The Journal of invasive cardiology
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This study sought to evaluate the frequency and efficacy of combination of bivalirudin and provisional glycoprotein (GP) IIb/IIIa blockade compared with bivalirudin monotherapy in current clinical practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES). ⋯ Provisional GP IIb/IIIa use in bivalirudin-treated patients is higher in contemporary non-emergent PCI practice than that seen in randomized trials and is associated with similar in-hospital ischemic events, but more frequent bleeding events. These data suggest that a strategy of bivalirudin monotherapy is preferable in order to reduce bleeding complications, and GP IIb/IIIa blockade should be reserved for patients with periprocedural complications in bivalirudin-treated patients undergoing PCI.
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Anaphylaxis during diagnostic catheterization and coronary intervention is a rare and potentially life-threatening complication. Fortunately, with standard intervention, fatality is rare. We report a case of medically refractory anaphylaxis during a coronary intervention that ultimately responded to percutaneous cardiopulmonary bypass (CPB). The proposed mechanics and use of CPB for shock are discussed.
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Drug-eluting stents were designed to reduce neointimal hyperplasia and thus diminish the likelihood of coronary restenosis. They may, however, carry long-term risks such as delayed stent endothelization and arterial healing. Here we report a case of late stent thrombosis in a drug-eluting stent in the perioperative period after abdominal surgery in a patient who could not absorb oral antiplatelet agents and who was treated with a glycoprotein IIb/IIIa antagonist. We will present issues related to discontinuation of antiplatelet therapy before non-cardiac surgery, coronary intervention in the perioperative period and the strategy for managing patients with stent thrombosis who cannot receive oral antiplatelet treatment.
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Randomized Controlled Trial
A prospective randomized clinical trial of the use of fluoroscopy in obtaining femoral arterial access.
There is no consensus on the utility of fluoroscopy in obtaining common femoral artery (CFA) access. ⋯ In this single-center, randomized trial, the use of fluoroscopy did not increase the probability of arterial puncture over the femoral head or the rate of successful CFA cannulation.