Colombo's Tips and Tricks for Drug-Eluting Stents

by Colombo; Antonio

• ISBN13: 9781841843964
• ISBN10: 1841843962
• Edition: CD
• Format: Hardcover
• Copyright: 2005-03-08
• Publisher: CRC Press

Summary

Drug-eluting stents are the device of choice in combating narrowed, blocked arteries, and for preventing restenosis of native and graft vessels. Presenting the most comprehensive guide available for those involved in coronary artery stenting, internationally renowned interventional cardiologist Antonio Colombo - along with Goran Stankovic and other distinguished experts - draws from his vast experience to deliver proven tips and tricks for dealing with diseased coronary arteries.

Table of Contents

Preface	p. xiii
List of contributors	p. xv
How to use the CD-ROMs	p. xvii
Drug-Eluting Stent Platforms	p. 1
Sirolimus-eluting stents: from clinical trials to real world	p. 3
Taxus tips & tricks	p. 11
General Approach with Drug-Eluting Stents	p. 21
Lesion-Specific Stenting	p. 29
Simple Lesions	p. 31
Direct stenting is encouraged (Case # 11844, 11677)	p. 31
Minimization of trauma (Case # 10813, 11659)	p. 32
Full lesion coverage (Case # 11632, 10825)	p. 32
Appropriate sizing (Case # 11708, 11826)	p. 33
Bifurcational Lesions	p. 34
Introduction: practical approaches to bifurcational lesions	p. 34
Lessons from the literature	p. 55
Case examples	p. 63
Stenting the main branch and dilating the side branch (provisional stenting) (Case # 11723/03)	p. 63
The classical 'crush' technique (Case # 11162/02)	p. 63
'Double crush' technique (Case # HSR 32290)	p. 65
Intravascular ultrasound (IVUS) documentation of the result following the crush stenting technique (Case # 11591/03)	p. 65
'Reverse' crush due to provisional stent strategy (Case # 11497/03)	p. 66
The 'inverse' crush technique (Case # 11728/03)	p. 67
The T-stenting technique (Case # 10706/02)	p. 68
The V-stenting technique (Case # 10916/02)	p. 69
Proximal stenting following V-stenting (Case # 11998/04)	p. 70
'Culottes' stenting technique (Case # 11470/03)	p. 70
Creating a 'funnel' or 'pseudobifurcation' technique (Case # 34101HSR)	p. 71
A bifurcational lesion: stenting from the main to the side branch (Case # 36474HSR)	p. 72
Measurement of fractional flow reserve (FFR) in a restenotic ostial lesion (Case # 11005/02)	p. 73
V-stenting for trifurcation lesion (Case # 119591)	p. 73
V-stenting for trifurcation lesion (Case # 11961)	p. 74
Didactic crushing cases	p. 75
Standard crushing technique (Case # 11645/04)	p. 75
Inverse crushing technique (Case # 11989/043)	p. 78
Reverse crushing technique (Case # 11497/04)	p. 81
Laboratory insights with different techniques of drug-eluting stent implantation in bifurcations	p. 84
Very Long Lesions	p. 99
Enhanced drug delivery with sonotherapy treatment (Case # 11005/02)	p. 99
A severely calcified lesion: importance of rotational atherectomy (Case # 11608/03)	p. 99
IVUS evaluation for long diffuse disease treatment (Case # 11761/03)	p. 100
Atherectomy and DES: is it needed? (Case # 11812/03)	p. 101
Small Vessels	p. 102
Multiple stents in a small vessel (Case # 9691/2000)	p. 102
Three bifurcations, a total occlusion, and small vessels with long diseased segment (Case # 10856/02)	p. 102
A long segment with diffuse disease (Case # 11195/02)	p. 104
Small vessel with severe calcification, tortuosity and subtotal occlusion (Case # 11895/04)	p. 104
Skipping a bifurcation in a small vessel with diffuse disease (Case # 11911/04)	p. 105
Ostial Lesions	p. 106
Ostial circumflex or unprotected left main stenting (Case # 11585/03)	p. 106
Use of debulking in a very proximal lesion (Case # 11609/03)	p. 107
Crush stenting for ostial LAD lesion (Case # 11645/03)	p. 107
A trifurcation of the left main with severe calcifications: provisional stenting on the intermediate branch (Case # 11244/03)	p. 108
A typical ostial LAD lesion (Case # 11795/03)	p. 109
Chronic Total Occlusions	p. 110
Complex in-stent chronic total occlusion (Case # 10750/02)	p. 110
A case of chronic total occlusion with stenting from proximal to distal (Case # 10923/02)	p. 110
Contra-lateral injection and stent implantation from proximal to distal site (Case # 11291/03)	p. 111
Parallel-wire technique for total occlusions (Case # 11272/03)	p. 112
Two total occlusions (Case # 11331/03)	p. 112
A technique of subintimal tracking to reopen a total occlusion: Case 1 (Case HRS/SQI)	p. 113
A technique of subintimal tracking to reopen a total occlusion: Case 2 (Case # 11875/04)	p. 113
Chronic total occlusion treatment with focal restenosis inside a Cypher: a different view according to angiography and IVUS (Case # 11082/02)	p. 114
The Frontrunner device for chronic total occlusions (Case # 11147/02)	p. 115
Poor distal run-off after a full metal jacket for chronic total occlusion (Case # 11193/02)	p. 115
Parallel-wire technique for chronic total occlusion (Case # 35956/04)	p. 116
New approaches to chronic total occlusions	p. 117
Thrombus-Containing Lesions	p. 126
Approach to thrombus-containing lesions	p. 126
Surgical Arena	p. 133
Left main stenting	p. 135
Crush or V-technique for a short left main with bifurcational disease (Case # 10974/02)	p. 135
Unprotected left main bifurcational stenting with cutting balloon pre-dilatation (Case # 11728/03)	p. 135
Directional atherectomy of the main branch to obtain access to the side branch (Case # 11717/03)	p. 136
A high-risk left main lesion (Case # 10971/02)	p. 137
The risks of the 'culottes' technique in left main trunk (Case # 11583/03)	p. 138
Restenosis in a DES implanted on a left main coronary artery (Case # 10845/02)	p. 138
Multivessel treatment	p. 140
Complex multivessel disease with good follow-up result (Case # 11021/02)	p. 140
Multiple stents for diffuse disease (Case # 10941/02)	p. 140
Complex multivessel disease treatment (Case # 11443/03)	p. 141
Multivessel disease: do we really need to debulk before implanting DES? Searching for a single-digit TVR in multivessel stenting (Case # 10943/02)	p. 142
Complete revascularization utilizing Taxus and Cypher stents (Case # 11714/02)	p. 143
Combination of debulking and stenting in a patient considered to be at very high risk of restenosis (Case # 11578/03)	p. 143
Restenosis after treatment of triple-vessel disease with multiple DES: do we need a new generation of DES? (Case # 10927/02)	p. 144
More puzzles after multivessel stenting with DES (Case # 10845/02)	p. 145
Fx Minirail for lesion preparation (Case # 11532/03)	p. 146
Multiple bifurcations and diffuse disease (Case # 10663/03)	p. 147
Multiple chronic dissections (Case # 11729/03)	p. 149
Special Subsets	p. 151
Drug-eluting stents for in-stent restenosis	p. 153
Restenosis following crush treated with another crush (Case # 11186/02)	p. 153
Restenosis following V-stenting treated with another V-stenting (Case # 10745/02)	p. 153
Ostial diagonal lesions: always a difficult problem (Case # 10815/02)	p. 154
Double dosing for a high-risk lesion (Case # 11055/02)	p. 155
Sirolimus-eluting stent for diffuse in-stent restenosis (Case # 29429HSR)	p. 155
Repeat restenosis occurring at the same site (Case # 23753HSR)	p. 156
Cypher for subacute Taxus stent thrombosis (Case # 11789/03)	p. 157
Treatment of saphenous vein grafts and left internal mammary artery	p. 158
Use of distal protection for saphenous vein graft treatment (Case # 11451/03)	p. 158
Treatment of an occluded saphenous vein graft: stents covered with bovine pericardium plus DES (Case # 11674/03)	p. 158
Treatment of an occluded saphenous vein graft (Case # 11631/03)	p. 159
Sandwich technique for ostial saphenous vein graft (Case # 10901/02)	p. 160
Flow deterioration in a saphenous vein graft (Case # 34552HSR)	p. 161
A retrograde rescue of a mammary artery (Case # 10696/02)	p. 161
Understanding the anatomy of a saphenous vein graft while reopening (Case # 11903/04)	p. 162
Special Procedures	p. 163
Atherectomy and rotablation	p. 165
Debulking with atherectomy before DES implantation: 'la creme de la creme' (Case # 11817/03)	p. 165
LAD ostial lesion and plaque shift towards the circumflex (Case # 11091/02)	p. 166
A severely calcified large vessel where rotablation is combined with cutting balloon (Case # 11628/03)	p. 166
Rotablation and crushing with a 6-Fr guiding catheter (step-crush technique) (Case # 11718/03)	p. 167
Double-vessel atherectomy for bifurcational lesion (Case # 10815/02)	p. 168
Buddy-wire to enhance stent delivery (Case # 11899/04)	p. 168
IVUS guidance	p. 170
IVUS guidance to increase final lumen cross-sectional area: a worthwhile effort? (Case # 11587/03)	p. 170
Many restenoses which occur at the site of a bifurcation are due to stent underexpansion and possibly stent recoil (Case # 11540/03)	p. 171
Ostial left main and ostial LAD: value of IVUS and angiography (Case # 11948/04)	p. 171
Intermediate lesion evaluation by IVUS (Case # 11688/03)	p. 172
Problems	p. 173
Drug-eluting stent complications	p. 175
Late-acquired stent malapposition (Case 9676/00)	p. 175
Wire-caused perforation, hematoma, slow flow and left main dissection (Case # 11374/03)	p. 175
Wire-caused perforation with delayed tamponade (Case # 11881/04)	p. 177
LIMA perforation (Case # 10780/02)	p. 178
Wire-caused perforation while attempting to re-open chronic total occlusion (Case # 11658/02)	p. 178
Intra-procedural stent thrombosis with DES (Case # 10766/02)	p. 179
Vessel perforation with difficulties in advancing a PTFE-covered stent (Case # HSR 35897)	p. 180
Managing a perforation (Case # 11281/03)	p. 181
Complications with drug-eluting stents: my worst nightmares	p. 182
Stent thrombosis after Cypher and Taxus stent implantation	p. 187
Drug-eluting stent failures	p. 199
Mode of failure with DES: gap and maldistribution of stent struts (Case # 11165/02)	p. 199
Another failure mode for DES: stent under-expansion (Case # 10885/02)	p. 199
Stent under-expansion and strut maldistribution as possible causes for restenosis in DES (Case MEN/HSR)	p. 200
Severe stent under-expansion: a possible cause of DES restenosis (Case # 10738/02)	p. 200
Is stent under-expansion a real cause of in-stent restenosis? (Case # 10994/02)	p. 201
Gaps, strut maldistribution, and stent under-expansion: possible causes for restenosis in a DES (Case # 11127/02)	p. 201
A constant 'traction' at a site of implantation of a DES as a possible cause of excess proliferation (Case # 10297/01)	p. 202
A transient 'restenosis' (Case JM)	p. 203
A View from the USA	p. 205
Experience with drug-eluting stents	p. 207
Noninvasive Evaluation	p. 217
Stress echo in percutaneous coronary interventions - should anything be changed in the drug-eluting stent era?	p. 219
Cost-Effectiveness Analysis	p. 231
Economic considerations of drug-eluting stents	p. 233
Index	p. 247
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