Ischaemic heart disease: coronary revascularisation Flashcards
Describe the surgical technique of CABG?
>Median sternotomy >Long saphenous vein >Internal Mammary artery >Cardio-pulmonary bypass >Cardioplegia
What kind of hospital tay does CABG require?
Overnight in ITU
7 days in hospital
2-3 months off work
What is the risk of CABG?
Risk of graft disease 8-10 years post-op
What are some complications of CABG?
Death 1-2% Stroke 2-3% MI 3% Atrial fibrillation Infection Cognitive impairment Sternal malunion Renal failure Failure to recover
What are the complications of PCI?
Death 0.8% Stroke 0.6% MI 1-2% Renal Failure Bleeding Vascular complications Stent thrombosis Stent restenosis
Describe the process of PCI?
- Vascular access
- Anti-platelet drugs, anticoagulation
- Catheter to ostium of coronary
- Guidewire down vessel
- Balloons threaded over wire
- Stent(s) implanted
- Balloon, catheter, wires removed
What is the current indication for angiography?
Severe symptoms
High risk
What is the current practice for suitability for revascularisation?
Multi-vessel disease
Left main disease
Diabetes
Co-morbitities
What is the current practice for PCI specific issues?
Dual anti platelet therapy
Vascular acess
What does the radial artery supply?
Dual supply to the hand
Why is the radial artery so accessible?
Superficial
Compressible
No adjacent nerve/vein
What is the negatives of using the radial artery?
Small
Prone to spasm
asymptomatic occlusion 5%
What is the emergency treatment for STEMI?
Primary PCI
What is the treatment for acute coronary syndrome?
Angiography with a view to revascularisation
What is the treatment for chronic stable angina?
Revascularisation for severe symptoms or high risk
-CABG vs PCI should be determined by discussion
