Journal of Clinical Medicine

Editorial

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4 pages, 156 KiB

Open AccessEditorial

Endotheliitis and Endothelial Dysfunction in Patients with COVID-19: Its Role in Thrombosis and Adverse Outcomes

by Wassim Mosleh, Kai Chen, Steven E. Pfau and Aseem Vashist

J. Clin. Med. 2020, 9(6), 1862; https://doi.org/10.3390/jcm9061862 - 15 Jun 2020

Cited by 61 | Viewed by 6359

Abstract

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), emerging in Wuhan, China and developing into a pandemic with rapidly emerging cardiovascular manifestations [...] Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

Review

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14 pages, 1147 KiB

Open AccessReview

Coronary Physiology in the Cardiac Catheterization Laboratory

by Samit M. Shah and Steven E. Pfau

J. Clin. Med. 2019, 8(2), 255; https://doi.org/10.3390/jcm8020255 - 18 Feb 2019

Cited by 10 | Viewed by 6872

Abstract

Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of myocardial ischemia. Recent technological advances now allow for [...] Read more.

Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of myocardial ischemia. Recent technological advances now allow for the assessment of coronary physiology in the catheterization laboratory at the time of diagnostic coronary angiography. Early studies focused on coronary flow reserve (CFR) but more recent work has demonstrated the physiologic accuracy and prognostic value of the fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) for the assessment of coronary artery disease. These measurements have been validated in large multi-center clinical trials and have become indispensable tools for guiding revascularization in the cardiac catheterization laboratory. The physiological assessment of chest pain in the absence of epicardial coronary artery disease involves coronary thermodilution to obtain the index of microcirculatory resistance (IMR) or Doppler velocity measurement to determine the coronary flow velocity reserve (CFVR). Physiology-based coronary artery assessment brings “personalized medicine” to the catheterization laboratory and allows cardiologists and referring providers to make decisions based on objective findings and evidence-based treatment algorithms. The purpose of this review is to describe the theory, technical aspects, and relevant clinical trials related to coronary physiology assessment for an intended audience of general medical practitioners. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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10 pages, 1091 KiB

Open AccessReview

Update in Spontaneous Coronary Artery Dissection

by Joseph Ingrassia, Daniel Diver and Aseem Vashist

J. Clin. Med. 2018, 7(9), 228; https://doi.org/10.3390/jcm7090228 - 21 Aug 2018

Cited by 9 | Viewed by 8191

Abstract

There has been increased awareness in the understanding and recognition of spontaneous coronary artery disease. Diagnosing this condition is of paramount importance as the treatment strategy differs greatly from traditional acute coronary syndrome patient. We review here the current state of management of [...] Read more.

There has been increased awareness in the understanding and recognition of spontaneous coronary artery disease. Diagnosing this condition is of paramount importance as the treatment strategy differs greatly from traditional acute coronary syndrome patient. We review here the current state of management of spontaneous coronary artery disease. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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10 pages, 2713 KiB

Open AccessReview

Percutaneous Left Main Coronary Intervention: A Review of Plaque Modification in Left Main Percutaneous Coronary Intervention

by Chirag A. Shah and Steven E. Pfau

J. Clin. Med. 2018, 7(7), 180; https://doi.org/10.3390/jcm7070180 - 23 Jul 2018

Cited by 6 | Viewed by 5126

Abstract

Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based [...] Read more.

Left main coronary artery (LMCA) stenosis has long been recognized as a marker of increased morbidity and mortality. Current treatment algorithms for LMCA stenosis consider both percutaneous coronary intervention (PCI) with drug eluting stents (DES) and coronary bypass surgery, each with advantages based on individual patient characteristics. Since the LMCA is the largest artery in the coronary tree, plaque volume and calcification is greater than other coronary segments and often extends to the distal bifurcation segment. In LMCA bifurcation lesions, larger minimal stent area is strongly associated with better outcome in the DES era. Plaque modification strategies such as rotational, orbital, or laser atherectomy are effective mechanisms to reduce plaque volume and alter compliance, facilitating stent delivery and stent expansion. We present a case of a calcified, medina class 1,1,1 LMCA lesion where intravascular ultrasound (IVUS) and orbital atherectomy were employed for optimal results. In this context, we review the evidence of plaque modification devices and the rationale for their use in unprotected left main PCI. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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8 pages, 676 KiB

Open AccessReview

Coronary Stents: History, Design, and Construction

by Torrey Schmidt and J. Dawn Abbott

J. Clin. Med. 2018, 7(6), 126; https://doi.org/10.3390/jcm7060126 - 29 May 2018

Cited by 85 | Viewed by 10966

Abstract

The history of percutaneous coronary intervention (PCI) is marked by rapid technological advancements that have taken place over the past 40 years. After a period of balloon angioplasty, which was marred by risk of abrupt vessel closure and vessel recoil, balloon expandable metal [...] Read more.

The history of percutaneous coronary intervention (PCI) is marked by rapid technological advancements that have taken place over the past 40 years. After a period of balloon angioplasty, which was marred by risk of abrupt vessel closure and vessel recoil, balloon expandable metal alloy stents were the mainstay of PCI. The introduction of drug eluting stents (DES) targeted in-stent restenosis, a common mode of stent failure, and ushered in the current PCI era. Since the first generation of DES, advances in polymer science and stent design have advanced the field. The current generation of DES has thin struts, are highly deliverable, have biocompatible or absorbable polymers, and outstanding safety and efficacy profiles. In this review, we discuss the technological advancements in stent development, design, and construction, with an emphasis on balloon expandable stents. The aspects of stent properties, metal alloys, bioresorbable vascular scaffolds, drug elution, and polymers will be covered. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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9 pages, 222 KiB

Open AccessReview

Review of the Latest Percutaneous Devices in Critical Limb Ischemia

by Leila Haghighat, Sophia Elissa Altin, Robert R. Attaran, Carlos Mena-Hurtado and Christopher J. Regan

J. Clin. Med. 2018, 7(4), 82; https://doi.org/10.3390/jcm7040082 - 14 Apr 2018

Cited by 8 | Viewed by 4774

Abstract

Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within [...] Read more.

Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

16 pages, 3207 KiB

Open AccessFeature PaperReview

Latest Innovations in the Treatment of Venous Disease

by Robert R. Attaran

J. Clin. Med. 2018, 7(4), 77; https://doi.org/10.3390/jcm7040077 - 11 Apr 2018

Cited by 21 | Viewed by 7815

Abstract

Venous disease is more common than peripheral arterial disease. Pathophysiologically, venous disease can be associated with obstruction, reflux, or both. A common feature in chronic venous disease is ambulatory venous hypertension. Inflammatory and pro-thrombotic mechanisms can be activated. The current therapies, including compression, [...] Read more.

Venous disease is more common than peripheral arterial disease. Pathophysiologically, venous disease can be associated with obstruction, reflux, or both. A common feature in chronic venous disease is ambulatory venous hypertension. Inflammatory and pro-thrombotic mechanisms can be activated. The current therapies, including compression, ablation, and recanalization are discussed. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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23 pages, 1122 KiB

Open AccessReview

Antiplatelet Therapy in Coronary Artery Disease: A Daunting Dilemma

by Surya Chaturvedula, Daniel Diver and Aseem Vashist

J. Clin. Med. 2018, 7(4), 74; https://doi.org/10.3390/jcm7040074 - 9 Apr 2018

Cited by 7 | Viewed by 6301

Abstract

Percutaneous coronary intervention (PCI) with stenting for the treatment of acute coronary syndrome (ACS) is the contemporary standard of care. Such treatment is followed by dual antiplatelet therapy (DAPT) comprising of aspirin and a P2Y12 inhibitor. The efficacy of this therapy has been [...] Read more.

Percutaneous coronary intervention (PCI) with stenting for the treatment of acute coronary syndrome (ACS) is the contemporary standard of care. Such treatment is followed by dual antiplatelet therapy (DAPT) comprising of aspirin and a P2Y12 inhibitor. The efficacy of this therapy has been well established but the optimal duration of DAPT remains elusive, and has thus far attracted a prodigious deal of scientific attention. The decision regarding DAPT duration can be clinically challenging in the modern era with the evolution of newer stents, more potent antiplatelet agents, and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. Major societal guidelines have emphasized comprehensive assessment of ischemic and bleeding risk, in turn recommending individualization of DAPT duration, thus encouraging “shared decision making”. The following review is aimed at critically evaluating the available evidence to help make these crucial clinical decisions regarding duration of DAPT and triple therapy. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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10 pages, 446 KiB

Open AccessReview

Safety, Efficacy and Evidence Base for Use of the Subcutaneous Implantable Cardioverter Defibrillator

by Carmen Adduci, Francesca Palano and Pietro Francia

J. Clin. Med. 2018, 7(3), 53; https://doi.org/10.3390/jcm7030053 - 11 Mar 2018

Cited by 9 | Viewed by 4391

Abstract

The trans-venous implantable cardioverter defibrillator (TV-ICD) is effective in treating life-threatening ventricular arrhythmia and reduces mortality in high-risk patients. However, there are significant short- and long-term complications that are associated with intravascular leads. These shortcomings are mostly relevant in young patients with long [...] Read more.

The trans-venous implantable cardioverter defibrillator (TV-ICD) is effective in treating life-threatening ventricular arrhythmia and reduces mortality in high-risk patients. However, there are significant short- and long-term complications that are associated with intravascular leads. These shortcomings are mostly relevant in young patients with long life expectancy and low risk of death from non-arrhythmic causes. Drawbacks of trans-venous leads recently led to the development of the entirely subcutaneous implantable cardioverter defibrillator (S-ICD). The S-ICD does not require vascular access or permanent intravascular defibrillation leads. Therefore, it is expected to overcome many complications associated with conventional ICDs. This review highlights data on safety and efficacy of the S-ICD and is envisioned to help in identifying the role of this device in clinical practice. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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8 pages, 657 KiB

Open AccessFeature PaperReview

Update on the Non-Pharmacological Management of Stroke Prevention in Patients with Atrial Fibrillation

by Aneesh Tolat and Neal Lippman

J. Clin. Med. 2018, 7(2), 32; https://doi.org/10.3390/jcm7020032 - 12 Feb 2018

Cited by 2 | Viewed by 4412

Abstract

Non-surgical left atrial appendage occlusion has emerged as an alternative to anticoagulant therapy in the management of stroke risk in patients with atrial fibrillation. This review reports on some of the more common devices that are currently being used to manage patients in [...] Read more.

Non-surgical left atrial appendage occlusion has emerged as an alternative to anticoagulant therapy in the management of stroke risk in patients with atrial fibrillation. This review reports on some of the more common devices that are currently being used to manage patients in this challenging group. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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15 pages, 3984 KiB

Open AccessFeature PaperReview

Robotic-Assisted Percutaneous Coronary Intervention: Rationale, Implementation, Case Selection and Limitations of Current Technology

by Michael Ragosta and Kanwar P. Singh

J. Clin. Med. 2018, 7(2), 23; https://doi.org/10.3390/jcm7020023 - 30 Jan 2018

Cited by 15 | Viewed by 5356

Abstract

Interventional cardiologists have witnessed an explosive growth in the field. A wide array of percutaneous procedures allow us to treat numerous cardiac conditions less invasively. However, the way we work has changed very little over the past decades. We continue to stand at [...] Read more.

Interventional cardiologists have witnessed an explosive growth in the field. A wide array of percutaneous procedures allow us to treat numerous cardiac conditions less invasively. However, the way we work has changed very little over the past decades. We continue to stand at the tableside for prolonged periods of time, exposing ourselves to the very real risks of radiation exposure as well as to the associated orthopedic injuries from radiation protection. The precision of our procedures is limited by the distance from the fluoroscopic images and, furthermore, patients are potentially at risk from operator fatigue caused by a physician standing at the table for prolonged periods while wearing cumbersome radiation protection gear. Robotic-assisted coronary intervention removes the operator from the radiation field and has been shown to markedly reduce operator exposure as well as allow for more precise positioning of balloons and stents. This technology holds great promise for making interventional procedures safer and more comfortable for the operators as well as reducing fatigue, potentially improving patient outcomes. Currently, we are in an ‘early adopter’ phase of this technology and this paper reviews the rationale, methodology, optimal case selection, and limitations of robotic-assisted coronary intervention. Full article

(This article belongs to the Special Issue Advances in Interventional Cardiology and Vascular Medicine)

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