Thursday 18 December 2014
Wednesday 19 November 2014
Question and Answers
What is thrombostar catheter?
- 6 Fr lowest profile
- Best internal diameter
- Round lumen and tip
- Best suction
- Core stylet inside to cross bends, curves, tortuosity
- Monorail within 2 cm of tip
- Hydrphylic coating in last 30 cm to helps slide down stenotic lesions to aspirate.
Finally best thrombus aspiration catheter in terms of suction of thrombus, flexibility, crossibility, pushebility, internal lumen as compare to other thrombo comic devises.
What is the problem of fibrotic lesions during PTCA?
Fibrotic lesions even if non calcified may not dilate with a NC balloon. And very high pressures balloon make dissect the vessel.
What is the problem of a DES?
- Drug disappears in 3 months time and taken care of problem of restenosis
- Polymer may remain permanent and become nidus for thrombosis and if DES is not endothelialized well, the metal and polymer create SAT and late stent thrombosis even after 2 to 3 years specially if DAP is discontinued.
- Sometimes polymer is inflammatory and if stent is not endothelialized then it can cause stent thrombosis.
What is ideal DES?
- Easy to deliver
- Polymer should disappear in four weeks time
- Drug should disappear in 28 days (maximum time of restenosis)
- Non-inflammatory stenosis
Which is a good approach in SVG PTCA?
- In fuzzy ulcerated lesions do direct stenting
- Otherwise predilate with small balloon and then implant of stent
What are the problems with 3.5 mm DES stent specially cypher?
- Difficulty in advancing DES across lesion
- Difficulty in removing balloon after deploying the stent
- With no proper guide support and guide wire, it is difficult to advance the stent
What is the benefit of PTCA in cardiogenic shock?
- Even 50 to 60 % improvement in TIMI flow improves the acute and long term outcome in LV function, mortality and morbidity.
Cardiogenic shock with RVMI and acute MR : option of treatment
- Best option is to stent the accluded RCA in AMI. There are chances that acute MR may disappear.
What is the approach of PTCA in AMI with TVD
- Culprit vessel PTCA first
- If Hemodynamics remain unstable, then only you do PTCA to another critically accluded vessel
What are the clinical situations prone to stent thrombosis?
- Diabetes
- Resistance to anti-platelets
- Discontinuation of anti platelets
- AMI
- Smaller final MLD
- Bifurcation stenting
- Patient with renal failure
Which are the conditions where long term DAP a MUST?
- Bifurcation stenting
- Long DES
- IDDM
- Renal failure
Innumerate anti-thrombin's
- Aspirin and clopidogrel
- LMWH
- IIb/IIIa glycoprotein inhibitor
- IV Bivaluridin
What are the causes of Hematoma in groin after introducing sheath in femoral arteries?
- Peri sheath oozing
- A small arterial branch puncture before and wire could not go and there was no adequate compression at the puncture site. So blood keeps oozing out of the side branch.
Which is a better carotid stent?
- Self expanding stent is better and it is best to Postdilate stent with a balloon
- Metallic balloon expandable stent are avoidable in the neck due to neck movements.
How to avoid Perforation of RV with temporary Pacing wire specially in RVMI?
- Use balloon tip pacing wire to 6 Fr bard pacing wire. Confirm position in LAO pacing wire to face towards the septum / spine
What is the deference between XB3 (Cordis) and EBU 3 (Metronic)?
- XB3 is like JL 4 and EBU 3 is like JL 3.5 guide catheters
What are the salient points of whisper wire?
- It is best wire for bends , curves and tortous vessels
- Best wire for retrograde thro collaterals for CTO
- The end of the wire is stiff so in very small branches it may cause perforation
What is the reason of a stent balloon not advancing forward after stent deployment?
- If balloon is getting stuck within the stent then inflate balloon and deflate and then it will easily go down to vessel
- The balloon sticks within the stent and it's not going forward if stent is not full expanded in that segment.
An RVMI with CHB - how long can you keep a temporary pacing wire?
- Maximum 5 to 7 days
- Longer you keep the wire more chances of perforation
What are the problems you face with angioplasty in ACS in patients with low platelet count?
- Some patients lower the platelet count with aspirin, clopidogrel and inj clexane
- Low platelets are reported more with clopidogrel then inj clexane
- Inj integrillin causes greater reduction in platelets
- Monitor platelet count when giving patient aspirin, clopidogrel, inj clexane and inj integrillin
- In patients with tendency to lowering platelets one can continue aspirin, clopidogrel and inj clexane. Inj integrillin can be started 2 to 3 hours, during and 2 hours after the procedure. If the platelet count after the procedure lowers less than 75000 than it is important to stop inj integrillin
Thursday 13 November 2014
Stern Warning on the eve of 'World Diabetes Day
Most of the diabetes patients will develop heart problems!
Saturday 1 November 2014
Control Diabetes or be prepared for Heart Problems: Dr. S.A. Merchant, Interventional Cardiologist
Mumbai, October, 2014: “If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke”, warns Dr. S. A. Merchant, a leading Interventional Cardiologist. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.
People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).
Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.
You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:
· Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.
· Having abnormal blood fat (cholesterol) levels.
o LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries—the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.
o Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
o HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.
· Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.
· Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.
Dr. S . A. Merchant has suggested regular checkups to prevent Diabetes and in turn Heart Problems
· Fasting and Post Meal blood sugar, Hb 1 Ac
· Sr Cholestrol, Sr.Triglycerides, Sr Creatinine, T3 TSH
· Urine for Micro-albumin,Creatinine Clearance Test
· ECG, 2-D Echo, Stress test
· Eyes-Fundoscopy, Slit-Lamp, Retinoscopy
· Carotid Artery Doppler
· Ultrasound Kidneys
· Lower Limb Arterial Doppler
· Ankle –brachial blood pressure, Periscope
· Sensitometer/ Vibrometer/ Foot Scan
Dr. Merchant, one of the leading cardiologist with regular patients in Maharashtra & Gujarat and now from abroad- Middle East & East Africa specializes in the complete array of heart related problems including- Cardiac Catheterization and Angiography, Coronary Angioplasty with drug eluting stent, Valvuloplasties and TAVI ( Transfemoral Aortic Valve Implant), Carotid, renal and peripheral below knee stenting,, Permanent pacemaker implant and arrhythmia management, Soluble Scaffolding for Complex Coronary Artery Disease.
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