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ABSTRACT: The use of drug-coated balloons (DEB) for preventing restenosis is new and has received increasing interest. We present a patient who was admitted with recurrent angina with repeat interventions for restenosis events in a very short time using both BMS and DES. The restenosis was treated with kissing drug eluting balloons in the LAD-Diagonal bifurcation. More than one year after the DEB PCI, the patient is free from symptoms.
Cardiovascular revascularization medicine: including molecular interventions 11/2012;
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Farzin Fath-Ordoubadi,
Yaron Barac,
Eitan Abergel,
Gian Battista Danzi,
Arthur Kerner,
Eugenia Nikolsky,
Majdi Halabi,
Mamas Mamas,
Magdi El-Omar,
Doug Fraser, Ariel Roguin
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ABSTRACT: Women have a higher risk of adverse outcomes after percutaneous coronary intervention (PCI) than men. However, in acute coronary syndrome (ACS), long-term outcomes after contemporary PCI with drug-eluting stent (DES) have not been fully investigated. We aimed to test the impact of gender on outcomes in patients with ACS after PCI with DES. We analyzed all patients with ACS from the prospective NOBORI-2 trial who underwent PCI with a Nobori DES from 2008 through 2009 in 125 centers worldwide. End points of the study were target lesion failure, cardiac death, myocardial infarction (MI), and clinically driven target lesion revascularization, and major adverse cardiac events (composite of cardiac death, MI, and target vessel revascularization) at 1 year and yearly up to 5 years. There were 1,640 patients with ACS, 1,268 men (77%) and 372 women (23%). Compared to men, women were 5 years older and more frequently had co-morbidities such as diabetes mellitus and hypertension. There were no gender differences for cardiac death (1.3% vs 2.7%), MI (2.1% vs 3.2%), or target lesion revascularization (2.6% vs 3.8%) at 1 year after the procedure for men and women, respectively. The trend was the same at 2 years (cardiac death 2.0% vs 2.3%, MI 2.5% vs 3.5%, target lesion revascularization 3.2% vs 4.6%). Target lesion failure rates were 4.5% and 5.9% at 1 year and 5.7% and 7.3% at 2 years in men and women, respectively (p = NS). Multivariate analysis, which included age, hypertension, diabetes mellitus, and number of diseased vessels, showed that gender was not a predictor for outcome. There were no differences in bleeding or stent thrombosis rates. Relief from anginal symptoms was similar. The same rate of adherence to dual antiplatelet therapy was observed and reached 73% at 1 year and 31% at 2 years after the ACS event and PCI. In conclusion, although women had worse baseline characteristics, no differences in outcomes were observed between men and women treated for ACS with contemporary DES.
The American journal of cardiology 05/2012; 110(5):636-42. · 3.58 Impact Factor
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ABSTRACT: The goal of this study was to examine the safety and results of interventional procedures performed during the broadcast of live case demonstrations.
Professional meetings using live case demonstrations to present cutting-edge technology are considered a valuable educational resource. There is an ongoing discussion on whether patients who are treated during live case demonstrations are exposed to a higher risk.
Between 1998 and 2010, 101 patients were treated during live transmissions from a single center in 15 invasive-cardiology conferences. Technical success was defined as the ability to effectively perform the planned procedure without any major complication. The primary endpoint of the study was the composite occurrence of death, myocardial infarction, or stroke.
The interventional procedures included coronary (n=66), carotid (n=15), peripheral (n=1), valvular (n=2), congenital heart disease (n=12), and complex electrophysiological mapping and ablation interventions (n=7). In 4 cases, the intended procedure was not done. The procedure was technically successful in 95%. In 5 cases, the procedure was unsuccessful because of the inability to cross a chronic total occlusion. There were no deaths during the hospital stay, and the composite primary endpoint occurred in 2 patients: a minor stroke following an atrial fibrillation ablation and a rise in serum troponin levels after percutaneous coronary intervention. These results were no different from those of 66 matched controls who underwent procedures performed by the same operators but not as live case demonstrations (relative risk: 0.32; 95% confidence interval: 0.02 to 3.62, p=0.62).
In this consecutive series of interventional cardiology procedures that were performed by expert operators during live demonstration courses, the procedural and 30-day clinical outcomes were similar to those found in daily practice and to those that have been reported in the contemporary published data. These results suggest that broadcasting live case demonstrations in selected patients from selected centers may be safe.
02/2012; 5(2):215-24. · 1.07 Impact Factor
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Jonathan Lessick,
Sobhi Abadi,
Yoram Agmon,
Zohar Keidar,
Shemi Carasso,
Doron Aronson,
Eduard Ghersin,
Shmuel Rispler,
Anat Sebbag,
Ora Israel,
Haim Hammerman, Ariel Roguin
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ABSTRACT: Despite advent of rapid arterial revascularization as 1st line treatment for acute myocardial infarction (AMI), incomplete restoral of flow at the microvascular level remains a problem and is associated with adverse prognosis, including pathological ventricular remodeling. We aimed to study the association between multidetector row computed tomography (MDCT) perfusion defects and ventricular remodeling post-AMI.
In a prospective study, 20 patients with ST-elevation AMI, treated by primary angioplasty, underwent arterial and late phase MDCT as well as radionuclide scans to study presence, size and severity of myocardial perfusion defects. Contrast echocardiography was performed at baseline and at 4 months follow-up to evaluate changes in myocardial function and remodeling.
Early defects (ED), late defects (LD) and late enhancement (LE) were detected in 15, 7 and 16 patients, respectively and radionuclide defects in 15 patients. The ED area (r=0.74), and LD area (r=0.72), and to a lesser extent LE area (r=0.62) correlated moderately well with SPECT summed rest score. By univariate analysis, follow-up end-systolic volume index and ejection fraction were both significantly related to ED and LD size and severity, but not to LE size or severity. By multivariate analysis, end-systolic volume index was best predicted by LD area (p<0.05) and ejection fraction by LD enhancement ratio.
LD size and severity on MDCT are most closely associated with pathological ventricular remodeling after AMI and may thus play a role in early identification and treatment of this condition.
European journal of radiology 12/2011; 81(10):2648-57. · 2.65 Impact Factor
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Saman Nazarian,
Rozann Hansford, Ariel Roguin,
Dorith Goldsher,
Menekhem M Zviman,
Albert C Lardo,
Brian S Caffo,
Kevin D Frick,
Michael A Kraut,
Ihab R Kamel,
Hugh Calkins,
Ronald D Berger,
David A Bluemke,
Henry R Halperin
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ABSTRACT: Magnetic resonance imaging (MRI) is avoided in most patients with implanted cardiac devices because of safety concerns.
To define the safety of a protocol for MRI at the commonly used magnetic strength of 1.5 T in patients with implanted cardiac devices.
Prospective nonrandomized trial. (ClinicalTrials.gov registration number: NCT01130896)
One center in the United States (94% of examinations) and one in Israel.
438 patients with devices (54% with pacemakers and 46% with defibrillators) who underwent 555 MRI studies. Intervention: Pacing mode was changed to asynchronous for pacemaker-dependent patients and to demand for others. Tachyarrhythmia functions were disabled. Blood pressure, electrocardiography, oximetry, and symptoms were monitored by a nurse with experience in cardiac life support and device programming who had immediate backup from an electrophysiologist.
Activation or inhibition of pacing, symptoms, and device variables.
In 3 patients (0.7% [95% CI, 0% to 1.5%]), the device reverted to a transient back-up programming mode without long-term effects. Right ventricular (RV) sensing (median change, 0 mV [interquartile range {IQR}, -0.7 to 0 V]) and atrial and right and left ventricular lead impedances (median change, -2 Ω [IQR, -13 to 0 Ω], -4 Ω [IQR, -16 to 0 Ω], and -11 Ω [IQR, -40 to 0 Ω], respectively) were reduced immediately after MRI. At long-term follow-up (61% of patients), decreased RV sensing (median, 0 mV, [IQR, -1.1 to 0.3 mV]), decreased RV lead impedance (median, -3 Ω, [IQR, -29 to 15 Ω]), increased RV capture threshold (median, 0 V, IQR, [0 to 0.2 Ω]), and decreased battery voltage (median, -0.01 V, IQR, -0.04 to 0 V) were noted. The observed changes did not require device revision or reprogramming.
Not all available cardiac devices have been tested. Long-term in-person or telephone follow-up was unavailable in 43 patients (10%), and some data were missing. Those with missing long-term capture threshold data had higher baseline right atrial and right ventricular capture thresholds and were more likely to have undergone thoracic imaging. Defibrillation threshold testing and random assignment to a control group were not performed.
With appropriate precautions, MRI can be done safely in patients with selected cardiac devices. Because changes in device variables and programming may occur, electrophysiologic monitoring during MRI is essential.
Annals of internal medicine 10/2011; 155(7):415-24. · 16.73 Impact Factor
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ABSTRACT: Early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) is important since the benefit from more aggressive and costly treatment strategies is proportional to the risk of adverse clinical events. In the present study we assessed whether hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) technology could be an appropriate tool in stratifying patients with NSTE-ACS.
SPECT/CCTA was performed in 90 consecutive patients with NSTE-ACS. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) was used to classify patients as low- or high-risk. Imaging was performed using SPECT/CCTA to identify haemodynamically significant lesions defined as >50% stenosis on CCTA with a reversible perfusion defect on SPECT in the corresponding territory.
CCTA demonstrated at least one lesion with >50% stenosis in 35 of 40 high-risk patients (87%) as compared to 14 of 50 low-risk patients (35%; TIMI-RS<3; p<.0001). Of the 40 high-risk and 50 (16%) low-risk TIMI-RS patients, 16 (40%) and 8 (16%), respectively, had haemodynamically significant lesions (p=0.01). Patients defined as high-risk by a high TIMI-RS, a positive CCTA scan or both (n=45) resulted in a sensitivity of 95%, specificity of 49%, PPV of 35% and NPV of 97% for having haemodynamically significant coronary lesions. Those with normal perfusion were spared revascularization procedures, regardless of their TIMI-RS.
Noninvasive assessment of coronary artery disease by SPECT/CCTA may play an important role in risk stratification of patients with NSTE-ACS by better identifying the subgroup requiring intervention.
European Journal of Nuclear Medicine 06/2011; 38(10):1917-25. · 4.53 Impact Factor
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ABSTRACT: Ablation has become an important tool in treating atrial fibrillation and ventricular tachycardia, yet the recurrence rates remain high. It is well established that ablation lines can be discontinuous and that conduction through the gaps in ablation lines can be affected by tissue heating. In this study, we looked at the effect of tissue conductivity and propagation of electric wave fronts across ablation lines with gaps, using both simulations and an animal model.
For the simulations, we implemented a 2-dimensional bidomain model of the cardiac syncytium, simulating ablation lines with gaps of varying lengths, conductivity, and orientation. For the animal model, transmural ablation lines with a gap were created in 7 mongrel dogs. The gap length was progressively decreased until there was conduction block. The ablation line with a gap was then imaged using MRI and was correlated with histology. With normal conductivity in the gap and the ablation line oriented parallel to the fiber direction, the simulation predicted that the maximum gap length that exhibited conduction block was 1.4 mm. As the conductivity was decreased, the maximum gap length with conduction block increased substantially, that is, with a conductivity of 67% of normal, the maximum gap length with conduction block increased to 4 mm. In the canine studies, the maximum gap length that displayed conduction block acutely as measured by gross pathology correlated well (R(2) of 0.81) with that measured by MRI.
Conduction block can occur across discontinuous ablation lines. Moreover, with recovery of conductivity over time, ablation lines with large gaps exhibiting acute conduction block may recover propagation in the gap over time, allowing recurrences of arrhythmias. The ability to see gaps acutely using MRI will allow for targeting these sites for ablation.
Circulation Arrhythmia and Electrophysiology 06/2011; 4(3):279-86. · 6.46 Impact Factor
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Zaid A Abassi,
Yaron D Barac,
Sawa Kostin, Ariel Roguin,
Elena Ovcharenko,
Hoda Awad,
Ayelet Blank,
Orit Bar-Am,
Tamar Amit,
Jutta Schaper,
Moussa Youdim,
Ofer Binah
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ABSTRACT: Despite the availability of many pharmacological and mechanical therapies, the mortality rate among patients with congestive heart failure (CHF) remains high. We tested the hypothesis that TVP1022 (the S-isomer of rasagiline; Azilect), a neuroprotective and cytoprotective molecule, is also cardioprotective in the settings of experimental CHF in rats.
In rats with volume overload-induced CHF, we investigated the therapeutic efficacy of TVP1022 (7.5 mg/kg) on cardiac function, structure, biomarkers, and kidney function. Treatment with TVP1022 for 7 days before CHF induction prevented the increase in left ventricular end-diastolic area and end-systolic area, and the decrease in fractional shortening measured 14 days after CHF induction. Additionally, TVP1022 pretreatment attenuated CHF-induced cardiomyocyte hypertrophy, fibrosis, plasma and ventricular B-type natriuretic peptide levels, and reactive oxygen species expression. Further, in CHF rats, TVP1022 decreased cytochrome c and caspase 3 expression, thereby contributing to the cardioprotective efficacy of the drug. TVP1022 also enhanced the urinary Na(+) excretion and improved the glomerular filtration rate. Similar cardioprotective effects were obtained when TVP1022 was given to rats after CHF induction.
TVP1022 attenuated the adverse functional, structural, and molecular alterations in CHF, rendering this drug a promising candidate for improving cardiac and renal function in this disease state.
Circulation Heart Failure 05/2011; 4(4):463-73. · 6.29 Impact Factor
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Ariel Roguin
Circulation Cardiovascular Interventions 04/2011; 4(2):206-9. · 6.06 Impact Factor
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ABSTRACT: Diabetes mellitus type-2 (DM-2) contributes to atherogenesis by inducing endothelial cell injury and dysfunction. Endothelial progenitor cells (EPCs) are essential to blood vessel formation, can differentiate into mature endothelial cells, and promote the repair of damaged endothelium. In DM-2, the circulating EPC count is low and their functionality is impaired. The mechanisms that underlie this reduced count and impaired functionality are poorly understood. Nitric oxide (NO) is a short-lived signalling molecule that is produced by vascular endothelial cells and participates in the maintenance of vascular tone. NO is also known to participate in other physiological processes, such as cell survival, proliferation, and migration. The bioavailability of NO is reduced in EPCs from DM-2 patients. Interestingly, an inverse relationship exists between the reduction in NO bioavailability in EPCs and the patient's plasma glucose and glycated haemoglobin levels. In addition, NO bioavailability in EPCs correlates with plasma oxidized low-density lipoprotein levels in DM-2. Although this reduction in NO bioavailability could be attributed to oxidative stress in DM-2 patients, it also may be due to impairment of one or more members of the protein signalling cascades that are responsible for NO production. The stimulation of NO production or its signalling cascades in EPCs may increase their numbers and improve their function, thus attenuating endothelium damage, independent of the vasodilatory effects of NO. This review summarizes the metabolic alterations that underlie the molecular mechanisms that may be responsible for EPC decrease and dysfunction in DM-2 with emphasis on the involvement of the NO system.
Cardiovascular research 01/2011; 91(1):9-15. · 5.80 Impact Factor
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International journal of cardiology 12/2010; 145(3):548-50. · 7.08 Impact Factor
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Ariel Roguin
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ABSTRACT: The "Bazett formula" is used for correcting the observed QT interval and is named after Henry Cuthbert Bazett who was born in England in 1885. He studied medicine and worked in Oxford and served in the British Medical Corps during World War I. In 1920, Bazett published his seminal paper on the different intervals length of the electrocardiogram recordings in a small group of healthy individuals, and proposed a formula for correcting the QT length for heart rate. Later, he moved to the University of Pennsylvania, in Philadelphia, and from 1931 until his death in 1950, he served as head of the Department of Physiology and a leader of the American Society of Physiology. Bazett's scientific work was largely concerned with temperature control, circulation, and blood volume, and he contributed greatly to the study of circulation in humans by using invasive catheterization.
Pacing and Clinical Electrophysiology 11/2010; 34(3):384-8. · 1.35 Impact Factor
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The Israel Medical Association journal: IMAJ 07/2010; 12(7):436-8. · 1.02 Impact Factor
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ABSTRACT: Endothelial progenitor cells (EPCs) contribute to the maintenance of vascular endothelial function. The moderate consumption of red wine provides cardiovascular protection.
We investigated the underlying molecular mechanism of EPC migration in young, healthy individuals who drank red wine.
Fourteen healthy volunteers consumed 250 mL red wine daily for 21 consecutive days. Vascular endothelial function, plasma stromal cell-derived factor 1alpha (SDF1alpha) concentrations, and the number, migration, and nitric oxide production of EPCs were determined before and after the daily consumption of red wine. EPCs were glucose stressed to study the effect of red wine on EPC migration, proliferation, and senescence and to study the expressions of CXC chemokine receptor 4 (CXCR4) and members of the Pi3K/Akt/eNOS (phosphatidylinositol 3-kinase/protein kinase B/endothelial nitric oxide synthase) signaling pathway by Western blotting.
Daily red wine consumption for 21 consecutive days significantly enhanced vascular endothelial function. Although plasma SDF1alpha concentrations were unchanged, EPC count and migration were significantly increased after this 21-d consumption period. Red wine increased the migration, proliferation, CXCR4 expression, and activity of the Pi3K/Akt/eNOS signaling pathway and decreased the extent of apoptosis in glucose-stressed EPCs.
The results of the present study indicate that red wine exerts its effect through the up-regulation of CXCR4 expression and activation of the SDF1alpha/CXCR4/Pi3K/Akt/eNOS signaling pathway, which results in increased EPC migration and proliferation and decreased extent of apoptosis. Our findings suggest that these effects could be linked to the mechanism of cardiovascular protection that is associated with the regular consumption of red wine.
American Journal of Clinical Nutrition 07/2010; 92(1):161-9. · 6.67 Impact Factor
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ABSTRACT: Type 2 diabetes mellitus (DM) patients with coronary artery disease (CAD) have elevated plasma oxidized-LDL (OxLDL) levels and impaired neovascularization. Hyperglycemia and hyperlipidemia impair endothelial progenitor cell (EPC) migration, and endothelial nitric oxide (NO) bioavailability and NO synthase (NOS) activity are essential for EPC migration. Stromal-derived factor-1alpha (SDF1alpha) contributes to EPC mobilization and homing by stimulating the CXC receptor-4 (CXCR4) on the EPC plasmalemma to activate the Pi3K/Akt/eNOS signaling pathway. Therefore, we investigated the effect of high glucose (HG) and OxLDL on the migration and NO bioavailability of EPCs from healthy individuals, and then correlated the findings with those of EPCs from type 2 DM patients with and without CAD.
EPCs from 15 healthy and 55 patients were exposed to HG, OxLDL, or both before evaluating EPC count, migration and NO production, and expression of CXCR4 and members of Pi3K/Akt/eNOS signaling cascade.
Counts, migration, CXCR4 expression, and NO production were significantly reduced in EPCs from DM and CAD patients compared with that obtained in EPCs from healthy, and were further reduced in DM patients with CAD. The expression of CXCR4 and activation of Pi3K/Akt/eNOS signaling cascade were suppressed in OxLDL- and HG-treated EPCs, and this suppression was exacerbated when EPCs were treated simultaneously with HG and OxLDL.
Hyperglycemia and elevated circulating OxLDL in DM patients with CAD severely impair EPC migration. These results suggest that the underlying mechanism for this impaired EPC migration is linked to the CXCR4/Pi3K/Akt/eNOS signaling pathway.
Thrombosis Research 03/2010; 126(3):166-74. · 2.44 Impact Factor
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The Journal of invasive cardiology 11/2009; 21(11):596-7. · 1.84 Impact Factor
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Azriel B Osherov, Ariel Roguin,
Doron Aronson,
Ehud Grenadier,
Arthur Kerner,
Monther Boulus,
Michael Kapeliovich,
Amad Hani,
Haim Hammerman,
Rafael Beyar,
Eugenia Nikolsky
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ABSTRACT: Worsening renal function in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is associated with adverse clinical outcomes. We hypothesised that platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) may decrease the rate of renal function deterioration in these patients through attenuation of platelet aggregation and the possible improvement of renal rheology and haemodynamics.
Based on prospectively collected data, we analysed rates of renal function deterioration in 603 consecutive patients (mean age 58+/-13 years, males 82%) with STEMI treated with primary or rescue PCI. Renal function deterioration was defined as an increase in serum creatinine level of >or=25% and/or >or=0.5 mg/dl at any time point post-PCI during index hospitalisation compared with baseline value. Outcomes were stratified by treatment with GPI. Patients treated with GPI (n=442) vs. patients who were not treated with GPI (n=161) had significantly lower rates of serum creatinine increase of >or=25% compared with baseline (22.9% vs. 31.9%, P=0.02, respectively), of serum creatinine increase >or=0.5 g/dL (4.1% vs. 8.8%, P=0.02). Treatment with GPI was associated with significantly lower mean maximal increase in serum creatinine level compared with baseline value (0.14+/-0.38 vs. 0.25+/-0.45 mg/dL, P=0.005). Rates of major bleeding did not differ significantly between the two groups (7.3% vs. 5.9%; P=0.42), while 30-day mortality was significantly lower in patients treated with GPI (2.3% vs. 7.5%; P=0.005). By multivariable analysis, treatment with GPI was an independent predictor of freedom from renal function deterioration (odds ratio 0.53; 95% confidence interval 0.33-0.86; P=0.01).
In this analysis, administration of GPI to patients with STEMI treated with primary PCI was associated with lower rates of worsening renal function and lower 30-day mortality.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 11/2009; 5(5):604-9. · 3.29 Impact Factor
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ABSTRACT: Recent data showed that patients with electrical implanted devices may under certain conditions be scanned safely by magnetic resonance imaging (MRI). The device must have been in place preferably for at least 4-8 weeks [Correction added after online publication 31-Aug-2009: number of weeks has been updated.] prior to MR imaging to allow healing and pacemaker pocket formation. We report on a patient with quadriplegia and suspected epidural hematoma referred for MR scan a day after he had a pacemaker implantation. The patient was also pacemaker-dependent. After considering the risk/benefit ratio in this patient, it was decided to perform the scan. The pacemaker was reprogrammed. MRI was performed under strict monitoring. A spinal cord contusion at the level of C1-3 was diagnosed. Based on the imaging findings no invasive procedure was done. Device interrogation found no change in sensing or pacing parameters or in the pacemaker's battery. At the end of the scan, the device was reprogrammed back to the initial settings. In this population, each scan should be discussed thoroughly and the risks to benefit ratio should be considered. Given appropriate precautions, in well-experienced imaging centers, MRI may be safely performed in patients with permanent cardiac electronic implantable devices.
Pacing and Clinical Electrophysiology 09/2009; 32(10):1355-6. · 1.35 Impact Factor
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ABSTRACT: Rapid reperfusion has been shown to decrease mortality and improve left ventricular (LV) function. Previous studies have reported that LV thrombus (LVT) is a major complication of ST-segment elevation acute anterior wall myocardial infarction (AMI). There are little data on LVT in the current primary percutaneous coronary intervention (PPCI) era. We sought to demonstrate the incidence of LVT after AMI in patients treated with PPCI compared with those treated with thrombolysis or with conservative management.
In a 6-year period, 642 patients with anterior wall AMI and echocardiography were treated with PPCI (n = 297), thrombolysis (n = 128), or conservative treatment (n = 217). Left ventricular thrombus was defined as an echodense mass adjacent to an abnormally contracting myocardial segment.
The rate of LVT among anterior wall AMI was 6.2%. Predictors for LVT were reduced ejection fraction (adjusted relative risk 0.71, 95% CI 0.52-0.96) and severe mitral regurgitation (adjusted relative risk 2.48, 95% CI 1.0-6.44). There was no statistical difference in LVT rate according to treatment: 21 (7.1%) of 297 patients in the PPCI group, 10 (7.8%) of 128 patients in the thrombolytic group, and 9 (4.1%) of 217 patients in the conservative group (P = .28). Those in the thrombolytic group were characterized by shorter duration from symptom onset and were generally also treated with heparin/low-molecular weight heparin.
This is the largest report to evaluate the incidence of LVT formation after AMI. In the current era of rapid reperfusion by PPCI, the rate of thrombus formation is similar to that reported in the past and not different than for patients currently treated conservatively or with thrombolysis.
American heart journal 07/2009; 157(6):1074-80. · 4.65 Impact Factor
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ABSTRACT: The majority of procedural training especially in interventional cardiology, still occurs on patients with direct mentoring by experienced physicians during an actual clinical procedure. In recent years there is an increase use of simulators especially for carotid artery stenting. However, most simulators use "generic" predefined cases.
We report here a simulation done on data of a real patient prior to intervention. The patient's specific carotid anatomy was modeled using CTA on an endovascular simulator. Pre-procedure patient-specific case rehearsal accurately predicted procedure experience.
A case rehearsal prior to an intervention may be useful in the planning and execution of carotid artery stenting. The use of patient specific simulation helps with planning of procedure and device selection, and may lead to use of less contrast and radiation, and shorter procedure duration. These may benefit the patient with increased success and lower complication rates.
Catheterization and Cardiovascular Interventions 07/2009; 75(2):279-82. · 2.29 Impact Factor
