PCI in the patient with sole remaining conduit

Jump to: navigation, search

Percutaneous coronary intervention Microchapters

Home

Patient Information

Overview

Risk Stratification and Benefits of PCI

Preparation of the Patient for PCI

Equipment Used During PCI

Pharmacotherapy to Support PCI

Vascular Closure Devices

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post-PCI Management

Risk Reduction After PCI

Post-PCI follow up

Hybrid coronary revascularization

PCI Complications

Factors Associated with Complications
Vessel Perforation
Dissection
Distal Embolization
No-reflow
Coronary Vasospasm
Abrupt Closure
Access Site Complications
Peri-procedure Bleeding
Restenosis
Renal Failure
Thrombocytopenia
Late Acquired Stent Malapposition
Loss of Side Branch
Multiple Complications

PCI in Specific Patients

Cardiogenic Shock
Left Main Coronary Artery Disease
Refractory Ventricular Arrhythmia
Severely Depressed Ventricular Function
Sole Remaining Conduit
Unprotected Left Main Patient
Adjuncts for High Risk PCI

PCI in Specific Lesion Types

Classification of the Lesion
The Calcified Lesion
The Ostial Lesion
The Angulated or Tortuous Lesion
The Bifurcation Lesion
The Long Lesion
The Bridge Lesion
Vasospasm
The Chronic Total Occlusion
The Left Internal Mammary Artery
Multivessel Disease
Distal Anastomotic Lesions
Left Main Intervention
The Thrombotic Lesion

PCI in the patient with sole remaining conduit On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of PCI in the patient with sole remaining conduit

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on PCI in the patient with sole remaining conduit

CDC on PCI in the patient with sole remaining conduit

PCI in the patient with sole remaining conduit in the news

Blogs on PCI in the patient with sole remaining conduit

Directions to Hospitals Treating Percutaneous coronary intervention

Risk calculators and risk factors for PCI in the patient with sole remaining conduit

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Vijayalakshmi Kunadian MBBS, MD, MRCP

PCI in the Patient with Sole Remaining Conduit

Sole remaining conduit (SRC) refers to the only remaining artery (native artery or bypass graft) with occlusion of the native and bypass supplies to the remaining two coronary arteries. There are insufficient data on percutaneous coronary intervention to a sole remaining conduit.

When patients with SRC present with severe anginal symptoms, there are three options to deal with these patients. First, perform PCI through and to the SRC. Second, to perform PCI to one or more chronic total occlusions and finally, to optimize patients with medical therapy. Other adjunct devices such as intra-aortic balloon pump may be beneficial in this setting[1].

Tavano et al studied 16 patients who underwent percutaneous coronary intervention in their sole remaining vessel[2]. All patients were symptomatic with unstable angina or minimal effort angina refractory to maximal medical therapy. In-hospital, one-month and 6-month major adverse cardiac events (defined as the composite of death, myocardial infarction, and target vessel revascularization) and angina status according to the Canadian Cardiovascular Society (CCS) score were assessed. During hospital stay one patient died 10 hours after the procedure secondary to acute pulmonary edema, urgent coronary angiography showed a patent target vessel. At one month 75% of patients were asymptomatic, the other 3 patients experienced symptom improvement from CCS III to I. After 6 months, a second patient died after an out-of-hospital cardiac arrest that occurred 4 months after the procedure. At one year, there were no additional deaths, one patient developed non-Q wave myocardial infarction and one patient underwent repeat PCI of the target vessel.

Conclusion

There is limited data on PCI to the sole remaining conduit. Small retrospective analysis support PCI as a treatment strategy for highly symptomatic and difficult-to-treat patient cohort.

References

  1. Briguori C, Sarais C, Pagnotta P, Airoldi F, Liistro F, Sgura F; et al. (2003). "Elective versus provisional intra-aortic balloon pumping in high-risk percutaneous transluminal coronary angioplasty.". Am Heart J. 145 (4): 700–7. PMID 12679768. doi:10.1067/mhj.2003.14. 
  2. Tavano D, Corbett S, Airoldi F, Montorfano M, Carlino M, Godino C; et al. (2007). "Percutaneous coronary intervention in patients with a single remaining vessel.". Am J Cardiol. 99 (4): 470–1. PMID 17293186. doi:10.1016/j.amjcard.2006.08.059. 

Linked-in.jpg