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

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

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

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

6. 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

7. 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

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

9. 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

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

14. INTERVENTIONAL CARDIOLOGY LIMITATIONS OF ANGIOGRAPHY

15. INTERVENTIONAL CARDIOLOGY

16. INTERVENTIONAL CARDIOLOGY

17. INTERVENTIONAL CARDIOLOGY

18. INTERVENTIONAL CARDIOLOGY ULCERATED PLAQUE

23. 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

24. 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

25. INTERVENTIONAL CARDIOLOGY

26. INTERVENTIONAL CARDIOLOGY

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

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

30. INTERVENTIONAL CARDIOLOGY

31. 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

32. 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

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

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

35. INTERVENTIONAL CARDIOLOGY

36. 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%)

37. INTERVENTIONAL CARDIOLOGY

39. INTERVENTIONAL CARDIOLOGY

40. 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%)

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

42. INTERVENTIONAL CARDIOLOGY

43. INTERVENTIONAL CARDIOLOGY NIR STENT

44. C:\WINDOWS\All Users\Application Data\Microsoft\Works\Portfolio\Sample
C:\WINDOWS\All Users\Application Data\Microsoft\Works\Portfolio\Sample.dir\70\Portfolio file 1.emf

48. INTERVENTIONAL CARDIOLOGY

49. INTERVENTIONAL CARDIOLOGY

57. INTERVENTIONAL CARDIOLOGY MITRAL VALVULOPLASTY

58. INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS

59. INTERVENTIONAL CARDIOLOGY CAROTID STENOSIS AFTER STENTING

60. INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS

61. INTERVENTIONAL CARDIOLOGY SUBCLAVIAN STENOSIS POST PTA

62. INTERVENTIONAL CARDIOLOGY PTMR

63. 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