120 | ||
| Hirudin | 120 | ||
| Argatroban | 120 | ||
| Bivalirudin | 120 | ||
| Special Groups | 122 | ||
| ST Segment Elevation Myocardial Infarction | 122 | ||
| Transitioning from “Upstream” Management to the Cath-Lab | 122 | ||
| Decreased Renal Function | 122 | ||
| Patients with Diabetes | 123 | ||
| Heparin-Induced Thrombocytopenia | 123 | ||
| Glycoprotein IIb/IIIa–Sparing Combination Approaches and Economic Considerations | 124 | ||
| Conclusion | 124 | ||
| References | 124 | ||
| 10 Lipid Lowering in Coronary Artery Disease | 126 | ||
| Key Points | 126 | ||
| Epidemiology | 126 | ||
| National Cholesterol Education Program Recommendations | 126 | ||
| Early Nonstatin Lipid-Lowering Trials | 127 | ||
| Early Secondary Prevention Statin Trials | 128 | ||
| Heart Protection Study and Cholesterol Treatment Trial Meta-Analysis | 129 | ||
| Intensive Statin Therapy for Acute Coronary Syndrome | 129 | ||
| PROVE IT-TIMI 22 Trial | 129 | ||
| A to Z Trial | 130 | ||
| Intensive Statin Therapy in Stable Coronary Artery Disease | 130 | ||
| TNT Trial | 130 | ||
| IDEAL Trial | 131 | ||
| SEARCH Trial | 131 | ||
| Meta-Analysis of Intensive versus Standard Therapy | 131 | ||
| Early Benefits of Intensive Statin Therapy for Acute Coronary Syndrome | 132 | ||
| Intensive Statin Therapy and Atherosclerosis | 133 | ||
| REVERSAL Trial | 133 | ||
| ASTEROID Study | 133 | ||
| Mechanisms of Benefit | 133 | ||
| Intensity of Low-Density Lipoprotein Reduction | 133 | ||
| Reduction in CRP Levels | 134 | ||
| Apolipoproteins | 135 | ||
| Oxidized Low-Density Lipoprotein | 136 | ||
| Raising High-Density Lipoprotein Cholesterol Levels | 136 | ||
| Cholesterol Ester Transfer Protein Inhibition | 136 | ||
| Niacin | 138 | ||
| Fibrates | 138 | ||
| Ezetimibe or Colesevelam | 139 | ||
| Glitazones | 139 | ||
| Novel Targets for Therapy | 139 | ||
| PCSK-9 | 139 | ||
| Antisense to Apolipoprotein B | 139 | ||
| Thyroid Hormone Analogues | 139 | ||
| Conclusion | 139 | ||
| References | 140 | ||
| 11 Thrombolytic Intervention | 142 | ||
| Key Points | 142 | ||
| Thrombolytic Agents | 142 | ||
| Major Historical Comparative Thrombolytic Trials | 143 | ||
| Timing of Thrombolytic Therapy | 143 | ||
| Early Treatment | 143 | ||
| Late Treatment | 146 | ||
| Adjunctive Therapies | 148 | ||
| Aspirin | 148 | ||
| Heparin | 148 | ||
| Direct Thrombin Inhibitors | 150 | ||
| Glycoprotein IIb/IIIa Inhibitor | 151 | ||
| Thienopyridines | 151 | ||
| Factor Xa Inhibitors | 152 | ||
| Facilitated Percutaneous Coronary Intervention | 153 | ||
| Pharmaco-Invasive Strategy | 155 | ||
| International Perspective | 156 | ||
| Summary | 156 | ||
| References | 156 | ||
| 12 Other Adjunctive Drugs for Coronary Intervention: | 159 | ||
| Key Points | 159 | ||
| β-Adrenergic Receptors | 159 | ||
| β-Adrenergic Receptor Blockers | 159 | ||
| Unstable Angina Pectoris | 159 | ||
| Percutaneous Coronary Intervention | 160 | ||
| Acute Myocardial Infarction | 161 | ||
| Early Trials | 161 | ||
| The MIAMI Trial. | 161 | ||
| The ISIS-1 Trial. | 161 | ||
| Recent Data—The COMMIT Trial | 161 | ||
| Patient Selection. | 161 | ||
| Study Protocol. | 161 | ||
| Endpoints. | 161 | ||
| Results. | 161 | ||
| Meta-Analysis Using COMMIT Patients. | 162 | ||
| Recommendations for β-Blockade during Acute Myocardial Infarction | 162 | ||
| Chronic Therapy after Myocardial Infarction. | 162 | ||
| Patient Selection: Role of Genomics. | 163 | ||
| Calcium Channels | 163 | ||
| Calcium Channel Blockers | 164 | ||
| Acute Myocardial Infarction | 164 | ||
| Recommendations for Acute Coronary Syndromes | 164 | ||
| Chronic Therapy after Myocardial Infarction | 164 | ||
| Early Trials | 164 | ||
| Recent Trials | 164 | ||
| The CAMELOT Trial. | 164 | ||
| The INVEST Trial. | 165 | ||
| Percutaneous Coronary Intervention | 165 | ||
| Angiotensin-Converting Enzyme | 165 | ||
| Angiotensin-Converting Enzyme Inhibitors | 166 | ||
| Percutaneous Coronary Intervention | 166 | ||
| Acute Myocardial Infarction | 166 | ||
| Conclusion | 166 | ||
| References | 166 | ||
| 3 Coronary Intervention | 169 | ||
| 13 Bare Metal and Drug-Eluting Coronary Stents | 171 | ||
| Key Points | 171 | ||
| Abbreviations | 171 | ||
| Introduction | 171 | ||
| Overview of Bare Metal Stents | 171 | ||
| Limitations of Balloon Angioplasty and Development of the Coronary Stent. | 171 | ||
| Stent Design: Impact on Performance and Clinical Outcomes. | 173 | ||
| Stent Composition. | 173 | ||
| Stent Configuration and Design. | 173 | ||
| Stent Coatings. | 173 | ||
| Balloon-Expandable versus Self-Expanding Stents. | 173 | ||
| Indications for Coronary Stenting and Comparison with Balloon Angioplasty | 174 | ||
| Stenting after Failed Balloon Angioplasty. | 174 | ||
| Routine Stenting during PCI. | 174 | ||
| Overview of Drug-Eluting Stents | 174 | ||
| Limitations of Bare Metal Stents. | 174 | ||
| Components of Drug-Eluting Stents. | 174 | ||
| Designs of Drug-Eluting Stents. | 174 | ||
| Basic Pharmacology of Drug-Eluting Stents. | 174 | ||
| Drug-Eluting Stent Polymers and Drug Carrier Systems. | 175 | ||
| Generational Classification of Drug-Eluting Stents. | 175 | ||
| First-Generation Drug-Eluting Stents | 175 | ||
| The Cypher Sirolimus-Eluting Stent. | 175 | ||
| The Taxus Paclitaxel-Eluting Stent. | 176 | ||
| Comparisons of First-Generation Drug-Eluting Stents and Metanalyses. | 178 | ||
| Second-Generation Drug-Eluting Stents | 179 | ||
| Everolimus-Eluting Stents (Xience V/Promus). | 180 | ||
| Zotarolimus-Eluting Stent I (Endeavor). | 182 | ||
| Zotarolimus-Eluting Stent II (Resolute). | 182 | ||
| Biolimus A9-Eluting Stents (BioMatrix). | 184 | ||
| Conclusions. | 184 | ||
| Drug-Eluting Stents in Specific Situations | 184 | ||
| Acute ST-Segment-Elevation Myocardial Infarction. | 184 | ||
| Diabetes Mellitus. | 185 | ||
| Left Main and Multivessel Disease. | 186 | ||
| Chronic Total Occlusions. | 188 | ||
| Bifurcation Lesions. | 188 | ||
| Saphenous Vein Grafts. | 189 | ||
| Stent Failure Mechanisms and Management | 189 | ||
| Stent Thrombosis. | 189 | ||
| Restenosis. | 190 | ||
| Conclusions and Future Directions | 192 | ||
| Acknowledgment | 192 | ||
| References | 192 | ||
| 14 Drug-Coated Balloons | 197 | ||
| Key Points | 197 | ||
| Introduction | 197 | ||
| Preclinical Data | 197 | ||
| Clinical Data on Drug-Coated Balloons | 199 | ||
| Human Pharmacokinetics of Current Drug-Coated-Balloon Technology | 199 | ||
| Data from the Coronary Application of Drug-Coated Balloons | 200 | ||
| Clinical Data from the Peripheral Vascular Application of Drug-Coated Balloons | 201 | ||
| The Future of Drug-Coated-Balloon Technology | 201 | ||
| Summary | 202 | ||
| References | 202 | ||
| 15 History of Coronary Balloon Angioplasty and Current Indications | 203 | ||
| Key Points | 203 | ||
| Introduction | 203 | ||
| Historical Overview of Cardiac Catheterization | 203 | ||
| Mechanisms | 203 | ||
| The Development of Coronary Angioplasty | 205 | ||
| Percutaneous Transluminal Coronary Angioplasty of Saphenous Vein Graft Stenosis | 206 | ||
| Clinical Trials of Percutaneous Transluminal Coronary Angioplasty in Coronary Artery Disease | 206 | ||
| Complications of Percutaneous Transluminal Coronary Angioplasty | 207 | ||
| Coronary Artery Dissection | 207 | ||
| Abrupt Closure | 207 | ||
| Distal Embolization | 207 | ||
| Restenosis after Percutaneous Transluminal Coronary Angioplasty | 207 | ||
| Death | 207 | ||
| Influence of Balloon Angioplasty in Interventional Cardiology | 207 | ||
| Current Indications for Balloon Angioplasty | 207 | ||
| Andreas Roland Grüntzig (1939–1985) | 208 | ||
| Conclusions | 208 | ||
| Acknowledgments | 208 | ||
| References | 208 | ||
| 16 Elective Intervention for Stable Angina or Silent Ischemia | 209 | ||
| Key Points | 209 | ||
| Introduction | 209 | ||
| Revascularization in Patients with Chronic Stable Angina | 209 | ||
| Addition of Revascularization to Optimal Medical Therapy | 212 | ||
| Selection of Revascularization Strategy | 215 | ||
| Revascularization in Patients with Silent Ischemia | 218 | ||
| Tools for Selection of Therapy | 218 | ||
| Summary | 219 | ||
| References | 221 | ||
| 17 Intervention for Non-ST-Segment Elevation Acute Coronary Syndromes | 223 | ||
| Key Points | 223 | ||
| Introduction | 223 | ||
| Background and Rationale for Percutaneous Coronary Intervention in Patients with Non-St-Segment Elevation Acute Coronary Syndrome | 223 | ||
| Risk Stratification | 223 | ||
| Predicting a Late Positive Serum Troponin Level in Initially Troponin-Negative Patients with Non-ST-Segment Elevation Acute Coronary Syndrome | 224 | ||
| Adjunctive Treatment during Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome | 224 | ||
| Antiplatelet Treatment | 224 | ||
| Anticoagulant Treatment | 225 | ||
| Glycoprotein Iib/Iiia Inhibitors | 226 | ||
| Early Invasive Strategy versus Conservative Strategy for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome | 227 | ||
| Optimal Timing Of Intervention | 229 | ||
| Patients Who Derive Benefit From An Early Invasive Strategy | 231 | ||
| Early Invasive Strategy In Women | 232 | ||
| Revascularization of Multivessel Disease In Non-ST-Segment Elevation Acute Coronary Syndrome | 232 | ||
| Drug-Eluting Stents for Patients with Non-ST-Segment Elevation Acute Coronary Syndrome | 233 | ||
| Statins and Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome | 233 | ||
| Management Summary of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome | 233 | ||
| Acknowledgment | 233 | ||
| References | 235 | ||
| 18 Percutaneous Coronary Intervention in Acute ST Segment Elevation Myocardial Infarction | 237 | ||
| Key Points | 237 | ||
| Primary Percutaneous Coronary Intervention Versus Thrombolysis | 237 | ||
| Time-to-Treatment Interval and Outcome | 240 | ||
| Interhospital Transfer for Primary Percutaneous Coronary Intervention | 244 | ||
| Facilitated Percutaneous Coronary Intervention | 246 | ||
| Routine Use of Percutaneous Coronary Intervention after Thrombolysis | 247 | ||
| Rescue Percutaneous Coronary Intervention | 248 | ||
| Technical Aspects of Primary Percutaneous Coronary Intervention | 248 | ||
| Primary Stenting in Patients with ST Elevation Myocardial Infarction | 248 | ||
| Drug-Eluting Stents in Patients with ST Elevation Myocardial Infarction | 249 | ||
| Adjunctive Thrombectomy and Distal Protection Devices in Primary Percutaneous Coronary Intervention | 251 | ||
| Peri-Procedural Anti-Thrombotic Therapy | 251 | ||
| Adjunct Pharmacologic Therapies to Improve Myocardial Tissue Reperfusion | 253 | ||
| Cell-Based Therapy and Regenerative Agents after ST Elevation Myocardial Infarction | 256 | ||
| Special Issues of Primary Percutaneous Coronary Intervention | 257 | ||
| Cardiogenic Shock | 257 | ||
| Primary Percutaneous Coronary Intervention During Off-Hours | 258 | ||
| Primary Percutaneous Coronary Intervention in Older Adults | 258 | ||
| Primary Percutaneous Coronary Intervention and Multi-vessel Intervention | 258 | ||
| Primary Percutaneous Coronary Intervention in Hospitals with and without Onsite Coronary Artery Bypass Graft Surgery | 259 | ||
| Conclusion | 260 | ||
| References | 260 | ||
| 19 Interventions in Cardiogenic Shock | 263 | ||
| Key Points | 263 | ||
| Background | 263 | ||
| Definition and Pathophysiology | 263 | ||
| Clinical Presentation | 263 | ||
| SHOCK Trial and Registry | 263 | ||
| Etiology | 265 | ||
| Clinical Manifestations | 265 | ||
| Treatment | 265 | ||
| General Measures | 265 | ||
| Management of Complications and Special Conditions | 266 | ||
| Mechanical Support | 266 | ||
| Reperfusion | 266 | ||
| Percutaneous Coronary Intervention in Cardiogenic Shock | 266 | ||
| Multi-Vessel Disease | 267 | ||
| Long-Term Survival and Quality of Life | 267 | ||
| Conclusion | 268 | ||
| References | 268 | ||
| 20 Bifurcations and Branch Vessel Stenting | 270 | ||
| Key Points | 270 | ||
| Bifurcation Lesions | 270 | ||
| Contemporary Studies | 270 | ||
| Approach to Treatment of Bifurcation Lesions | 274 | ||
| Guiding Catheter Selection | 274 | ||
| General Outline for Treating a Bifurcation Lesion | 274 | ||
| Difficult Access to the Side Branch | 275 | ||
| Role of Final Kissing Balloon Inflation | 276 | ||
| A Second Stent in the Side Branch Following the Provisional Approach | 276 | ||
| European Bifurcation Club Approach to Bifurcation Stenting | 278 | ||
| Two Stents as Intention to Treat | 278 | ||
| Size and Territory of Distribution of the Side Branch | 279 | ||
| Length of Lesions at the Ostium of the Side Branch | 279 | ||
| Angle between the Main Branch and the Side Branch and the Narrowing at the Ostium of the Side Branch | 279 | ||
| Two-Stent Techniques | 279 | ||
| Culotte Technique | 279 | ||
| Technique Description | 279 | ||
| Mini-Crush Technique (Side Branch Stent Crushed by the Main Branch Stent) | 280 | ||
| Technique Description | 280 | ||
| Step Crush | 282 | ||
| 4 Peripheral Vascular Interventions | 479 | ||
| 37 Lower Extremity Interventions | 481 | ||
| Key Points | 481 | ||
| Introduction | 481 | ||
| Vascular Anatomy of the Lower Extremity | 481 | ||
| Diagnosis of Lower Extremity Peripheral Artery Disease | 482 | ||
| History and Physical Examination | 482 | ||
| Ankle-Brachial Index | 482 | ||
| Pulse Volume Recording | 482 | ||
| Segmental Blood Pressure | 482 | ||
| Duplex Ultrasonography | 482 | ||
| Computed Tomography Angiography | 483 | ||
| Magnetic Resonance Angiography | 483 | ||
| Contrast Angiography | 484 | ||
| Interventions | 484 | ||
| Iliac Artery Intervention (Inflow Disease) | 484 | ||
| Indications | 484 | ||
| Revascularization Options | 484 | ||
| Techniques | 485 | ||
| Access and Recanalization Techniques | 485 | ||
| Stent Choice | 486 | ||
| Clinical Data | 486 | ||
| Complications and Their Management | 487 | ||
| When to Refer to Surgery | 487 | ||
| Femoropopliteal Intervention (Outflow Disease) | 487 | ||
| Indications | 487 | ||
| Techniques | 487 | ||
| Profunda Femoris Artery | 487 | ||
| Superficial Femoral Artery | 487 | ||
| Stent Choice. | 488 | ||
| Specific Techniques (Laser, Atherectomy, Silver Hawk, etc.). | 488 | ||
| Clinical Data | 488 | ||
| Complications and Their Management | 490 | ||
| When to Refer to Surgery | 490 | ||
| Infrapopliteal Peripheral Arterial Disease (Runoff Disease) | 490 | ||
| Indications | 490 | ||
| Techniques | 491 | ||
| Access and Recanalization Techniques and Devices. | 491 | ||
| Stent Choice. | 491 | ||
| Specific Techniques. | 491 | ||
| Clinical Data. | 491 | ||
| When to Refer to Surgery | 491 | ||
| Acute Limb Ischemia | 491 | ||
| Management Strategies For Acute Limb Ischemia | 492 | ||
| Interventional Treatment | 492 | ||
| Pharmacological Thrombolysis | 492 | ||
| Percutaneous Aspiration Thrombectomy | 492 | ||
| Percutaneous Mechanical Thrombectomy | 492 | ||
| Surgery | 492 | ||
| Critical Leg Ischemia | 492 | ||
| Interventional Treatment and Surgery | 493 | ||
| Periprocedural Antithrombotic Therapy | 493 | ||
| Sequelae Of Peripheral Bypass Surgery | 493 | ||
| Miscellaneous Conditions | 493 | ||
| Burger’S Diseases (Thromboangiitis) | 493 | ||
| Peripheral Aneurysm | 494 | ||
| Femoral Artery Aneurysm | 494 | ||
| Popliteal Artery Aneurysm | 494 | ||
| Atheroembolism | 494 | ||
| Conclusions and Future Directions | 494 | ||
| References | 495 | ||
| 38 Upper Extremities and Aortic Arch | 496 | ||
| Key Points | 496 | ||
| Introduction | 496 | ||
| Objectives | 496 | ||
| Normal Anatomy | 497 | ||
| Anatomical Variants | 497 | ||
| Bovine Arch. | 497 | ||
| Double Aortic Arch. | 497 | ||
| Right Aortic Arch. | 497 | ||
| Left Vertebral Artery Originating from the Aorta. | 497 | ||
| Aberrant Right Subclavian Artery. | 497 | ||
| Aberrant Left Subclavian Artery. | 498 | ||
| Brachial, Radial, and Ulnar Arteries. | 498 | ||
| Classifications | 500 | ||
| Initial Evaluation | 500 | ||
| History | 500 | ||
| Physical Examination | 501 | ||
| Laboratory | 501 | ||
| Vascular Laboratory | 501 | ||
| Measuring Segmental Limb Pressures | 501 | ||
| Finger Pressure Pulse Contours/Photoplethysmography Waveforms | 502 | ||
| Imaging | 502 | ||
| Duplex Ultrasonography | 502 | ||
| Tomographic Imaging Techniques | 502 | ||
| Angiography/Digital Subtraction Angiography | 503 | ||
| Subclavian Steal Syndrome | 504 | ||
| Definition, Historical Background, and Controversy | 504 | ||
| Presentation | 504 | ||
| Etiology | 504 | ||
| Establishing the Diagnosis | 505 | ||
| Prognosis | 505 | ||
| Therapy | 505 | ||
| Coronary Subclavian Steal Syndrome | 506 | ||
| Thoracic Outlet Syndrome | 506 | ||
| Definition | 506 | ||
| Etiology and Prevalence | 507 | ||
| Presentation | 507 | ||
| Diagnosis | 508 | ||
| Therapy and Prognosis | 509 | ||
| Axillary Artery Disease | 509 | ||
| Embolic Disease | 510 | ||
| Conclusion | 510 | ||
| Acknowledgments | 511 | ||
| References | 511 | ||
| 39 Carotid and Cerebrovascular Intervention | 513 | ||
| Key Points | 513 | ||
| Introduction | 513 | ||
| Carotid Bifurcation Intervention | 513 | ||
| Carotid Bifurcation Atherosclerosis and Stroke | 513 | ||
| Natural History of Carotid Artery Bifurcation Disease | 513 | ||
| Benefit of Carotid Revascularization | 516 | ||
| Percutaneous Carotid Revascularization | 516 | ||
| Carotid Artery Stenting: The Procedure14 | 516 | ||
| Preprocedural Assessment | 516 | ||
| Baseline Angiography | 517 | ||
| Interventional Technique | 517 | ||
| Delivery of Sheath or Guide to the Common Carotid Artery. | 517 | ||
| Delivery of Embolic Protection Device. | 518 | ||
| Angioplasty and Stenting | 519 | ||
| Predilation | 519 | ||
| Stent Selection and Placement | 519 | ||
| Postdilation | 520 | ||
| Removal of the Embolic Protection Device and Final Angiography | 520 | ||
| Postprocedural Care and Follow-Up | 521 | ||
| Complications of Carotid Intervention | 521 | ||
| Stroke | 521 | ||
| Hemodynamic Depression | 522 | ||
| Hyperperfusion Syndrome | 523 | ||
| Adverse Cardiac Events | 524 | ||
| Restenosis | 524 | ||
| Carotid Artery Stenting—Clinical Data | 524 | ||
| Carotid Artery Stenting in High-Risk Patients | 525 | ||
| Carotid Artery Stenting in Normal-Risk Patients | 526 | ||
| Carotid Artery Stenting— Future Perspective | 527 | ||
| Proximal Vertebral Artery Intervention | 528 | ||
| Technique78 | 529 | ||
| Endovascular Outcomes | 529 | ||
| Intracranial Intervention | 530 | ||
| Technique | 531 | ||
| Intracranial Intervention— Clinical Outcomes | 531 | ||
| Conclusions | 532 | ||
| References | 532 | ||
| 40 Chronic Mesenteric Ischemia: | 534 | ||
| Key Points | 534 | ||
| Introduction | 534 | ||
| Clinical Presentation | 534 | ||
| Diagnosis | 534 | ||
| Treatment | 534 | ||
| Conclusion | 536 | ||
| References | 537 | ||
| 41 Renal Artery Stenosis | 538 | ||
| Key Points | 538 | ||
| Introduction | 538 | ||
| Epidemiology and Natural History | 538 | ||
| The Pathophysiology of Renovascular Hypertension and Ischemic Nephropathy | 538 | ||
| Diagnostic Tests and Imaging | 539 | ||
| Peak Systolic Renal Parenchymal Velocity | 540 | ||
| Magnetic Resonance Angiography and Computed Tomography Angiography | 540 | ||
| Functional Assessment of Renal Artery Stenosis | 540 | ||
| Identification of At-Risk Patients and Indications for Renal Artery Revascularization | 540 | ||
| Clinical Follow-Up | 541 | ||
| Renal Endovascular Interventions | 541 | ||
| Invasive Assessment of Renal Ischemia | 541 | ||
| Renal Contrast Angiography | 542 | ||
| Renal Artery Stenting | 542 | ||
| Distal Protection Devices to Prevent Atheroembolization | 543 | ||
| Management of In-Stent Restenosis | 545 | ||
| Complications | 545 | ||
| Percutaneous Renal Sympathetic Denervation to Treat Resistant Hypertension | 545 | ||
| References | 547 | ||
| 42 Aortic Vascular Interventions (Thoracic and Abdominal) | 548 | ||
| Key Points | 548 | ||
| Introduction | 548 | ||
| Interventional Treatment of Aortic Dissection | 548 | ||
| Current Indications for Endovascular Aortic Interventions | 548 | ||
| Stable Acute Type B Aortic Dissection | 551 | ||
| Unstable Acute Type B Aortic Dissection | 552 | ||
| Chronic Type B Aortic Dissection | 552 | ||
| Technique of Aortic Stent Graft Placement | 553 | ||
| Retrograde Type A Thoracic Aortic Dissection | 554 | ||
| Timing of Endovascular Repair | 554 | ||
| Conclusion | 554 | ||
| Descending Thoracic Aortic Aneurysm | 554 | ||
| Endovascular Repair by Stent Grafts | 554 | ||
| Technical Aspects of Endovascular Repair | 556 | ||
| Hybrid Procedures for Aortic Arch Pathologies | 556 | ||
| Clinical Experience | 556 | ||
| Complications and Current Conclusions | 558 | ||
| Abdominal Aortic Aneurysm | 558 | ||
| Therapeutic Strategies for Abdominal Aortic Aneurysm | 558 | ||
| Indications for Treatment | 559 | ||
| Randomized Data and Current Conclusions | 560 | ||
| References | 561 | ||
| 43 Venous Intervention | 563 | ||
| Key Points | 563 | ||
| Introduction | 563 | ||
| The Venous System: Basic Histology and Physiology | 563 | ||
| Vein Valves | 563 | ||
| Physiology | 563 | ||
| Varicose Veins | 564 | ||
| Chronic Venous Disease | 564 | ||
| Central Venous Stenosis | 564 | ||
| Diagnosis of Central Venous Stenosis | 565 | ||
| Technique | 565 | ||
| Stent Selection | 565 | ||
| Complications | 566 | ||
| Deep Venous Thrombosis of the Upper Extremity | 566 | ||
| Diagnostic Testing | 567 | ||
| Contrast Venography | 567 | ||
| Duplex Ultrasonography | 567 | ||
| Magnetic Resonance Imaging | 568 | ||
| Computed Tomography Venography | 568 | ||
| Treatment Options | 568 | ||
| Anticoagulation | 568 | ||
| Thrombolytic Therapy | 568 | ||
| Interventional Therapy | 568 | ||
| Surgical Therapy | 568 | ||
| Deep Venous Thrombosis of the Lower Extremity | 569 | ||
| Diagnosis of Acute Deep Venous Thrombosis of the Lower Extremity | 569 | ||
| Venous Duplex Ultrasound | 569 | ||
| Diagnostic Testing and Clinical Risk Stratification | 570 | ||
| Goals of Therapy | 570 | ||
| Catheter-Directed Thrombolysis | 570 | ||
| Percutaneous Mechanical Thrombectomy | 572 | ||
| References | 574 | ||
| 44 Stroke Centers and Interventional Cardiology | 576 | ||
| Key Points | 576 | ||
| New Imaging Strategies | 576 | ||
| Management of Physiologic Variables | 576 | ||
| Hypertension | 576 | ||
| Hypoglycemia | 577 | ||
| Hyperglycemia | 577 | ||
| Fever | 577 | ||
| Reperfusion Strategies | 577 | ||
| Intravenous Thrombolysis | 577 | ||
| Intra-arterial Thrombolysis | 577 | ||
| Mechanical Thrombectomy | 578 | ||
| Angioplasty and Stent Placement | 578 | ||
| Neuroprotection | 579 | ||
| Stroke Centers | 579 | ||
| The Role of Cardiology in a Stroke Program | 580 | ||
| References | 581 | ||
| 5 Intracardiac Intervention | 583 | ||
| 45 Imaging for Intracardiac Interventions | 585 | ||
| Key Points | 585 | ||
| Introduction | 585 | ||
| Fluoroscopy | 585 | ||
| Left Ventriculogram | 585 | ||
| Right Ventriculogram | 586 | ||
| Right Atrial Angiogram | 587 | ||
| Left Atrial Angiogram | 587 | ||
| Aortogram | 588 | ||
| Pulmonary Angiogram | 588 | ||
| Trans-Esophageal Echocardiography | 589 | ||
| Intracardiac Echocardiography | 591 | ||
| Specific Procedural Uses for Intracardiac Imaging | 594 | ||
| Trans-septal Puncture | 594 | ||
| Patent Foramen Ovale | 594 | ||
| Secundum Atrial Septal Defect | 595 | ||
| Mitral Valvuloplasty | 596 | ||
| Aortic Valvuloplasty | 597 | ||
| Pulmonary Valvuloplasty | 597 | ||
| Percutaneous Mitral Valve Repair | 598 | ||
| Percutaneous Aortic Valve Replacement | 599 | ||
| Mechanical Prosthetic Valve Assessment | 600 | ||
| References | 601 | ||
| 46 Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defect | 603 | ||
| Key Points | 603 | ||
| Introduction | 603 | ||
| Embryology | 603 | ||
| Patent Foramen Ovale | 603 | ||
| Patent Foramen Ovale and Cryptogenic Stroke | 604 | ||
| Stroke Recurrence and Risk Identification | 605 | ||
| Diagnosis of a Paradoxical Embolic Stroke | 606 | ||
| Treatment for Cryptogenic Stroke | 606 | ||
| Medical Treatment | 606 | ||
| Surgical Treatment | 606 | ||
| Percutaneous Treatment | 606 | ||
| Migraine Headache | 607 | ||
| Platypnea–Orthodeoxia and Hypoxia | 607 | ||
| Decompression Sickness | 607 | ||
| Diagnosis | 608 | ||
| Devices | 609 | ||
| Amplatzer Patent Foramen Ovale Occluder | 609 | ||
| STARFlex Septal Occluder | 609 | ||
| Premere Patent Foramen Ovale Closure System | 609 | ||
| Future Devices | 610 | ||
| Indications for Patent Foramen Ovale Closure | 610 | ||
| Technique | 611 | ||
| Infection Prophylaxis | 611 | ||
| Venous Access | 612 | ||
| Crossing the Inter-atrial Septum | 612 | ||
| Anticoagulation | 612 | ||
| Device Selection | 612 | ||
| Delivery Sheath Insertion and Device Preparation | 612 | ||
| Device Positioning and Release | 612 | ||
| Postprocedure Care | 613 | ||
| Special Considerations | 613 | ||
| Trans-septal Puncture | 613 | ||
| Multiple Shunts | 613 | ||
| Atrial Septal Aneurysms | 613 | ||
| Lipomatous Hypertrophy of the Atrial Septum | 613 | ||
| Complications | 613 | ||
| Procedure-Related Complications | 613 | ||
| Air Embolism. | 613 | ||
| Device-Related Complications | 613 | ||
| Conclusion | 613 | ||
| Atrial Septal Defect | 614 | ||
| Embryology | 614 | ||
| Anatomic and Morphologic Considerations | 614 | ||
| Clinical Presentation | 615 | ||
| Hemodynamics | 615 | ||
| Diagnosis | 615 | ||
| Echocardiography | 615 | ||
| Cardiac Catheterization | 615 | ||
| Indication for Closure | 615 | ||
| Devices for Percutaneous Closure of a Secundum Atrial Septal Defect | 615 | ||
| Amplatzer Occlusion Device | 616 | ||
| Gore Helex Occluder | 616 | ||
| Procedural Details | 617 | ||
| Complications | 617 | ||
| Closure of Large Atrial Septal Defects | 618 | ||
| Miscellaneous Techniques | 618 | ||
| Multi-Fenestrated Atrial Septal Defects | 619 | ||
| Multiple Atrial Septal Defects | 619 | ||
| Atrial Septal Defect Closure and Pulmonary Hypertension | 620 | ||
| Diastolic Left Ventricular Dysfunction and Atrial Septal Defect Closure | 620 | ||
| Conclusion | 621 | ||
| Reference | 621 | ||
| 47 Left Atrial Appendage Closure and Stroke: | 623 | ||
| Key Points | 623 | ||
| Atrial Fibrillation and Stroke | 623 | ||
| Warfarin | 623 | ||
| State of the Art for Stroke Prophylaxis in Atrial Fibrillation | 623 | ||
| Hemorrhage in Patients Taking Warfarin | 624 | ||
| Other Pharmacologic Therapies for Stroke Prevention | 624 | ||
| Left Atrial Appendage | 625 | ||
| Embryology, Structure, and Function | 625 | ||
| Left Atrial Appendage as the Principal Source of Cardioemboli | 626 | ||
| Occlusion of the Left Atrial Appendage: A Viable Stroke Prevention Strategy in Atrial Fibrillation | 626 | ||
| Percutaneous, Catheter-Based Occlusion of the Left Atrial Appendage | 627 | ||
| Clinical Trial: PROTECT-AF | 629 | ||
| Additional Occlusion Technologies | 633 | ||
| Conclusion | 633 | ||
| References | 633 | ||
| 48 Mitral Valvuloplasty | 635 | ||
| Key Points | 635 | ||
| Introduction | 635 | ||
| Personal Experience | 635 | ||
| Patients | 635 | ||
| Procedure | 635 | ||
| Results | 635 | ||
| Immediate Hemodynamic and Echocardiographic Results | 635 | ||
| Technical Failures and Complications | 635 | ||
| Long-Term Results | 635 | ||
| Devices and Techniques | 636 | ||
| Trans-arterial or Retrograde Approach | 636 | ||
| Trans-venous or Antegrade Approach | 636 | ||
| Double-Balloon Technique | 636 | ||
| Inoue Technique | 637 | ||
| Metallic Commissurotome | 637 | ||
| Monitoring of the Procedure and Evaluation of Immediate Results | 638 | ||
| Monitoring of the Procedure | 638 | ||
| Immediate Results | 639 | ||
| Failures | 639 | ||
| Hemodynamics | 639 | ||
| Complications | 640 | ||
| Predictors of Immediate Results | 641 | ||
| Long-Term Results | 641 | ||
| Particular Applications of Percutaneous Mitral Commissurotomy | 642 | ||
| Percutaneous Mitral Commissurotomy after Surgical Commissurotomy | 642 | ||
| Percutaneous Mitral Commissurotomy in Patients with High Surgical Risk | 643 | ||
| Percutaneous Mitral Commissurotomy and Left Atrial Thrombosis | 643 | ||
| Selection of Patients | 643 | ||
| Evaluation of the Patient’s Clinical Condition | 643 | ||
| Valve Anatomy | 643 | ||
| Experience of the Medical and Surgical Teams | 644 | ||
| Potential Indications | 645 | ||
| Future Prospects | 646 | ||
| References | 646 | ||
| 49 Percutaneous Mitral Valve Repair | 647 | ||
| Key Points | 647 | ||
| Introduction | 647 | ||
| Mitral Valve Disease | 647 | ||
| Mitral Valve Anatomy | 647 | ||
| Etiology and Mechanism of Mitral Regurgitation | 647 | ||
| Natural History | 648 | ||
| Imaging: Echocardiography | 649 | ||
| Alternative Imaging Modalities | 650 | ||
| Surgical Mitral Valve Repair | 651 | ||
| Surgical Approach | 651 | ||
| Isolated Annuloplasty | 651 | ||
| Annuloplasty with Leaflet Repair | 651 | ||
| Isolated Leaflet Repair with Edge-to-Edge Technique | 652 | ||
| Percutaneous Mitral Valve Repair | 652 | ||
| Edge-to-edge (Double-Orifice) Leaflet Repair with the MitraClip™ System | 653 | ||
| Indirect Annuloplasty Via Coronary Sinus | 655 | ||
| Percutaneous Trans-venous Mitral Annuloplasty System | 655 | ||
| CARILLON™ Mitral Contour System | 655 | ||
| MONARC™ Percutaneous Trans-venous Mitral Annuloplasty System | 657 | ||
| Cardiac Chamber Remodeling Devices | 658 | ||
| Coapsys™ and iCoapsys™ | 658 | ||
| Percutaneous Septal Sinus Shortening (PS3) System | 658 | ||
| Trans-ventricular (Retrograde) Direct Annuloplasty | 658 | ||
| Mitralign Direct Annuloplasty System | 658 | ||
| GDS AccuCinch Annuloplasty System | 658 | ||
| Other Annuloplasty Devices | 659 | ||
| Trans-Catheter Mitral Valve Implantation | 659 | ||
| Patient Selection | 659 | ||
| Future Directions | 659 | ||
| References | 660 | ||
| 50 Trans-catheter Aortic Valve Interventions: | 661 | ||
| Key Points | 661 | ||
| Balloon Aortic Valvuloplasty | 662 | ||
| The Retrograde Approach | 662 | ||
| Patient Preparation | 662 | ||
| Technique for Retrograde Crossing of the Native Aortic Valve | 662 | ||
| Equipment Required for Balloon Aortic Valvuloplasty | 662 | ||
| Guidewire | 662 | ||
| Sheaths | 662 | ||
| Balloon Catheters | 663 | ||
| Rapid Ventricular Pacing | 663 | ||
| Balloon Inflation | 664 | ||
| Immediate Management after Balloon Aortic Valvuloplasty | 664 | ||
| The Antegrade Trans-septal Approach | 665 | ||
| Patient Preparation | 665 | ||
| Trans-septal Catheterization | 666 | ||
| Crossing the Aortic Valve | 666 | ||
| The “Essential” Guidewire Loop in the Left Ventricle | 666 | ||
| Atrial Septostomy | 666 | ||
| Antegrade Balloon Aortic Valvuloplasty | 666 | ||
| Results Using Contemporary Balloon Aortic Valvuloplasty Techniques | 666 | ||
| Current Perspectives of Balloon Aortic Valvuloplasty | 666 | ||
| Trans-Catheter Aortic Valve Implantation | 667 | ||
| Risk Stratification | 667 | ||
| Patient Screening | 668 | ||
| Vascular Screening | 668 | ||
| The Edwards-SAPIEN Valve | 668 | ||
| The Balloon Catheter | 668 | ||
| The Crimping Tool | 668 | ||
| The RetroFlex Guiding Catheter and the Ascendra Delivery System | 669 | ||
| Delivery Sheath | 669 | ||
| Trans-femoral Valve Implantation | 670 | ||
| Room Requirements | 670 | ||
| Anesthesia | 670 | ||
| Infection and Anti-thrombotic Prophylaxis | 670 | ||
| Venous and Arterial Accesses | 670 | ||
| Aortic Angiography | 670 | ||
| Temporary Pacemaker Placement | 670 | ||
| Crossing the Aortic Valve | 670 | ||
| Delivery Sheath Insertion | 670 | ||
| Balloon Aortic Valvuloplasty | 670 | ||
| Valve Insertion and Deployment | 670 | ||
| Sheath Removal and Arteriotomy Closure | 670 | ||
| Trans-apical Approach | 670 | ||
| Results | 671 | ||
| PARTNER European Registry | 672 | ||
| SOURCE Registry | 672 | ||
| Canadian Edwards-SAPIEN Registry | 672 | ||
| FRANCE Registry | 672 | ||
| PARTNER US | 673 | ||
| Complications | 673 | ||
| Stroke | 673 | ||
| Heart Block and Arrhythmias | 673 | ||
| Renal dysfunction | 673 | ||
| Severe Aortic Insufficiency | 673 | ||
| Valve Embolization | 674 | ||
| Vascular Complications | 674 | ||
| Coronary obstruction | 674 | ||
| Corevalve | 674 | ||
| The CoreValve Revalving System | 674 | ||
| Anatomic–Pathologic Findings after CoreValve Implantation | 674 | ||
| Patient Selection | 674 | ||
| Clinical Criteria | 675 | ||
| Anatomic Criteria | 675 | ||
| Vascular Criteria | 675 | ||
| Procedure Description | 675 | ||
| Alternative Vascular Access Sites | 675 | ||
| Valve-in-Valve and Other Anatomic Circumstances | 676 | ||
| Clinical Series | 676 | ||
| Valve Performance after CoreValve Implantation | 677 | ||
| Improvements in Quality of Life | 678 | ||
| Mid-term and Late Mortality Rates | 678 | ||
| Complications | 678 | ||
| Strokes and Transient Ischemic Attacks | 678 | ||
| Aortic Regurgitation | 679 | ||
| Vascular Access Complications | 679 | ||
| Conduction System Disturbances | 679 | ||
| Coronary Artery Occlusion | 679 | ||
| Acute Renal Failure | 680 | ||
| Planned Investigations | 680 | ||
| USA CoreValve Pivotal Trial | 680 | ||
| SURTAVI | 680 | ||
| ADVANCE | 680 | ||
| ADVANCE-II | 680 | ||
| Other Prostheses | 680 | ||
| Future Directions | 680 | ||
| Conclusion | 680 | ||
| Disclosures | 680 | ||
| References | 681 | ||
| 51 Pulmonary and Tricuspid Valve Interventions | 684 | ||
| Key Points | 684 | ||
| Introduction | 684 | ||
| Transcatheter Pulmonary Valve Implantation | 684 | ||
| Background and Clinical Indications | 684 | ||
| The Device | 685 | ||
| The Delivery System | 685 | ||
| Animal Studies | 685 | ||
| Clinical Studies | 685 | ||
| Patient Cohort | 686 | ||
| The Procedure | 686 | ||
| Modification of the Technique | 686 | ||
| Results | 686 | ||
| Procedural | 686 | ||
| Hemodynamics | 687 | ||
| Procedural Complications | 687 | ||
| Follow-up and Clinical Consequences | 687 | ||
| Device-Related Complications | 688 | ||
| The “Hammock” Effect. | 688 | ||
| Stent Fractures. | 688 | ||
| Hemolysis. | 688 | ||
| Endocarditis. | 688 | ||
| Thromboembolism. | 688 | ||
| Treatment of Device-Related Complications. | 689 | ||
| Midterm Follow-Up and Mortality | 689 | ||
| Comparison with Surgery | 689 | ||
| Patient Selection | 689 | ||
| Extending the Indications | 690 | ||
| Stent Design | 690 | ||
| Hybrid Procedures | 690 | ||
| Rethinking the Substrate | 690 | ||
| Future Directions | 691 | ||
| Transcatheter Tricuspid Valve Implantation | 691 | ||
| Background and Clinical Indications | 691 | ||
| Animal Studies | 691 | ||
| Clinical Studies | 691 | ||
| Future Directions | 692 | ||
| Summary | 692 | ||
| References | 692 | ||
| 52 Hypertrophic Cardiomyopathy | 694 | ||
| Key Points | 694 | ||
| Introduction | 694 | ||
| Epidemiology | 694 | ||
| Natural History of the Disease | 694 | ||
| Clinical Presentation | 695 | ||
| Diagnosis | 696 | ||
| Echocardiography | 696 | ||
| Electrocardiography | 697 | ||
| Magnetic Resonance Imaging | 697 | ||
| Catheterization and Hemodynamics | 697 | ||
| Genetic Overview | 698 | ||
| Treatment | 698 | ||
| Medical Therapy | 698 | ||
| Pharmacotherapy | 698 | ||
| Beta-Adrenergic Receptor Blocking Agents. | 698 | ||
| Verapamil. | 698 | ||
| Disopyramide. | 699 | ||
| Amiodarone. | 699 | ||
| Dual-Chamber Pacing | 699 | ||
| ICD Implantation | 699 | ||
| Surgery | 699 | ||
| Septal Ablation | 700 | ||
| Procedural Technique | 700 | ||
| Acknowledgments | 705 | ||
| References | 705 | ||
| 53 Percutaneous Balloon Pericardiotomy for Patients with Pericardial Effusion and Tamponade | 707 | ||
| Key Points | 707 | ||
| Introduction | 707 | ||
| Pericardial Effusion and Tamponade | 707 | ||
| Pericardiocentesis | 707 | ||
| Indications | 707 | ||
| Technique | 708 | ||
| Complications | 708 | ||
| Postpericardiocentesis Management | 708 | ||
| Percutaneous Balloon Pericardiotomy | 708 | ||
| Technique | 709 | ||
| Postprocedural Management | 711 | ||
| Mechanism of Percutaneous Balloon Pericardiotomy | 711 | ||
| Evidence-Based Literature | 712 | ||
| The Multicenter Registry Experience | 712 | ||
| Percutaneous Balloon Pericardiotomy: Technical Considerations | 712 | ||
| Echocardiographic and Chest Radiographic Qualifications | 712 | ||
| Prophylactic Antibiotic Administration | 712 | ||
| Patients with Bleeding Risk | 713 | ||
| Fluoroscopic Guidance | 713 | ||
| Risks of Cardiac and Pulmonary Injury | 713 | ||
| Pleural Effusion | 713 | ||
| Duration of Catheter Placement | 714 | ||
| Management of Balloon Rupture | 714 | ||
| Adjunctive Diagnostic Approaches | 714 | ||
| Percutaneous Balloon Pericardiotomy: Summary | 714 | ||
| Novel Catheter-Based Intervention Techniques in the Pericardial Space | 715 | ||
| Epicardial Mapping and Ablation | 715 | ||
| Intrapericardial Echocardiography | 715 | ||
| Percutaneous Pericardial Biopsy | 716 | ||
| Pericardioscopy | 716 | ||
| Other Pericardial Interventions | 716 | ||
| References | 717 | ||
| 54 Transcatheter Therapies for Congenital Heart Disease | 718 | ||
| Key Points | 718 | ||
| Introduction | 718 | ||
| Pulmonary Balloon Valvuloplasty | 718 | ||
| Technique | 718 | ||
| Acute Results | 720 | ||
| Infants | 721 | ||
| Adults | 721 | ||
| Long-Term Studies | 723 | ||
| Complications | 723 | ||
| Conclusions and Recommendations | 723 | ||
| Aortic Balloon Valvuloplasty | 723 | ||
| Technique | 724 | ||
| Acute Results | 725 | ||
| Infants | 726 | ||
| Fetal Intervention | 727 | ||
| Young Adults | 727 | ||
| Long-Term Studies | 727 | ||
| Complications | 728 | ||
| Conclusions and Recommendations | 728 | ||
| Balloon-Expandable Stenting for Pulmonary Artery Stenosis | 729 | ||
| Animal Studies | 729 | ||
| Clinical Studies | 729 | ||
| Conclusions and Recommendations | 729 | ||
| Balloon-Expandable Stenting for Coarctation of the Aorta | 731 | ||
| Animal Studies | 731 | ||
| Clinical Studies | 731 | ||
| Conclusions and Recommendations | 733 | ||
| Transcatheter Closure of the Secundum Atrial Septal Defect | 733 | ||
| Physiology | 733 | ||
| Clinical Presentation and Diagnosis | 733 | ||
| Treatment and Outcome | 733 | ||
| Follow-Up | 736 | ||
| Transcatheter Closure of the Patent Ductus Arteriosus | 736 | ||
| Physiology | 736 | ||
| Clinical Presentation and Diagnosis | 736 | ||
| Treatment and Outcome | 736 | ||
| Coils | 737 | ||
| Ductal Occluder Devices | 737 | ||
| Follow-Up | 739 | ||
| Transcatheter Pulmonary Valve Replacement (within Existing RV-PA Conduits) | 739 | ||
| Physiology | 739 | ||
| Clinical Presentation and Diagnosis | 739 | ||
| Treatment and Outcomes | 741 | ||
| Technique | 741 | ||
| Results | 741 | ||
| Complications | 742 | ||
| Conclusion | 742 | ||
| References | 742 | ||
| 55 Stem Cell Therapy for Ischemic Heart Disease | 745 | ||
| Key Points | 745 | ||
| Introduction | 745 | ||
| Approaches to Cell Therapy | 745 | ||
| Differentiated Cell Transplantation | 745 | ||
| Myocardial Regeneration | 746 | ||
| Bone Marrow-Derived Mononuclear Cells | 746 | ||
| Novel Autologous Stem Cell Indications and Types | 748 | ||
| Mesenchymal Stem Cells and Multipotent Adult Progenitor Cells | 748 | ||
| Cardiac Regeneration | 750 | ||
| Stem Cell-Based Chemokine and Cytokine Strategies | 750 | ||
| Electrical Effects of Cell Therapy | 751 | ||
| Future Directions and Controversies | 751 | ||
| Bench Investigation | 751 | ||
| Clinical Investigation | 751 | ||
| Conclusions | 752 | ||
| References | 752 | ||
| 6 Evaluation of Interventional Techniques | 755 | ||
| 56 Qualitative and Quantitative Coronary Angiography | 757 | ||
| Key Points | 757 | ||
| Introduction | 757 | ||
| Qualitative Angiography | 757 | ||
| Update On The Acc/Aha Task Force On Lesion Morphology | 757 | ||
| The Syntax Score | 758 | ||
| Risk Assessment Using Specific Lesion Morphological Criteria | 759 | ||
| Irregular Lesions | 759 | ||
| Angulated Lesions | 759 | ||
| Lesion Calcification | 759 | ||
| Degenerated Saphenous Vein Grafts | 759 | ||
| Thrombus | 760 | ||
| Ostial Location | 760 | ||
| Long Lesions | 760 | ||
| Bifurcation Lesions | 760 | ||
| Total Occlusion | 761 | ||
| Angiographic Complications After Percutaneous Coronary Intervention | 761 | ||
| Coronary Dissection | 761 | ||
| “No-Reflow” | 762 | ||
| Distal Embolization | 763 | ||
| Coronary Perforation | 763 | ||
| Coronary Spasm | 763 | ||
| Abrupt Closure | 763 | ||
| Stent Thrombosis | 763 | ||
| Restenosis Pattern | 763 | ||
| Late Aneurysm Formation | 763 | ||
| Coronary Perfusion | 764 | ||
| Classification Scheme for TIMI Flow Grade | 764 | ||
| TIMI Frame Count | 764 | ||
| TIMI Myocardial Perfusion Grade | 765 | ||
| Coronary Flow Velocity | 767 | ||
| Quantitative Angiography | 767 | ||
| Nonquantitative Estimates of Lesion Severity | 767 | ||
| Computer-Assisted Quantitative Coronary Angiography | 767 | ||
| Cardiovascular Angiography Analysis System | 768 | ||
| Coronary Measurement System | 768 | ||
| Factors Contributing To Variability Using Quantitative Coronary Angiography | 769 | ||
| Biological Variability | 770 | ||
| Acquisition Variability | 770 | ||
| Measurement Variability | 771 | ||
| Quantitative Angiographic Indices | 772 | ||
| Measurement of Plaque Regression | 772 | ||
| Luminal Improvements after Percutaneous Coronary Intervention | 772 | ||
| Angiographic Success | 772 | ||
| Binary Angiographic Restenosis | 772 | ||
| Late Luminal Loss | 772 | ||
| Three-Dimensional Imaging | 773 | ||
| Quantitative Coronary Angiography in Patients Undergoing Brachytherapy | 773 | ||
| Limitations of Quantitative Coronary Angiography | 773 | ||
| References | 773 | ||
| 57 Intracoronary Pressure and Flow Measurement | 776 | ||
| Key Points | 776 | ||
| Fundamental Concepts of Coronary Blood Flow | 776 | ||
| Coronary Flow and Flow Reserve | 777 | ||
| Intracoronary Pressure Measurements and Fractional Flow Reserve | 778 | ||
| Methodology of Coronary Pressure Measurement | 779 | ||
| General Setup and Guidewire Manipulation | 779 | ||
| Safety of Intracoronary Sensor Wire Measurements | 780 | ||
| Radiation, Procedure Time, Contrast Use for Fractional Flow Reserve | 780 | ||
| Pharmacologic Hyperemic Stimuli | 780 | ||
| Adenosine | 781 | ||
| Intracoronary Adenosine Triphosphate | 781 | ||
| Dobutamine Hyperemia | 781 | ||
| Sodium Nitroprusside | 781 | ||
| Clinical Validation of Intracoronary Pressure Measurements | 781 | ||
| Intracoronary Pressure and Flow Measurements and Myocardial Perfusion Imaging | 781 | ||
| Intracoronary Physiologic Measurements and Intravascular Ultrasound Measurements | 782 | ||
| Usefulness of Fractional Flow Reserve in Daily Clinical Practice | 783 | ||
| Determining the Need for Revascularization in Single-Vessel Disease with an Intermediate Stenosis | 783 | ||
| Multi-vessel Disease | 783 | ||
| Fractional Flow Reserve and Coronary Artery Bypass Grafting | 784 | ||
| Left Main Coronary Artery Disease | 785 | ||
| Serial (Multiple) Lesions in a Single Vessel | 785 | ||
| Diffuse Coronary Disease | 786 | ||
| Ostial Lesions and “Jailed” Side Branches | 786 | ||
| Unstable Angina and Non–ST Segment Elevation Myocardial Infarction | 786 | ||
| Recent ST Elevation Myocardial Infarction | 787 | ||
| Intracoronary Physiologic Measurements as a Research Tool | 788 | ||
| Microvascular Disease and Chest Pain with Normal Coronary Arteries | 788 | ||
| Simultaneous Measurement of Flow Velocity and Trans-Stenotic Pressure Gradient | 790 | ||
| Conclusion | 790 | ||
| References | 792 | ||
| 58 Intravascular Ultrasound | 793 | ||
| Key Points | 793 | ||
| Imaging Systems and Procedures | 793 | ||
| Basic Principles | 793 | ||
| Solid-State Dynamic Aperture System | 793 | ||
| Mechanically Rotating Single-Transducer System | 793 | ||
| Head-to-Head Comparisons | 793 | ||
| Imaging Procedures | 794 | ||
| Safety | 794 | ||
| Image Interpretation | 795 | ||
| Three-Layered Appearance of Arterial Wall | 795 | ||
| Image Orientation | 795 | ||
| Quantitative Vessel Measurements | 795 | ||
| Plaque Composition on Gray-Scale Intravascular Ultrasound | 796 | ||
| Advanced Tissue Characterization | 797 | ||
| Diagnostic Applications: Insights into Plaque Formation and Distribution | 797 | ||
| Serial Monitoring of Disease Progression or Regression | 798 | ||
| Interventional Applications | 798 | ||
| Preinterventional Assessment | 798 | ||
| Angiographic Lesion Ambiguity | 798 | ||
| Strategic Plaque Assessment | 799 | ||
| Re-stenotic Lesions | 799 | ||
| Bare Metal Stents | 800 | ||
| Insights into Mechanism of Action | 800 | ||
| Common Stent Problems | 801 | ||
| Suboptimal Stenting and Subacute Thrombosis | 802 | ||
| Impact of Stent Expansion on Long-Term Outcomes | 802 | ||
| Drug-Eluting Stents | 802 | ||
| Mechanism of Action | 802 | ||
| Intravascular Ultrasound Predictors of Failure of Drug-Eluting Stents | 802 | ||
| Late-Acquired Incomplete Stent Apposition | 802 | ||
| Stent Edge Re-stenosis | 805 | ||
| Strut Fracture | 805 | ||
| Impact of Intravascular Ultrasound Guidance on the Outcomes of Drug-Eluting Stents | 806 | ||
| Summary and Future Perspectives | 807 | ||
| Acknowledgments | 807 | ||
| References | 807 | ||
| 59 High-Risk Vulnerable Plaques: | 809 | ||
| Key Points | 809 | ||
| Clinical Characteristics | 809 | ||
| Definition and Clinical Evidence | 809 | ||
| Incidence | 809 | ||
| Risk Factors | 809 | ||
| Anatomic Distribution | 811 | ||
| Plaque Composition | 811 | ||
| Thin Fibrous Cap with Increased Stress–Strain Relationship | 811 | ||
| Large Necrotic Core with Increased Free Cholesterol to Esterified Cholesterol Ratio | 813 | ||
| Increased Plaque Inflammation | 813 | ||
| Degree of Vascular Remodeling | 813 | ||
| Vasa-Vasorum Neovascularization | 814 | ||
| Intra-plaque Hemorrhage | 815 | ||
| Plaque Composition: Summary | 816 | ||
| Plaque Imaging | 817 | ||
| Invasive Techniques | 817 | ||
| Intravascular Ultrasound | 817 | ||
| Virtual Histology | 818 | ||
| Elastography and Palpography | 821 | ||
| Optical Coherence Tomography | 822 | ||
| Surface and Intravascular Magnetic Resonance Imaging | 826 | ||
| Angioscopy | 831 | ||
| Spectroscopy | 833 | ||
| Thermography | 833 | ||
| Noninvasive Imaging Techniques | 833 | ||
| Coronary Computed Tomographic Angiography | 833 | ||
| Nuclear Imaging | 833 | ||
| Plaque Imaging: Summary | 834 | ||
| Therapy | 835 | ||
| Systemic Therapy | 835 | ||
| Regional Therapy | 835 | ||
| Local Therapy | 835 | ||
| Summary and Future Directions | 837 | ||
| References | 838 | ||
| 60 Optical Coherence Tomography | 842 | ||
| Key Points | 842 | ||
| Physical Principles of Optical Coherence Tomography Imaging | 842 | ||
| Image Acquisition | 844 | ||
| Artifacts | 844 | ||
| Image Interpretation | 845 | ||
| Current Clinical Applications | 845 | ||
| Assessment of Coronary Atherosclerosis | 845 | ||
| Stent Assessment | 846 | ||
| Optical Coherence Tomography Principles for Stent Analysis | 847 | ||
| Qualitative Stent Assessment | 847 | ||
| Quantitative Stent Assessment | 849 | ||
| Strut Apposition. | 849 | ||
| Strut Coverage. | 849 | ||
| Bioabsorbable Stents and Polymers. | 852 | ||
| Promising Clinical Applications in Stented Coronary Lesions. | 852 | ||
| Use of Optical Coherence Tomography in Noncoronary Arteries | 853 | ||
| Quantitative Measurements. | 853 | ||
| Plaque Measurements. | 854 | ||
| Stent Measurements. | 854 | ||
| Technologies Under Development | 854 | ||
| Future of Optical Coherence Tomography | 856 | ||
| Conclusion | 856 | ||
| Acknowledgments | 856 | ||
| References | 856 | ||
| 7 Outcome Effectiveness of Interventional Cardiology | 859 | ||
| 61 Medical Economics in Interventional Cardiology | 861 | ||
| Key Points | 861 | ||
| Medical Economics: Concepts and Methods | 861 | ||
| Medical Cost Definitions and Terminology | 861 | ||
| Methodologic Issues in Medical Cost Studies | 862 | ||
| Cost Measurement | 862 | ||
| Cost Study Structures | 864 | ||
| Importance of Perspective in Cost Analysis | 864 | ||
| Time Effects in Cost Analysis | 864 | ||
| Geographic and Market Factors | 864 | ||
| Cost-Effectiveness Analysis | 865 | ||
| Economics of Interventional Cardiology | 866 | ||
| General Issues | 866 | ||
| Coronary Revascularization | 866 | ||
| Costs of Percutaneous Coronary Intervention | 866 | ||
| Costs of Coronary Artery Bypass Grafting | 868 | ||
| Comparisons of Treatment Options for Coronary Artery Disease | 869 | ||
| Revascularization versus Medical Therapy in Stable Coronary Artery Disease. | 869 | ||
| Percutaneous Coronary Intervention with Bare Metal Stents versus Coronary Artery Bypass Grafting in Stable Multi-vessel Disease. | 869 | ||
| Drug-Eluting Stents versus Bare Metal Stents. | 869 | ||
| Drug-Eluting Stents versus Coronary Artery Bypass Grafting. | 870 | ||
| Reperfusion of Acute ST Elevation Myocardial Infarction | 870 | ||
| Thrombolytic Therapy | 870 | ||
| Primary Percutaneous Coronary Reperfusion | 871 | ||
| Early Invasive Strategies versus Early Conservative Strategies in Patients with Acute Coronary Syndrome | 871 | ||
| Anti-platelet Therapy | 872 | ||
| Anti-thrombin Therapy | 873 | ||
| Preventive Therapies | 873 | ||
| Cost-Effectiveness and Health Policy | 873 | ||
| Summary | 874 | ||
| References | 875 | ||
| 62 Quality of Care in Interventional Cardiology | 877 | ||
| Key Points | 877 | ||
| A Brief History of Quality Efforts in U.S. Medicine | 877 | ||
| Quality in Interventional Cardiology | 879 | ||
| Building Blocks of Quality in Health Care | 879 | ||
| Clinical Practice Guidelines | 879 | ||
| Data Standards | 880 | ||
| Performance Measures | 881 | ||
| Outcome Measures | 882 | ||
| Real-World Impact of Performance Measures and Guidelines | 882 | ||
| Appropriate Use Criteria | 882 | ||
| Judging Quality in Interventional Cardiology | 884 | ||
| Structure | 884 | ||
| Process | 885 | ||
| Outcomes | 885 | ||
| Quality Assurance versus Continuous Quality Improvement | 886 | ||
| Developing a Quality Culture in Interventional Cardiology | 888 | ||
| Organizational Culture | 888 | ||
| Physician-Champions | 889 | ||
| Benchmarking | 889 | ||
| Public Reporting—the New Frontier | 890 | ||
| The Unintended Consequences of Public Reporting | 891 | ||
| Conclusion | 892 | ||
| References | 892 | ||
| 63 Volume and Outcome | 894 | ||
| Key Points | 894 | ||
| Evidence for a Volume–Outcome Relationship | 894 | ||
| Public Policy Implications | 897 | ||
| Conclusion | 897 | ||
| References | 897 | ||
| Index | 899 | ||
| A | 899 | ||
| B | 900 | ||
| C | 901 | ||
| D | 902 | ||
| E | 902 | ||
| F | 903 | ||
| G | 903 | ||
| H | 903 | ||
| I | 904 | ||
| J | 904 | ||
| K | 904 | ||
| L | 904 | ||
| M | 904 | ||
| N | 905 | ||
| O | 905 | ||
| P | 905 | ||
| Q | 906 | ||
| R | 906 | ||
| S | 907 | ||
| T | 908 | ||
| U | 908 | ||
| V | 908 | ||
| W | 909 | ||
| X | 909 | ||
| Y | 909 | ||
| Z | 909 |