Cutting Balloon Versus Conventional Balloon Angioplasty for the Treatment of Coronary Artery Disease
|
|
- Cody McDowell
- 7 years ago
- Views:
Transcription
1 Cutting Balloon Versus Conventional Balloon Angioplasty for the Treatment of Coronary Artery Disease a report by Dr Remo Albiero Director, Cardiac Catheterisation Laboratory, Clinica San Rocco, Brescia Dr Remo Albiero is Director of the Cardiac Catheterisation Laboratory at the Clinica San Rocco (Gruppo San Donato) in Brescia, Italy. He was previously Senior Associate of the Catheterisation Laboratory at EMO Centro Cuore Columbus in Milan, Italy. Since 1989 he has had 124 abstracts presented at the American College of Cardiology (ACC)/European Society of Cardiology (ESC)/American Heart Association (AHA) congresses 21 as first author. He also has 68 English language publications, with 2 of these as first author. He has been co-author on numerous journal articles. Dr Albiero graduated in medicine and surgery from the University of Verona in 1987, and a obtained diploma in cardiology from the same university in The cutting balloon (CB) 1 is a special balloon catheter with three or four atherotomes (microsurgical blades) bonded longitudinally to its surface, suitable for creating discrete longitudinal incisions in the atherosclerotic target coronary segment during balloon inflation. With the cutting balloon, the increase in the vessel lumen diameter is obtained in a more controlled fashion and with a lower balloon inflation pressure than conventional percutaneous transluminal coronary angioplasty () this controlled dilatation could reduce the extent of vessel wall injury and the incidence of restenosis. The Global trial, 2 a multicentre, randomised trial on 1,238 patients, tested the hypothesis that surgical dilatation using the CB (617 patients) could result in less arterial trauma, fewer dissections and less frequent restenosis than conventional (621 patients). The lesion selected in this study (simple type A/B1 lesions) were treated by a single cutting balloon inflation, with a balloon artery ratio of 1.1:1. The controlled dilatation of the cutting balloon did not reduce the rate of angiographic restenosis compared with conventional (CB 31.4%, compared with 3.4%, p=.75). Five coronary perforations occurred only in the CB arm (.8% compared with %, p=.3). The results of the Global trial indicate that CB angioplasty in simple lesions is not superior to conventional for the prevention of restenosis and should probably be reserved for more complex lesions in which the controlled dilatation of the CB could provide better acute and mid-term results compared with conventional. In fact, this device is mainly used to treat in-stent restenosis (ISR), ostial lesions, bifurcation lesions and smaller vessels and to expand resistant fibrocalcified plaques not dilated by high pressure conventional balloons. subgroup of patients with diffuse and/or severe ISR. 3,5,7 1 Numerous small retrospective studies have shown the benefits of the CB for the prevention of the recurrence of ISR compared with conventional. 11,12 These studies were followed by small pilot randomised studies that also showed a clinical benefit associated with the use of a CB. 13 The author s prior observation 14 demonstrated a greater capacity of cutting balloon angioplasty (CBA) to extrude a fibrous residual neo-intimal plaque out of the stent struts than conventional. The microblades of the cutting balloon were able to surgically incise the restenotic plaques up to the metallic stent cage these incisions probably facilitated the maximum extrusion of the neo-intimal plaque. This hypothesis was confirmed by an intravascular ultrasound (IVUS) study 11 that showed a larger luminal area acute gain after CBA (2.5 ±.8mm 2 ) than after conventional (1.8 ± 1.mm 2 ), which translated into a lower restenosis rate at 5.4-month follow-up (CBA 24%; 59%). Two large prospective, randomised, multicentre studies both failed to demonstrate an advantage of the CB over for the treatment of ISR: the Restenosis Cutting Balloon Evaluation Trial (RESCUT); and the Restenosis Reduction by Cutting Balloon Evaluation (REDUCE) II trial. The RESCUT trial 15 is a European study designed to assess the results of CB (n = 214) compared with conventional (n = 214) for the treatment of ISR. The study included lesions shorter than 25mm in native coronary arteries with all types of ISR patterns (focal, multifocal, diffuse and proliferative). 48 In-stent Restenosis With the rapid explosion in stent use, ISR has become a significant clinical problem. 3 Re-dilatation using a conventional balloon has been the most commonly used approach to treat ISR, 4 7 but with a high recurrent restenosis rate, especially in the This large multicentre randomised study differed from previous reports in that the rates of clinical events (death, myocardial infarction (MI) and target lesion revascularisation (TLR)) were similar between the two groups (see Figure 1), as well as the rates of restenosis and its patterns (see Figure 2 and 3).
2 albiero_papextended.qxp 14/4/5 12:43 pm Page 49 Cutting Balloon Versus Conventional Balloon Angioplasty for the Treatment of CAD The CB demonstrated some practical advantages over conventional : revascularisation compared with conventional angioplasty (1.2% compared with 16.6%; p=.4).16 balloon slippage was less frequent in the CB group (6.5% compared with 25%, p<.1); and The use of CBs could not translate into clinical or angiographic benefits for patients with ISR treated with drug-eluting stents (DES), as a result of the procedural differences in the treatment of ISR using adjunctive brachytherapy compared with restenting using a DES. In the first case (before adjunctive brachytherapy), it is recommended to optimally treat ISR by conventional/cba or atherectomy, avoiding additional stenting to reduce the risk of late stent thrombosis. In the case of restenting with a DES, an optimal balloon pre-treatment of ISR is not necessary, nor is the use of a CB to avoid balloon slippage, because the operator can reduce the risk of vessel injury at the stent edges, even in the event of balloon slippage, by simply predilating the ISR lesion using an undersized non-compliant conventional balloon. there was a trend towards a lower need for additional stenting (CB 3.9% compared with 8.%, p=.7), mainly due to a lower frequency of residual stenosis more than 3% and type D F dissections. These advantages could be explained as follows: conventional balloons, particularly short balloons when positioned within in-stent restenotic lesions, tend to move forwards or backwards during inflation into larger segments with lower resistance, because the hyperplastic tissue has a smooth slippery surface. With a CB this problem is prevented by the blades, which anchor the balloon to the plaque during balloon inflation, reducing the risk of dissection at the stent margins. This fact could be important when there is the need to carefully control the boundaries of the injured segment, for example before coronary brachytherapy, as demonstrated in the Registry Novoste (RENO) where pre-treatment with CB before brachytherapy (performed using beta radiation) significantly reduced six-month target-vessel The second randomised multicentre trial to be discussed is the Japanese REDUCE II trial on 416 patients. The six-month result of this study (not yet published at the time of press) were not different between the two groups binary restenosis was 24% in the CB group compared with 22% in the arm and TLR was 2% in both arms.
3 Figure 1: RESCUT Cumulative MACE 2 1 Figure 2: RESCUT Restenosis at Seven-month Follow-up 35 p=ns Death MI TLR p= compared with CB angioplasty and conventional. A total of 263 patients with a lesion in a small vessel (reference diameters less than 3mm) were randomly assigned to undergo GPBA (n=85), CBA (n=88), or conventional (n=9). The cumulative inflation time was more than 1 minutes in GPBA. Compared with conventional, GPBA resulted in a lower final residual diameter stenosis (27.3% compared with 34.2%, p=.1) and decreased the need for stent placement (8.% compared with 22.2%, p=.31). At follow-up, the restenosis rates were lower with GPBA (31.3%, p=.34) and CBA (32.9%, p=.59) than conventional (5.6%). Target lesion revascularisation was less frequently needed with GPBA (2.5%, p=.43) and CBA (2.%, p=.33) than conventional plain old balloon angioplasty (POBA) (37.6%) Restenosis Figure 3: RESCUT Patterns of Restenosis Another retrospective study in small coronary arteries evaluated the clinical and angiographic benefits of stenting compared with CB angioplasty and conventional. A total of 327 lesions in small vessels (reference diameters less than 2.5mm by quantitative coronary angiography (QCA)) were analysed stenting (n=11), CB (n=87) and conventional (n=13). Angiographic restenosis was encountered in 43.9% of the stent, 31% of the CB and 46.5% of the conventional groups (p =.48) p=ns Major adverse coronary events (MACE; death, MI and TLR) at follow-up were significantly lower in the CB compared with other groups (CB, 2.3%; conventional, 37.3%; stent, 33.3%; p=.36). In conclusion, in small vessels less than 2.5mm, the CB procedure provided superior angiographic and clinical outcomes to stenting or conventional. 19 Focal <1mm Ostial or Bifurcation Lesions The CB may provide an advantage over conventional in complex lesions such as ostial or bifurcation lesions; however, a large retrospective study of 1,58 patients did not show a lower TLR in patients treated with the CB compared with conventional in ostial or bifurcation lesions. 17 Small Vessels Diffuse >1mm Before Stenting By favourably scoring the plaque prior to stent implantation, CBA may be preferable (compared with a conventional balloon) before stent placement. This hypothesis was evaluated in the REDUCE III study, a Japanese prospective, randomised multicentre trial on 52 patients. At six-month follow-up, restenosis rate was significantly lower in the CB group compared with conventional (1.7% compared with 17.1%, respectively, p=.58). Table 1 summarises the possible indications for use of the CB, instead of a conventional balloon, before implanting a DES. 5 Small vessel size represents a critical risk factor for an adverse outcome after both conventional and stenting. A recent study in small coronary arteries evaluated the clinical and angiographic benefits of gradual and prolonged balloon angioplasty (GPBA) using a perfusion balloon, to cause less arterial trauma, CB Complications and Drawbacks A trend for higher complication rates have been reported with the use of CB, including vessel perforation when using oversized balloons or when the CB is used outside the stent, 2,21 dissection, 22,23
4 Cutting Balloon Versus Conventional Balloon Angioplasty for the Treatment of CAD spasm and entrapment. 24 The co-existence of many, rather than a single, anatomical and procedural characteristics may increase the risk of vascular complications following CB angioplasty. The lesion eccentricity is probably the most important factor, followed by vessel calcification and a large balloon artery ratio. The appearance, at angiography, of an overdilated vessel after CBA should raise suspicion of an excessively deep cut of the device. 23 Finally, the cost of the CB is higher (US$1, compared with US$25 for conventional balloon). Conclusions Based on the available data, the CB can be used: to treat in-stent restenosis, due to some procedural advantages over conventional the microblades (atherotomes) prevent balloon slippage (melon-seeding), reducing the injury zone and edge dissection; to treat small vessels, although a gradual and prolonged CBA using a perfusion balloon could be equally effective in reducing restenosis; based on anecdotal data, to reduce plaque shift in ostial/bifurcation lesions; based on anecdotal data, to treat resistant Table1: Reasons to Use the Cutting Balloon Before Implantation of a DES Type of lesion Reason to use cutting balloon In-stent restenosis (ISR) Conventional balloon slips causing injury distally. CB scores the intimal hyperplasia which favours plaque extrusion through original stent struts, maximising lumen area before DES placement. Small vessel CB compressed the plaque, creating a larger lumen area for stent placement. Bifurcation CB reduces plaque shift, while direct stenting and POBA cause it. In highly fibrotic lesions, CB severs the fibrotic strands. In focal lesions, the 6mm long CB controls the injury zone. Ostial CB reduce plaque shift, while direct stenting and (side branch and aorta) POBA cause it. In highly fibrotic lesions, CB severs the fibrotic strands. In focal lesions, the 6mm long CB controls the injury zone. Resistant POBA and stenting do not resolve the stenosis. (hard plaque and calcium) Easier to use than rotational atherectomy. lesions, although rotational atherectomy is preferred (CB is difficult to deliver in moderate to severe calcified lesions); and before stenting using a bare-metal stent (REDUCE III). New Vascular Horizons PEOPLE. IDEAS. PASSION. Stroke Management Emboli Management Peripheral Intervention PRIMUS Peripheral Embolisation THE ENDOVASCULAR COMPANY TM
5 References 1. Barath P, Fishbein M C, Vari S et al., : a novel approach to percutaneous angioplasty, Am. J. Cardiol. (1 November 1991);68(11): pp. 1,249 1, Mauri L, Bonan R, Weiner B H et al., angioplasty for the prevention of restenosis: results of the Cutting Balloon Global Randomized Trial, Am. J. Cardiol. (15 November 22);9(1): pp. 1,79 1, Mintz G S, Hoffmann R, Mehran R et al., In-stent restenosis: the Washington Hospital Center experience, Am. J. Cardiol. (9 April 1998);81(7A):7E 13E. 4. Baim D S, Levine M J, Leon M B et al., Management of restenosis within the Palmaz-Schatz coronary stent (the U.S. multicenter experience. The U.S. Palmaz-Schatz Stent Investigators, Am. J. Cardiol. (1 February 1993);71(4): pp Bauters C, Banos J L, Van Belle E et al., Six-month angiographic outcome after successful repeat percutaneous intervention for in-stent restenosis, Circulation (3 February 1998);97(4): pp Reimers B, Moussa I, Akiyama T et al., Long-term clinical follow-up after successful repeat percutaneous intervention for stent restenosis, J. Am. Coll. Cardiol. (July 1997);3(1): pp Bossi I, Klersy C, Black A J et al., In-stent restenosis: long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty, J. Am. Coll. Cardiol. (May 2);35(6): pp. 1,569 1, Mehran R, Dangas G, Abizaid A S et al., Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome, Circulation (2 November 1999);1(18): pp. 1,872 1, Kini A, Marmur J D, Dangas G et al., Angiographic patterns of in-stent restenosis and implications on subsequent revascularization, Catheter Cardiovasc. Interv. (Jan 2);49(1): pp Eltchaninoff H, Koning R, Tron C et al., Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate, J. Am. Coll. Cardiol. (October 1998);32(4): pp Muramatsu T, Tsukahara R, Ho M et al., Efficacy of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound evaluation, J. Invasive Cardiol. (June 21);13(6): pp Adamian M, Colombo A, Briguori C et al., angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty, J. Am. Coll. Cardiol. (September 21);38(3): pp Montorsi P, Galli S, Fabbiocchi F et al., Randomized trial of conventional balloon angioplasty versus cutting balloon for in-stent restenosis. Acute and 24-hour angiographic and intravascular ultrasound changes and long-term follow-up, Ital. Heart J. (April 24);5(4): pp Albiero R, Nishida T, Karvouni E et al., angioplasty for the treatment of in-stent restenosis, Catheter Cardiovasc. Interv. (August 2);5(4): pp Albiero R, Silber S, Di Mario C et al., versus conventional balloon angioplasty for the treatment of instent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT), J. Am. Coll. Cardiol. (17 March 24);43(6): pp Roguelov C, Eeckhout E, De Benedetti E et al., Clinical outcome following combination of cutting balloon angioplasty and coronary beta-radiation for in-stent restenosis: a report from the RENO registry, J. Invasive Cardiol. (December 23);15(12): pp Bair et al., J. Am. Coll. Cardiol. (23);41:5A 18. Umeda H, Iwase M, Kanda H et al., Promising efficacy of primary gradual and prolonged balloon angioplasty in small coronary arteries: a randomized comparison with cutting balloon angioplasty and conventional balloon angioplasty, Am. Heart J. (January 24);147(1):E Iijima R, Ikari Y, Wada M et al., angioplasty is superior to balloon angioplasty or stent implantation for small coronary artery disease, Coron. Artery Dis. (November 24);15(7): pp Ako J, Honda Y, Fitzgerald P J, Impending coronary perforation after cutting balloon angioplasty, Heart (January 25);91(1):e Quan V H, Stone J R, Couper G S et al., Coronary artery perforation by cutting balloon resulting in dissecting subepicardial hematoma and avulsion of the vasculature, Catheter Cardiovasc. Interv. (February 25);64(2): pp Haridas K K, Vijayakumar M, Viveka K et al., Fracture of cutting balloon microsurgical blade inside coronary artery during angioplasty of tough restenotic lesion: a case report, Catheter Cardiovasc. Interv. (February 23);58(2): pp Montorsi P, Galli S, Fabbiocchi F et al., Different types of coronary artery wall injury following cutting balloon angioplasty, Ital. Heart J. (November 22);3(11): pp Guven H, Thanigaraj S, Beardslee M, Noninvasive evaluation of a cutting balloon entrapped in a left main coronary artery using transesophageal echocardiography, Echocardiography (February 25);22(2): pp
Rotational Atherectomy for the Treatment of In-Stent Restenosis
Home SVCC Area: English - Español - Português Rotational Atherectomy for the Treatment of In-Stent Restenosis Steven L. Goldberg, MD Cardiac Catheterization Laboratory, University of Washington Medical
More informationClinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up
Hellenic J Cardiol 45: 379-383, 2004 Clinical Research Intracoronary Stenting with Crushing in Coronary Artery Bifurcation Lesions: Initial Results and Medium-Term Follow Up PETROS S. DARDAS, DIMITRIS
More informationEvolu'on of Balloon Angioplasty From POBA to newer technologies NCVH May 26, 2015
Evolu'on of Balloon Angioplasty From POBA to newer technologies NCVH May 26, 2015 Cezar Staniloae, MD Heart and Vascular Ins7tute New York University Medical Center Overview 1. Physics of balloon angioplasty
More informationORIGINAL ARTICLES: Morphology and Location of Restenosis Following Bare Metal Coronary Stenting
Page 1 / 7 ORIGINAL ARTICLES: Morphology and Location of Restenosis Following Bare Metal Coronary Stenting - Marc J. Schweiger, MD, Ehsan Ansari, MD, Gregory R. Giugliano, MD, *James Mathew, MD, Ashequl
More informationReview of Intracoronary Radiation for In-Stent Restenosis
Review of Intracoronary Radiation for In-Stent Restenosis Robert Lew, MBBS, FRACP, Andrew Ajani, MD, Ron Waksman, MD, FACC Vascular Brachytherapy using beta and gamma radiation is the standard care for
More informationEuropean Heart Journal (1999) 20, 1014 1019 Article No. euhj.1998.1395, available online at http://www.idealibrary.com on
European Heart Journal (1999) 20, 1014 1019 Article No. euhj.1998.1395, available online at http://www.idealibrary.com on Working Group Report Indications for intracoronary stent placement: the European
More informationOstial LAD: Single stent approach is the best. Antonio A. Pocoví, MD, FSCAI, MTSAC, Advisory Council Member, CACI
Ostial LAD: Single stent approach is the best Antonio A. Pocoví, MD, FSCAI, MTSAC, Advisory Council Member, CACI Chair, Interventional Cardiology Sanatorio San Lucas Instituto Alexander Fleming Buenos
More informationMEDICAL POLICY No. 91580-R1 DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE
DRUG-ELUTING STENTS FOR ISCHEMIC HEART DISEASE Effective Date: October 1, 2015 Review Dates: 10/11, 10/12, 10/13, 8/14, 8/15 Date Of Origin: October 12, 2011 Status: Current Summary of Changes Clarifications:
More informationGUIDELINES ON MEDICAL DEVICES EVALUATION OF CLINICAL DATA - A GUIDE FOR MANUFACTURERS AND NOTIFIED BODIES -
EUROPEAN COMMISSION ENTERPRISE AND INDUSTRY DIRECTORATE-GENERAL Consumer goods Cosmetics and Medical Devices MEDDEV 2.7.1 Appendix 1 December 2008 GUIDELINES ON MEDICAL DEVICES EVALUATION OF CLINICAL DATA
More informationCoronary Bifurcation Treatment: Update from the European Bifurcation Club. Remo Albiero, MD Ist. Clinico S. Rocco Brescia (Italy)
Coronary Bifurcation Treatment: Update from the European Bifurcation Club Remo Albiero, MD Ist. Clinico S. Rocco Brescia (Italy) Disclosure Statement of Financial Interest Within the past 12 months, I
More informationDrug-Eluting Balloons. Klaus Bonaventura Department of Cardiology and Angiology Heart Thorax Vascular Center, Klinikum Ernst von Bergmann, Potsdam
Drug-Eluting Balloons Klaus Bonaventura Department of Cardiology and Angiology Heart Thorax Vascular Center, Klinikum Ernst von Bergmann, Potsdam Potential conflicts of interest Speaker s name: Klaus Bonaventura
More informationThe Bioresorbable Vascular Stent Dr Albert Ko
The Bioresorbable Vascular Stent Dr Albert Ko Dr Albert Ko MB BS, FRACP, FCSANZ Interventional/General Cardiologist Ascot Cardiology Symposium 2013 Treatment Goals for Coronary Artery Disease Relieve of
More informationThe Pantera Lux Paclitaxel DEB Device Description and Clinical Studies. Christoph Hehrlein, University Clinic Freiburg i.br.
The Pantera Lux Paclitaxel DEB Device Description and Clinical Studies Christoph Hehrlein, University Clinic Freiburg i.br. Germany Disclosure Statement of Financial Interest Within the past 12 months,
More informationNOVOSTE BETA-CATH SYSTEM
HOSPITAL INPATIENT AND OUTPATIENT BILLING GUIDE FOR THE NOVOSTE BETA-CATH SYSTEM INTRAVASCULAR BRACHYTHERAPY DEVICE This guide is intended solely for use as a tool to help hospital billing staff resolve
More informationA Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III
A Post-market Study to Assess the STENTYS Self-exPanding COronary Stent In AcuTe myocardial InfarctiON in Real Life APPOSITION III Gilles Montalescot, MD, PhD Pitié-Salpêtrière Hospital, Paris, France
More informationMajestic Trial 12 Month Results
Majestic Trial 12 Month Results S.Müller-Hülsbeck, MD, EBIR, FCIRSE, FICA ACADEMIC HOSPITALS Flensburg of Kiel University Ev.-Luth. Diakonissenanstalt zu Flensburg Knuthstraße 1, 24939 FLENSBURG Dept.
More informationDuration of Dual Antiplatelet Therapy After Coronary Stenting
Duration of Dual Antiplatelet Therapy After Coronary Stenting C. DEAN KATSAMAKIS, DO, FACC, FSCAI INTERVENTIONAL CARDIOLOGIST ADVOCATE LUTHERAN GENERAL HOSPITAL INTRODUCTION Coronary artery stents are
More informationEditorial. Adult Cardiology - Meta-analysis
Editorial Adult Cardiology - Meta-analysis Simple Versus Complex Bifurcation Stenting Strategies A Meta Analysis of Randomized Controlled Trials in the Drug Eluting Stent Era Ana Beatriz R. Medrano, MD
More informationOCT ASSESSMENT OF CUTTING BALLOON ANGIOPLASTY FOR IN-STENT RESTENOSIS
OCT ASSESSMENT OF CUTTING BALLOON ANGIOPLASTY FOR IN-STENT RESTENOSIS Division of Cardiology, Mount Sinai Hospital, New York, NY, USA Yuliya Vengrenyuk, PhD; and Annapoorna Kini, MD OCT ASSESSMENT OF CUTTING
More informationStatus of Drug-Eluting Coronary Stents
Status of Drug-Eluting Coronary Stents EVOLUTION OF PERCUTANEOUS CORONARY INTERVENTIONAL TECHNOLOGIES The introduction of percutaneous transluminal coronary angioplasty (PTCA) in the late1970s provided
More informationCalifornia Health and Safety Code, Section 1256.01
California Health and Safety Code, Section 1256.01 1256.01. (a) The Elective Percutaneous Coronary Intervention (PCI) Pilot Program is hereby established in the department. The purpose of the pilot program
More informationIntracoronary Stenting and. Robert A. Byrne, Julinda Mehilli, Salvatore Cassese, Franz-Josef Neumann, Susanne Pinieck, Tomohisa Tada,
Prospective, Randomized Trial of Paclitaxel-Eluting Balloon versus Paclitaxel-Eluting Stent versus Balloon Angioplasty for Treatment of Coronary Restenosis in Limus- Eluting Stents Intracoronary Stenting
More informationImaging of Thoracic Endovascular Stent-Grafts
Imaging of Thoracic Endovascular Stent-Grafts Tariq Hameed, M.D. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana Disclosures: No relevant financial
More informationIs Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient?
Is Stenting or Coronary Artery By-pass Grafting the Better Treatment for This Patient? --- NIRS-IVUS TVC Imaging Adds Additional Information for the Heart Team Dr. Luis Tami Memorial Regional Hospital
More informationExperience of Direct Coronary Stenting at National Institute of Cardiovascular Diseases
Experience of Direct Coronary Stenting at National Institute of Cardiovascular Diseases T. Masood,T. Sagheer,D. Jan,N. Qamar,A.M.A. Faruqui ( National Institute of Cardiovascular Diseases (NICVD), Karachi.
More informationCilostazol versus Clopidogrel after Coronary Stenting
Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background
More informationAntiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty
Round Table: Antithrombotic therapy beyond ACS Antiplatelet and anticoagulation treatment of patients undergoing carotid and peripheral artery angioplasty M. Matsagkas, MD, PhD, EBSQ-Vasc Associate Professor
More informationSTONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY
STONY BROOK UNIVERSITY HOSPITAL VASCULAR CENTER CREDENTIALING POLICY Per Medical Board decision March 18, 2008: These credentialing standards do NOT apply to peripheral angiography performed in the context
More informationCopenhagen University Hospital Rigshospitalet Aarhus University Hospital Skejby Denmark
Long-term outcome after drug-eluting versus bare-metal stent implantation in patients with ST-elevation myocardial infarction 3 year follow-up of the randomised trial Peter Clemmensen, Henning Kelbæk,
More informationPRECOMBAT Trial. Seung-Whan Lee, MD, PhD On behalf of the PRECOMBAT Investigators
Premier of Randomized Comparison of Bypass Surgery versus Angioplasty Using Sirolimus-Eluting Stent in Patients with Left Main Coronary Artery Disease PRECOMBAT Trial Seung-Whan Lee, MD, PhD On behalf
More informationThe Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program
The Minvasys Amazonia Pax & Nile Pax Polymer Free Paclitaxel Eluting Stent Program Jean Fajadet, MD, FESC Clinique Pasteur - Toulouse - France Disclosure statement Nothing to disclose Dedicated Delivery
More informationSAMPLE. Asia-Pacific Interventional Cardiology Procedures Outlook to 2020. Reference Code: GDMECR0061PDB. Publication Date: May 2014
Asia-Pacific Interventional Cardiology Procedures Outlook to 2020 Reference Code: GDMECR0061PDB Publication Date: May 2014 Page 1 1 Table of Contents 1 Table of Contents... 2 1.1 List of Tables... 4 1.2
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationAND SYLLABUS FOR INTERVENTIONAL CARDIOLOGY SUBSPECIALITY TRAINING IN EUROPE
CURRICULUM AND SYLLABUS FOR INTERVENTIONAL CARDIOLOGY SUBSPECIALITY TRAINING IN EUROPE Document prepared by: Carlo Di Mario, FESC Germano Di Sciascio, FESC Jean-Luc Dubois-Rande,FESC Rolf Michels, FESC
More informationCORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ. Charles White MD
CORONARY ARTERY BYPASS GRAFTS, STENTS, AND EXTRACORONARY CARDIAC DZ Charles White MD Director of Thoracic Imaging Department of Radiology University of Maryland CORONARY ARTERY BYPASS GRAFTS First performed
More informationSeQuent Please balloon catheter for in-stent coronary restenosis. NICE medical technology guidance 1. Issue date: December 2010
Issue date: December 2010 SeQuent Please balloon catheter for in-stent coronary restenosis NICE medical technology guidance 1 1 NICE medical technology guidance 1 NICE medical technology guidance 1 SeQuent
More informationINTRODUCTION. Key Words:
Case Report Acta Cardiol Sin 2014;30:485 489 Successful Revascularization of Chronic Total Occlusion in Native Coronary Arteries through an Occluded Saphenous Bypass Vein Graft: A Retrograde Alternative
More informationLEADERS: 5-Year Follow-up
LEADERS: -Year Follow-up from a Prospective, Randomized Trial of Biolimus A9-eluting Stents with a Biodegradable Polymer vs. Sirolimus-eluting Stents with a Durable Polymer : Final Report of the LEADERS
More informationPATIENT INFORMATION BOOKLET
PATIENT INFORMATION BOOKLET Wingspan Stent System with Gateway PTA Balloon Catheter TABLE OF CONTENTS Definitions... 2 What is the Purpose of This Booklet?... 3 What is an Intracranial Lesion?... 3 Who
More informationEarly And Late Outcome For Single Versus Double Stenting For Bifurcational Coronary Artery Lesions
ORIGINAL CONTRBUTION / CLINICAL INVESTIGATION Early And Late Outcome For Single Versus Double Stenting For Bifurcational Coronary Artery Lesions Aram J. Mirza Correspondence: Dr. Aram J.Mirza Interventional
More informationINTERVENTION IN OSTIAL CORONARY LESIONS:
INTERVENTION IN OSTIAL CORONARY LESIONS: Antony (92), le 18 septembre 2013 JEAN MARC PERNES Hopital Privé Antony FRANCE Perfection of Precise Ostial Stent Placement Ostial lesions, including aorta ostial
More informationClinical Programs. Medtronic Coronary Stent Systems. driver BMS
Clinical Programs Medtronic Coronary Stent Systems Endeavor DES driver BMS July 2010 Contents Overview of Clinical Programs... 2 Drug-Eluting Stents ENDEAVOR I*... 4 ENDEAVOR II*... 6 ENDEAVOR II Continued
More informationAntonio Colombo MD on behalf of the SECURITY Investigators
Second Generation Drug-Eluting Stents Implantation Followed by Six Versus Twelve-Month - Dual Antiplatelet Therapy - The SECURITY Randomized Clinical Trial Antonio Colombo MD on behalf of the SECURITY
More informationFundación Favaloro. Fundación Favaloro
Superficial Femoral Artery: Which h Factors Influence Patency? Oscar A. Mendiz.MD.FACC.FSCAI Chairman hi of Interventional Cardiology dil March 2010 Name: Oscar A. Mendiz Disclosure I have the following
More informationPerioperative Cardiac Evaluation
Perioperative Cardiac Evaluation Caroline McKillop Advisor: Dr. Tam Psenka 10-3-2007 Importance of Cardiac Guidelines -Used multiple times every day -Patient Safety -Part of Surgical Care Improvement Project
More informationCoronary Stents. What is a Coronary Artery stent?
What is a Coronary Artery stent? Coronary Stents A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the
More informationAngioplasty and Stent Education Guide
Angioplasty and Stent Education Guide Table of Contents Treating coronary artery disease...2 What is coronary artery disease...3 Coronary artery disease treatment options...4 What are coronary artery
More informationPolymer-Based, Paclitaxel-Eluting TAXUS Liberté Stent in De Novo Lesions: The Pivotal TAXUS ATLAS Trial
Polymer-Based, Paclitaxel-Eluting Stent in De Novo Lesions: The Pivotal TAXUS ATLAS Trial Mark A. Turco, John A. Ormiston, Jeffrey J. Popma, Lazar Mandinov, Charles D. O'Shaughnessy, Tift Mann, Thomas
More informationRepeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation
Original Contribution Repeat Coronary Revascularization Procedures after Successful Bare-Metal or Drug-Eluting Stent Implantation Cynthia A. Yock, MS, J. Michael Isbill, MS, Spencer B. King III, MD, Mark
More informationCOMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) DRAFT
European Medicines Agency London, 22 March 2007 Doc. Ref. EMEA/CHMP/EWP/110540/2007 COMMITTEE FOR MEDICINAL PRODUCTS FOR HUMAN USE (CHMP) DRAFT GUIDELINE ON THE DEVELOPMENT OF MEDICINAL SUBSTANCES CONTAINED
More informationESC PCI Guidelines: / Sigmund Silber et al. 1
For the first time! ESC PCI Guidelines: / Sigmund Silber et al. 1 in 2002: 649.332 in 2002: 541.964 ESC PCI Guidelines: Introduction and Definitions / Sigmund Silber et al. 2 ESC PCI Guidelines: Introduction
More informationTAXUS Express 2. Paclitaxel-Eluting Coronary Stent System. Patient Information Guide
TAXUS Express 2 Paclitaxel-Eluting Coronary Stent System Patient Information Guide 1 Table of Contents Coronary Artery Disease...2 Who Is at Risk?...3 Diagnosis of Coronary Artery Disease...3 Treatment
More informationUNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K x ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the year ended December 31,
More informationEuropean Cardiology. Volume 6 Issue 4 Extract. Svelte Acrobat Stent-On- A-Wire Coronary Stent System. J Ribamar Costa Jr and Alexandre Abizaid
European Cardiology Volume 6 Issue 4 Extract Svelte Acrobat Stent-On- A-Wire Coronary Stent System J Ribamar Costa Jr and Alexandre Abizaid Instituto Dante Pazzanese de Cardiologia, São Paulo www.touchcardiology.com
More informationMedical publications - Open Vs Closed Cell Stents
Designing the Ideal Stent Stent cell geometry and its clinical significance in carotid stenting. BY MARK H. WHOLEY, MD, AND ENDER A. FINOL, PHD Balloon-expandable closed-cell stents were introduced for
More informationέΰζβν αππ έκυ,νσϊίία κν1γν πλδζέκυνβί1γ π ηία δεόμνκαλ δκζόΰκμ, θν δ υγυθ άμνγνκαλ /εάμ ΚζδθδεάμΝ υλωεζδθδεάμν
ΝΠθ ζζάθδκνσθϋ λδκν έΰκ μνεδν ιωθκ κεκη δεάμνι λδεάμ έΰζβν έκ,νσϊίί κν1γν λδζέκνβί1γ Α Α φ ; έζ δκμννένσθόμ ηί δεόμνκλ δκζόΰκμ, θν δ γθ άμνγνκλ /εάμ ΚζδθδεάμΝ λωεζδθδεάμν ένivus Scientific Director, Mediolanum
More informationPopliteal artery: to stent or not to stent?
Popliteal artery: to stent or not to stent? Karl-Ludwig Schulte Vascular Center Berlin Ev. Hospital Königin Elisabeth St. Gertrauden Hospital University Hospital Charité, CC11 Humboldt-University Berlin
More informationRenovascular Hypertension
Renovascular Hypertension Philip Stockwell, MD Assistant Professor of Medicine (Clinical) Warren Alpert School of Medicine Cardiology for the Primary Care Provider September 28, 201 Renovascular Hypertension
More informationUniversity of Ulsan College of Medicine, Asan Medical Center on behalf of the REAL-LATE and the ZEST-LATE trial
Duration of Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park MD PhD Seung-Jung Park, MD, PhD, University of Ulsan
More informationRounds CARDIOLOGYTM. Percutaneous coronary intervention in the management of coronary artery disease. www.cardiologyrounds.ca.
Now Now available available on on the the Internet Internet www.cardiologyrounds.ca A U G U S T / S E P T E M B E R 2 0 0 1 volume VI, issue 7 CARDIOLOGYTM Rounds AS PRESENTED IN THE ROUNDS OF THE DIVISION
More informationClinical Results of Unprotected Left Main Coronary Stenting
Original Articles IMAJ VOL 11 MARCH 2009 Clinical Results of Unprotected Left Main Coronary Stenting Itsik Ben-Dor MD, Hana Vaknin-Assa MD, Eli Lev MD, David Brosh MD, Shmuel Fuchs MD, Abid Assali MD and
More informationPayment policies are potentially a strong driver of diffusion of
Medical Devices Diffusion Of New Technology And Payment Policies: Coronary Stents The implementation of a higher payment rate for stenting did not drive the acceleration of the technology s diffusion,
More informationCoronary in-stent restenosis predictors, treatment and prevention
European Heart Journal (2000) 21, 1739 1749 doi:10.1053/euhj.2000.2153, available online at http://www.idealibrary.com on Review Coronary in-stent restenosis predictors, treatment and prevention R. Hoffmann
More informationUniversity of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital
PROGRAM DIRECTOR: Dr. Steven Laster University of Missouri Kansas City School of Medicine and the Mid America Heart Institute of Saint Luke s Hospital 1 Interventional Cardiology Fellowship Training Program
More informationTAXUS Express2 Paclitaxel-Eluting Coronary Stent System TAXUS Liberté Paclitaxel-Eluting Coronary Stent System. A Patient s Guide
TAXUS Express2 Paclitaxel-Eluting Coronary Stent System TAXUS Liberté Paclitaxel-Eluting Coronary Stent System A Patient s Guide Table of Contents Coronary Artery Disease... 2 Who Is at Risk?... 3 Diagnosis
More informationSUTTER MEDICAL CENTER, SACRAMENTO Department of Cardiovascular Disease Cardiology - Delineation of Privileges
INITIAL: [ ] RENEWED: [ ] DATE: ADDITIONAL: [ ] Privileges are granted for Sutter General Hospital, Sutter Memorial Hospital, Sutter Center for Psychiatry, Sutter Oaks Midtown and the Capitol Pavilion
More informationCARDIAC RISKS OF NON CARDIAC SURGERY
CARDIAC RISKS OF NON CARDIAC SURGERY N E W S T U D I E S & N E W G U I D E L I N E S W. B. C A L H O U N, M D, F A C C 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management
More informationR EFERENCES. Summary and conclusions
R EFERENCES Summary and conclusions 129 S UMMARY AND CONCLUSIONS SUMMARY AND GENERAL DISCUSSION 130 Constant vasodilatation, inhibition of platelet and monocyte adhesion, and local thrombolysis are the
More informationIntracoronary stenting is an established treatment
Indian Heart J 2001; 53: 275 281 Bahl et al. Elective Stenting in Small Coronary Arteries 275 Elective Stenting in Small Coronary Arteries: Lessons Learnt from Recent Trials Editorial VK Bahl, R Narang
More informationClinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013. Reference: NHSCB/A09/PS/b
Clinical Commissioning Policy Statement: Percutaneous mitral valve leaflet repair for mitral regurgitation April 2013 Reference: NHS Commissioning Board Clinical Commissioning Policy Statement: Percutaneous
More informationValidation of a Risk Score for Target Vessel Revascularization after Coronary Stent Implantation
Original Contribution Validation of a Risk Score for Target Vessel Revascularization after Coronary Stent Implantation a Alexandre S. Quadros, MD, PhD, b Fabiane Diemer, RN, b Dulce Welter, RN, Thais Modkowski,
More informationGRAFTMASTER RX Coronary Stent Graft System PPL2082232 (2/1/13)
GRAFTMASTER RX Coronary Stent Graft System PPL2082232 (2/1/13) Graphical Symbols for Medical Device Labeling Manufacturer Sterilized using ethylene oxide Catalogue number Batch code French size Outer diameter
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationCoronary Stents. Artery Disease Review of Firs00t 1. Coronary Stents in the Management of
Coronary Stents in the Management of Coronary Stents Artery Disease Review of Firs00t 1 S C Ng, FSCAP', Chen Sawatt, SRN, L K Foo, SRN, 0 Hitam, ASMLT, P G Khor, ASMLT, Y K Lee, ASMLT, *Ccmsuli:ant Interventional
More informationOPINION OPtical frequency domain imaging vs. INtravascular ultrasound in percutaneous coronary InterventiON
OPINION OPtical frequency domain imaging vs. INtravascular ultrasound in percutaneous coronary InterventiON - Baseline preliminary results - Takashi Akasaka, MD, PhD, FESC Wakayama Medical University,
More information6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology
Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die
More information2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions
2014 Procedural Reimbursement Guide Select Percutaneous Coronary Interventions IC-221010-AA Jan 2014 Page 1 of 10 Interventional Cardiology This for interventional cardiology procedures provides coding
More informationMeasure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care
Measure #257 (NQF 1519): Statin Therapy at Discharge after Lower Extremity Bypass (LEB) National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
More informationChristopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona
Christopher M. Wright, MD, MBA Pioneer Cardiovascular Consultants Tempe, Arizona Areas to be covered Historical, current, and future treatments for various cardiovascular disease: Atherosclerosis (Coronary
More information2015 European Coronary Stent New Product Innovation Award
2015 European Coronary Stent New Product Innovation Award 2015 Contents Background and Company Performance... 3 Industry Challenges... 3 New Product Attributes and Customer Impact... 3 Conclusion... 4
More informationCarotid Artery Stenting? Comparison of the outcome of octogenarian patients according to the stent type. Data from a multicentre registry
Closed- or Open-cell stents in Carotid Artery Stenting? Comparison of the outcome of octogenarian patients according to the stent type. Data from a multicentre registry Nikas D 1, Reimers B 2, Iakovou
More informationUnderstanding Coronary Artery Disease, Cardiac Catheterization, and Treatment Options. A Guide for Patients
Understanding Coronary Artery Disease, Cardiac Catheterization, and Treatment Options A Guide for Patients Coronary Artery Disease If you or a member of your family has been diagnosed with coronary artery
More informationIschemia and Infarction
Harvard-MIT Division of Health Sciences and Technology HST.035: Principle and Practice of Human Pathology Dr. Badizadegan Ischemia and Infarction HST.035 Spring 2003 In the US: ~50% of deaths are due to
More informationOCT STEMI: OCT guidance during stent implantation
OCT STEMI: OCT guidance during stent implantation in primary PCI. A Randomized Multicenter study with 9-month optical coherence tomography follow-up Červinka P 1,2, Kala P 3, Jakl M 2,4, Kaňovský J 3,
More informationReview Article CORONARY STENTS - PAST, PRESENT AND FUTURE.
Review Article CORONARY STENTS - PAST, PRESENT AND FUTURE. VV JAIN*, S YELWATKAR**, OP GUPTA*** Introduction The advent of period of angioplasty has revolutionized the practice of interventional cardiology.
More informationFirst Experience With Drug-Eluting Balloons in Infrapopliteal Arteries
Journal of the American College of Cardiology Vol. 58, No. 11, 2011 2011 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.05.034
More informationWingspan Stent System with Gateway PTA Balloon Catheter
Wingspan System with Gateway PTA Balloon Catheter Directions for Use AUS Australian Sponsor Address Boston Scientific (Australia) Pty Ltd PO Box 332 BOTANY NSW 1455 Australia Free Phone 1800 676 133 Free
More informationUltrasound in Vascular Surgery. Torbjørn Dahl
Ultrasound in Vascular Surgery Torbjørn Dahl 1 The field of vascular surgery Veins dilatation and obstruction (varicose veins and valve dysfunction) Arteries dilatation and narrowing (aneurysms and atherosclerosis)
More informationIntravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting: Future Research Needs
Future Research Needs Paper Number 25 Intravascular Diagnostic Procedures and Imaging Techniques Versus Angiography Alone in Coronary Stenting: Future Research Needs Future Research Needs Paper Number
More informationThe largest clinical study of Bayer's Xarelto (rivaroxaban) Wednesday, 14 November 2012 07:38
Bayer HealthCare has announced the initiation of the COMPASS study, the largest clinical study of its oral anticoagulant Xarelto (rivaroxaban) to date, investigating the prevention of major adverse cardiac
More informationCardiovascular disease has become a dominant cause of
Abstract Immediate and Six-month Clinical Outcome of Percutaneous Coronary Intervention in a Tertiary Hospital in the Sultanate of Oman Panduranga Prashanth, Mohamed Mukhaini, Abdulla A. Riyami, Kadhim
More informationFFR CT : Clinical studies
FFR CT : Clinical studies Bjarne Nørgaard Department Cardiology B Aarhus University Hospital Skejby, Denmark Disclosures: Research grants: Edwards and Siemens Coronary CTA: High diagnostic sensitivity
More informationEverolimus Eluting Coronary Stent System. Patient Information Guide
Everolimus Eluting Coronary Stent System Patient Information Guide Table of Contents Coronary Artery Disease (CAD)...5 Your Heart...5 What is CAD?...5 What are the Symptoms of CAD?...5 What are the Risk
More informationHigh incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: Angioscopic comparison with sirolimus-eluting stent
High incidence of thrombus formation at 18 months after paclitaxel-eluting stent implantation: Angioscopic comparison with sirolimus-eluting stent Masahiko Hara, MD, Masami Nishino, MD, Masayuki Taniike,
More informationREPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES
REPORTING STENT PLACEMENT FOR NONOCCLUSIVE VASCULAR DISEASE IN LOWER EXTREMITIES Effective January 1, 2015, there was a change in CPT that affects reporting specific endovascular services provided in the
More informationDrug-Eluding Stents as an Alternative to Traditional Stenting in the Treatment of Coronary Artery Disease
TITLE: Drug-Eluding Stents as an Alternative to Traditional Stenting in the Treatment of Coronary Artery Disease AUTHOR: Mitchell D. Feldman, MD, M.Phil. Professor of Medicine Division of General Internal
More informationCardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg
Cardiac Assessment for Renal Transplantation: Pre-Operative Clearance is Only the Tip of the Iceberg 2 nd Annual Duke Renal Transplant Symposium March 1, 2014 Durham, NC Joseph G. Rogers, M.D. Associate
More informationINVESTIGATION OF METALLIC SURFACE AREA OF CORONARY STENTS
INVESTIGATION OF METALLIC SURFACE AREA OF CORONARY STENTS Dóra Károly 1, Miksa Kovács 1, Andrew Attila Terdik 1, Eszter Bognár 1,2 1Department of Materials Science and Engineering, Faculty of Mechanical
More informationST. DAVID S MEDICAL CENTER CARDIOLOGY - Special, Invasive, Diagnostic, or High-Risk Procedure Requirements
ST. DAVID S MEDICAL CENTER CARDIOLOGY - Special, Invasive, Diagnostic, or High-Risk Procedure Requirements Cardiac Catheterization & Peripheral Angiography Completion of a fellowship in Cardiovascular
More information