INTERVENTIONAL CARDIOLOGY AN OVERVIEW Timothy P. Morris, D.O., F.A.C.C.

INTERVENTIONAL CARDIOLOGY DIAGNOSTIC CATHETERIZATION CORONARY ANGIOPLASTY AORTIC AND PERIPHERAL ANGIOPLASTY PERCUTANEOUS CLOSURE OF SHUNTS FOREIGN BODY REMOVAL STIMULATION OF COLLATERAL FORMATION

INTERVENTIONAL CARDIOLOGY UNITED STATES 1.2 MILLION DIAGNOSTIC CATHETERIZATIONS PER YEAR 480,000 CORONARY ANGIOPLASTIES PER YEAR 1 MILLION WORLDWIDE

INTERVENTIONAL CARDIOLOGY HISTORY FORSSMAN 1929 1st RIGHT HEART CATH ZIMMERMAN 1950 1st LEFT HEART CATH SELDINGER 1953 SONES 1958 GRUENTZIG 1977

INTERVENTIONAL CARDIOLOGY INDICATIONS ASYMPTOMATIC POSITIVE STRESS TEST SUDDEN CARDIAC DEATH INDIVIDUALS IN HIGH RISK PROFFESIONS PRIOR TO SURGERY WITH BORDERLINE POSITIVE NONINVASIVE STRESS TESTS AND RISK FACTORS

INTERVENTIONAL CARDIOLOGY SYMPTOMATIC FAILED MEDICAL THERAPY UNSTABLE ANGINA PECTORIS PRINZMETAL’S ANGINA ANGINA PECTORIS INTOLERANCE TO MEDS HIGH RISK OCCUPATION MARKEDLY ABNORMAL STRESS TEST PRIOR TO VASCULAR SURGERY

INTERVENTIONAL CARDIOLOGY ATYPICAL CHEST PAIN HIGH RISK NON-INVASIVE STUDIES SUSPECTED CORONARY VASOSPASM CONGESTIVE HEART FAILURE POST MYOCARDIAL INFARCTION FAILED THROMBOLYTIC THERAPY SUSPECTED COMPLICATIONS

INTERVENTIONAL CARDIOLOGY VALVULAR HEART DISEASE POSITIVE NON-INVASIVE STRESS TEST PRIOR TO VALVE REPLACEMENT MALES > 35 y.o. FEMALES > 40 y.o. CONGENITAL HEART DISEASE SUSPECTED CORONARY ANOMALIES MALES > 40 y.o., POST MENOPAUSAL FEMALES

INTERVENTIONAL CARDIOLOGY PROCEDURE ARTERIAL ACCESS VENOUS ACCESS LEFT HEART CATH RIGHT HEART CATH SELECTIVE CORONARY ANGIOGRAPHY

INTERVENTIONAL CARDIOLOGY LIMITATIONS OF ANGIOGRAPHY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY ULCERATED PLAQUE

INTERVENTIONAL CARDIOLOGY INDICATIONS FOR PTCA ASYMPTOMATIC , MILD SYMPTOMS SUDDEN CARDIAC DEATH SEVERE MYOCARDIAL ISCHEMIA FAILURE MEDICAL THERAPY INTOLERANT OF MEDICAL THERAPY PRIOR TO HIGH RISK SURGERY

INTERVENTIONAL CARDIOLOGY INDICATIONS FOR PTCA SYMPTOMATIC UNSTABLE ANGINA PECTORIS FAILED MEDICAL THERAPY LARGE AREA VIABLE MYOCARDIUM RESCUE PTCA PRIMARY PTCA IN ACUTE MI CARDIOGENIC SHOCK

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY PTCA PROCEDURE FEMORAL ARTERIAL/ VENOUS ACCESS PLACE GUIDE CATHETER WIRE LESION BALLOON ANGIOPLASTY STENT “SEAL ARTERIOTOMY”

INTERVENTIONAL CARDIOLOGY PHARMACOLOGIC THERAPY ASPIRIN HEPARIN GLYCOPROTEIN 2B-3A INHIBITORS TICLID PLAVIX TREATMENT OF RISK FACTORS

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY CONTRAINDICATIONS ABSOLUTE UNPROTECTED LEFT MAIN LESION LESS THEN 50% NO SURGICAL BACKUP RELATIVE DIFFUSELY DISEASED SVG DIFFUSELY DISEASED NATIVE VESSELS WITH GOOD DISTAL TARGETS

INTERVENTIONAL CARDIOLOGY CONTRAINDICATIONS RELATIVE (continued) BLEEDING DIASTHESIS PTCA OF NON-INFARCT VESSEL DURING PRIMARY PTCA HIGH RISK ANATOMY FOR ABRUPT CLOSURE SOLE VESSEL SUPPLYING HEART DIABETICS WITH MULTIVESSEL Dx

INTERVENTIONAL CARDIOLOGY MAJOR COMPLICATIONS DEATH (0.5%-1%) Q-WAVE MYOCARDIAL INFARCTION ( 1%-3%) EMERGENT SURGERY (1%)

INTERVENTIONAL CARDIOLOGY PROCEDURAL COMPLICATIONS ACUTE CLOSURE (4%-8%) SPASM THROMBUS DISECTION EMBOLISM TREATABLE WITH STENTS PERFORATION

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY SHORT TERM RESULTS SUCCESS RATES (90%-95%) RESTENOSIS OCCURS IN 2-4 MONTHS ,RARE AFTER 6 MONTHS RATE (32%-57%) STENTS ( 20%-30%)

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY LONG TERM RESULTS SURVIVAL 1 YEAR ( 97%) 5 YEARS (88%-97%) 10 YEARS (78%-90%) EVENT-FREE SURVIVAL 1 YEAR (81%-90%) 5 YEARS ( 79%) 10 YEARS ( 65%)

INTERVENTIONAL CARDIOLOGY NEW DEVICES STENTS DIRECTIONAL ATHERECTOMY ROTATIONAL ATHERECTOMY TRANSLUMINAL ATHERECTOMY ANGIOJET RADIATION PMR

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY NIR STENT

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INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY

INTERVENTIONAL CARDIOLOGY MITRAL VALVULOPLASTY

INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS

INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS AFTER STENTING

INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS

INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS POST PTA

INTERVENTIONAL CARDIOLOGY PTMR

INTERVENTIONAL CARDIOLGY SUMMARY RAPIDLY GROWING FIELD PTCA IDEAL FOR SINGLE VESSEL AND 2-VESSEL DISEASE WITHOUT PROXIMAL LAD INVOLVEMENT STENTS USED IN 80% PTCA CASES RESTENOSIS A LIMITING FACTOR NON-CORONARY PTA EXPANDING