PCI in the angulated or tortuous lesion: Difference between revisions
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In the treatment of angulated and tortuous lesions, the main goals include successfully delivering the equipment, avoiding complications, and maximizing procedural success. Complications to avoid include vessel [[perforation]], [[dissection]], and premature stent deployment. Procedural success includes the restoration of normal epicardial flow and myocardial perfusion. | In the treatment of angulated and tortuous lesions, the main goals include successfully delivering the equipment, avoiding complications, and maximizing procedural success. Complications to avoid include vessel [[perforation]], [[dissection]], and premature stent deployment. Procedural success includes the restoration of normal epicardial flow and myocardial perfusion. | ||
==Treatment Choices== | |||
===Guiding Catheter=== | |||
There are specific guiding catheters that may be selected so that coaxial alignment may be optimized. For instance, larger guiding catheters (8 Fr) offer improved support. Additionally, the material which composes the catheter is also important, as the material affects torque control, kink resistance, risk of vessel trauma, and stiffness. Different catheters can also be used depending on whether you are working with the left or right system. Extra backup (XB) guiding catheters in the left coronary system, and Ampltaz left (AL) guiding catheters in the right coronary system, can provide improved support. However, these catheters can increase the risk of guide trauma to the proximal vessel, so extra care must be taken. | |||
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Revision as of 16:08, 28 June 2010
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Overview
Severe tortuosity and moderate-to-severe calcification have long been identified as significant predictors of procedure failure, as well as worse clinical outcomes.
Angulated Lesions
- Balloon angioplasty of highly angulated lesions is associated with an increased for risk coronary dissection.
- In the settings of coronary stenting, angulated lesions represent a challenge due to the inability of delivering the stent to the stenosis and straightening of the arterial silhouette after stent implantation that may predispose to the presence of stent fracture.
- Vessel curvature at the site of maximum stenosis should be measured in the most unforeshortened projection using a length of curvature that approximates the balloon length used for coronary dilation.
Goals of Treatment
In the treatment of angulated and tortuous lesions, the main goals include successfully delivering the equipment, avoiding complications, and maximizing procedural success. Complications to avoid include vessel perforation, dissection, and premature stent deployment. Procedural success includes the restoration of normal epicardial flow and myocardial perfusion.
Treatment Choices
Guiding Catheter
There are specific guiding catheters that may be selected so that coaxial alignment may be optimized. For instance, larger guiding catheters (8 Fr) offer improved support. Additionally, the material which composes the catheter is also important, as the material affects torque control, kink resistance, risk of vessel trauma, and stiffness. Different catheters can also be used depending on whether you are working with the left or right system. Extra backup (XB) guiding catheters in the left coronary system, and Ampltaz left (AL) guiding catheters in the right coronary system, can provide improved support. However, these catheters can increase the risk of guide trauma to the proximal vessel, so extra care must be taken.