Carotid Disease and CABG: What is the best Treatment
|
|
- Godwin Oliver
- 5 years ago
- Views:
Transcription
1 Carotid Disease and CABG: What is the best Treatment Dual Antiplatelets Luis A Guzman, MD, FACC, FSCAI Professor of Medicine Director, Cardiovascular Cath Lab Virginia Commonwealth University
2 Stroke during CABG. Main Causes Incidence 2% Low cardiac output Arrhythmias Oxygenation system Perfusion system Aortic arch Atherosclerosis Carotid stenosis
3 Stroke during CABG. Main Causes Incidence 2% Low cardiac output Arrhythmias Oxygenation system Perfusion system Aortic arch Atherosclerosis Carotid stenosis
4 Stroke Rate in Carotid Stenosis and CABG Carotid (-) Carotid (+) Carotid (-) Carotid >5 Bilateral Occlusion Stroke Stroke Brener et al. J Th Surg 1984 Naylor et al. Eur J Vasc Endovasc Surg. 23;26:23-41
5 Carotid Revascularization prior to CABG The guidelines by the AHA/ACC states that carotid endartherectomy is probably recommended before CABG or concomitant to CABG in patients with a symptomatic carotid stenosis or in asymptomatic patients with a unilateral or bilateral internal carotid stenosis of 8% or more (Indication IIa; Level of Evidence: C) AHA/ACC Guidelines. Circulation 26;113:1474
6 Carotid Revascularization prior to CABG Rational Strokes are associated with carotid stenosis CEA or CAS are indicated to decrease the incidence of stroke that would otherwise happen if carotid revascularization was not performed Where is the evidence?
7 Carotid Revascularization prior to CABG Rational Not a single randomized study exist today evaluating the hypothesis of stroke prevention for carotid revascularization prior to or during CABG In the USA there are +25, combined procedures/year
8 Carotid Revascularization prior to CABG Concerns and Flawed Many reports do not discriminate between symptomatic and asymptomatic Many report do not differentiate between unilateral, bilateral or occlusions Overestimation of event. Publication bias
9 Carotid Revascularization prior to CABG Concerns Among patients with stroke post CABG 5% had no Carotid disease 6% had disease in the opposite carotid Most strokes are in those with prior stroke but no carotid stenosis Overall, only 2% of the strokes were related to the ipsilateral carotid stenosis DeAgostino RS et al. Ann Thor Surgery 1996;82:1714
10 Carotid Revascularization prior to CABG Symptomatic Carotid Stenosis This is a different patient The associated CAD will change the risk profile but carotid revascularization should be performed first In very unusual situation with associated Unstable CAD, combined surgery could be considered
11 CEA and CABG Metaanalysis of 97 publications Combined Staged ,972 Asymptomatic Patients Stroke Death/Stroke Naylor et al. Eur J Vasc Endovasc Surg. 23;25:38-9
12 CEA and CABG Metaanalysis of 97 publications <1% of pts Combined Staged Carotid (-) Carotid >5 Bilateral Occlusion Stroke Death/Stroke Stroke Naylor et al. Eur J Vasc Endovasc Surg. 23;25:38-9
13 Stroke rate after CABG in Asymptomatic Severe Carotid Stenosis A Metaanalysis 2,531 pts All Symptomatic/Asymptomatic Patients Asymptomatic Patients 1 9, ,4 7, ,5 5, , > 5% > 7% > 8% > 5% > 7% Bilateral CEA/CABG Naylor AR et al. Eur J Vasc Endovasc 211,41:67-24
14 Stroke rate after CABG in Asymptomatic Bilateral Severe Carotid Stenosis with Combined Unilateral CEA: A Metaanalysis 22 pts 8 7 Contralateral Stroke 6, ,8 3,8 5,2 Bilat 5-99 Occlusion + >5% No CEA Bilat No CEA Occlusion Naylor AR et al. Eur J Vasc Endovasc 211,41:67-24
15 Carotid Stenting prior to CABG Possible Advantages of Stent over CEA No general anesthesia Less Invasive Antiplatelets therapy can be maintained Stroke rate? Mortality?
16
17 Carotid Stenting prior to CABG Systematic Analysis of 277 pts Major Events after Stent at Discharge Deaths 2 Fatal strokes 2 Cardiac deaths < Stroke > Stroke Death Death/Str
18 Carotid Stenting prior to CABG Systematic Analysis of 277 pts Major Events after Stent waiting for CABG < Stroke > Stroke Death Death/Str All 6 patients died due to a cardiac causes
19 Carotid Stenting prior to CABG Systematic Analysis of 277 pts 1 8 Major Events 3 days after CABG Stroke Death Death/Str
20 15 Carotid Stenting prior 21 Deaths to CABG 4 Fatal strokes 17 Cardiac deaths 2 post stent Systematic Analysis of 277 pts Overall Major Events 3 days after CABG 6 waiting for CABG 9 post CABG < Stroke > Stroke Death Death/>Str Death/Str
21 Simultaneous versus Delay CEA + CABG Randomized Study of Asymptomatic Patients with Unilateral Severe Carotid Stenosis: 9 Days Outcomes Simultaneous (n:94) Delay (n:91) 1 1,1 All Strokes occurred after CABG, before CEA Patients was aortic disease were excluded Overall Stroke: 4.5% D/Stroke: 4.9% Death Stroke D/Stroke 7 1 8,8 Illuminati G et al. J Vasc Surgery 211,54:993-9
22 Endovascular, Surgical or Hybrid for Patients with Combined Carotid and CAD The FRIENDS trail (n:659) 1 8 Predictors of Primary end point Endovascular: OR=.369; 95%CI= , p=.1 Hybrid: OR=3.98; 95%CI= , p=.7 8, ,25 4,8 2,4 All Surgery Endovascular Hybrid Ribichini F et al. Eurointervention 21,3:328-35
23 Endovascular, Surgical Combined or Surgical Staged for Patients with Associated Carotid and CAD. The CCF Registry (n:35) 3 Days Results P=.1 P=.1 Stent (n:11) 24 Most MI occurred while waiting for CABG in Staged group CAS delay to CABG mean 47 days CEA delay to CABG, mean 14 days P= Combined (n:195) Staged (n:45) 6 D/MI/Stroke Death Stroke MI 7 2 P= Shishehbor et al. JACC 213;62:
24 Endovascular, Surgical Combined or Surgical Staged for Patients with Associated Carotid and CAD. The CCF Registry (n:35) 1 Year Results P=.1 Combined (n:195) Staged (n:45) Stent (n:11) P= P= P=.6 8,7 6,7 D/MI/Stroke Death Stroke MI 1,8 1 3,6 Shishehbor et al. JACC 213;62:
25 Combined Carotid Endartherectomy and Off Pump CABG?
26 Carotid Revascularization prior to CABG High Risk Patients: Screening LMT Associated PAD Smoker 65 years Prior CVA/TIA Bilateral disease Chronic occlusion AHA/ACC Guidelines. Circulation 26;113:1474
27 Do We Need Carotid Screening in Asymptomatic Patients? Lin J et. J Vasc Surgery 216: 63:71-14
28 Outcomes post CABG According to Carotid Screening Carotid Screening (n:36) No Screening (n:1417) P=.27 4,3 P=.7 2,9 2,9 2,6 2 Death Stroke
29 Randomized Studies of CEA vs Medical management in CABG Patients with Asymptomatic stenosis. Does not include Stent arm. CABACS Trial Asymptomatic High Grade Carotid Stenosis CABG CABG + CEA N CABG + Stent Arm Int J Stroke, 7 (212), pp
30 Combined CAD and Carotid Stenosis Symptomatic Carotid Asymptomatic Carotid Asymptomatic CAD Symptomatic CAD Prior Stroke Severe Bilateral Dz Contralateral Occlusion Unilateral Stenosis No prior Strokes Carotid Revascularization CEA vs CAS CAD Treatment Combined Carotid (1 st ) and CABG CAS vs CEA According to anatomy No data (?) Higher risk group CABG alone probably as good as Combined CABG + Medical Management Unless prior stroke Carotid Screening is not required
31 Combined CAD and Carotid Stenosis Symptomatic Carotid Asymptomatic Carotid Asymptomatic CAD Symptomatic CAD Prior Stroke Severe Bilateral Dz Contralateral Occlusion Unilateral Stenosis No prior Strokes Carotid Revascularization CEA vs CAS CAD Treatment Combined Carotid (1 st ) and CABG CAS vs CEA According to anatomy No data (?) Higher risk group CABG alone probably as good as Combined Role of Carotid Stent? Role of Coronary stent? CABG + Medical Management Unless prior stroke Carotid Screening is not required
CardioLucca2014. Fare luce sulla scelta ottimale del trattamento nella rivascolarizzazione delle stenosi carotidee. Fabrizio Tomai
CardioLucca2014 Fare luce sulla scelta ottimale del trattamento nella rivascolarizzazione delle stenosi carotidee Fabrizio Tomai European Hospital e Aurelia Hospital Roma Treatment of Carotid Artery Disease
More informationESC Congress 2011 SIMULTANEOUS HYBRID REVASCULARIZATION OF CAROTID AND CORONARY DISEASE INITIAL RESULTS OF A NEW THERAPEUTIC APPROACH
ESC Congress 2011 SIMULTANEOUS HYBRID REVASCULARIZATION OF CAROTID AND CORONARY DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROME: INITIAL RESULTS OF A NEW THERAPEUTIC APPROACH AUTHORS: Marta Ponte 1, RICARDO
More informationPrevention and Management of Cardiac Adverse Event
Prevention and Management of Cardiac Adverse Event Carlo Cernetti Department of Interventional Cardiology Mirano (Italy) Cannes MEEC 14 June 2007 Are these risks factors of Haemodynamic Instability
More informationManagement of combined coronary & carotid disease
Management of combined coronary & carotid disease Combined Carotid and coronary artery diseases Frequent combination Fear of imminent death psychologically traumatic for the patients and their families
More informationNew Trials in Progress: ACT 1. Jon Matsumura, MD Cannes, France June 28, 2008
New Trials in Progress: ACT 1 Jon Matsumura, MD Cannes, France June 28, 2008 Faculty Disclosure I disclose the following financial relationships: Consultant, CAS training director, and/or research grants
More informationCAROTID STENTING A 2009 UPDATE. Hoang Duong, MD Director of Interventional Neuroradiology Memorial Regional Hospital
CAROTID STENTING A 2009 UPDATE Hoang Duong, MD Director of Interventional Neuroradiology Memorial Regional Hospital TREATMENT FOR CAROTID STENOSIS Best medical management Antiplatelet therapy Antihypertensive
More informationOpen heart surgery or carotid endarterectomy. Which procedure should be done first?
Open heart surgery or carotid endarterectomy. Which procedure should be done first? Pedro Pinto Sousa 1, Gabriela Teixeira 2, João Gonçalves 2 ; Luís Vouga 1, Rui Almeida 2 ; Pedro Sá Pinto 2 1 Centro
More informationFast-track CEA: a 3-year experience
Fast-track CEA: a 3-year experience Giorgio L. Poletto, MD Milano, Italy 6th ACST-2 Collaborators Meeting, Palau de Congresos, Valencia. 24th and 25th September 2018. Stroke prevention Primary prevention:
More informationNon-Selective Carotid Artery Ultrasound Screening in Patients Undergoing Coronary Artery Bypass Grafting: Is It Necessary?
Non-Selective Carotid Artery Ultrasound Screening in Patients Undergoing Coronary Artery Bypass Grafting: Is It Necessary? Khalil Masabni, Joseph F. Sabik III, Sajjad Raza, Theresa Carnes, Hemantha Koduri,
More informationTAVR y Enfermedad Coronaria. Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine
TAVR y Enfermedad Coronaria Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor of Medicine CAD and AS Similar Pathological Processes CAD in TAVR Patients (n=390)
More informationCarotid Artery Stent: Is it ready for prime time?
2010 CATH LAB SYMPOSIUM Carotid Artery Stent: Is it ready for prime time? Luis F. Tami, MD, FACC, FSCAI Interventional Cardiology and Vascular Medicine Memorial Regional Hospital August 2010 CAE and CAS
More informationPeter A. Soukas, M.D., FACC, FSVM, FSCAI, RPVI
Peter A. Soukas, M.D., FACC, FSVM, FSCAI, RPVI Director, Peripheral Vascular Interventional Laboratory Director, Vascular & Endovascular Medicine Fellowship Program Assistant Professor of Medicine The
More informationCardiac evaluation for the noncardiac. Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology
Cardiac evaluation for the noncardiac patient Nathaen Weitzel MD University of Colorado Denver Dept of Anesthesiology Objectives! Review ACC / AHA guidelines as updated for 2009! Discuss new recommendations
More informationSurgery for patients with diffuse atherosclerotic disease
Surgery for patients with diffuse atherosclerotic disease Special hospital for surgery Skopje Macedonia September, 2012 Mitrev Z, Anguseva T, E.Stoicovski, Hristov N, E.Idoski Oktomvri, 2008 Atherosclerosis
More informationI have the following potential conflicts of interest to report. honorarium: 1. St Jude Medical 2. Biotronik 3. Boston Scientific
Stenting carotideo nel paziente sintomatico alla luce dei nuovi trials Savona, 11 Aprile 2015 Gioel GabrioSecco, MD, PhD Emodinamica e CardiologiaInterventistica Ospedale SantiAntonio e Biagio e Cesare
More informationA new era in the treatment of peripheral artery disease (PAD)?
A new era in the treatment of peripheral artery disease (PAD)? Prof. Dr. Jan Beyer-Westendorf Head of Thrombosis Research, University Hospital Carl Gustav Carus, TU Dresden; Germany Senior Lecturer Thrombosis
More informationDCB use in fem-pop lesions of patients with CLI (RCC 4-5): subgroup analysis of IN.PACT Global 12-month outcomes
DCB use in fem-pop lesions of patients with CLI (RCC 4-5): subgroup analysis of IN.PACT Global 12-month outcomes Carlos Mena, MD FACC FSCAI Associate Professor of Medicine - Cardiology Director Cardiac
More informationPerioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease
2012 대한춘계심장학회 Perioperative Cardiology Consultations for Noncardiac Surgery Ischemic Heart Disease 울산의대울산대학병원심장내과이상곤 ECG CLASS IIb 1. Preoperative resting 12-lead ECG may be reasonable in patients with
More information03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE
CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no
More informationThe Great Swedish Debate. Håkan Pärsson Department Vascular Surgery Helsingborgs Lasarett, University Lund
The Great Swedish Debate Håkan Pärsson Department Vascular Surgery Helsingborgs Lasarett, University Lund My Disclosures Trying to bribe the moderators What do my patients expect? Balanced information
More informationSurgery Grand Rounds
Surgery Grand Rounds Coronary Artery Bypass Grafting versus Coronary Artery Stenting Charles Ted Lord, R1 Coronary Artery Disease Stenosis of epicardial vessels Metabolic & hematologic Statistics 500,000
More informationCarotid Endarterectomy vs. Carotid artery Stenting (Surgeon Perspective)
Carotid Endarterectomy vs. Carotid artery Stenting (Surgeon Perspective) T-Woei Tan, MD, FACS, RPVI Assistant Professor of Surgery Vascular and Endovascular Surgery Louisiana State University Health -
More informationCarotid Artery Disease How the Data Will Influence Management The Symptomatic vs. the Asymptomatic Patient
Carotid Artery Disease How the 2014-2015 Data Will Influence Management The Symptomatic vs. the Asymptomatic Patient Christopher J. White, MD, MSCAI, FACC, FAHA, FESC Professor and Chair of Medicine Ochsner
More informationMy Latest Take on RCT Data: When is CEA or CAS the Best Option? The Interventional Position
LINC 2016 Leipzig, Jan 26-29, 2016 My Latest Take on RCT Data: When is CEA or CAS the Best Option? The Interventional Position Horst Sievert, Iris Grunwald CardioVasculäres Centrum Frankfurt - CVC, Frankfurt
More informationDESCRIPTION: Percent of asymptomatic patients undergoing CEA who are discharged to home no later than post-operative day #2
Measure #260: Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without Major Complications (Discharged to Home by Post-Operative Day #2) National Quality Strategy Domain: Patient Safety
More informationMEET Θ symptomatic patients. K. Mathias Department of Radiology Teaching Hospital of Dortmund - Germany
MEET Θ 2006 Why I stent asymptomatic and symptomatic patients K. Mathias Department of Radiology Teaching Hospital of Dortmund - Germany Evidence for treating symptomatic patients symptomatic patients
More information2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY
Measure #260: Rate of Carotid Endarterectomy (CEA) for Asymptomatic Patients, without Major Complications (Discharged to Home by Post-Operative Day #2) National Quality Strategy Domain: Patient Safety
More informationControversies in Cardiac Pharmacology
Controversies in Cardiac Pharmacology Thomas D. Conley, MD FACC FSCAI Disclosures I have no relevant relationships with commercial interests to disclose. 1 Doc, do I really need to take all these medicines?
More informationHidden coronary disease in carotid patients
6 th ACST-2 Collaborators Meeting in Valencia, Spain 24th and 25th September 2018 Hidden coronary disease in carotid patients Valerio Tolva Policlinico di Monza Italy Are we always aware of coronary anatomy?
More informationCardiac Perioperative Risk Assessment American Heart Association Guidelines
Cardiac Perioperative Risk Assessment American Heart Association Guidelines Dr Gary Liew, MBBS, PhD, FRACP US Board Certified in Cardiovascular CT Executive Committee, Cardiac Institute, Epworth Healthcare
More informationCarotid Artery Stenting
Carotid Artery Stenting Woong Chol Kang M.D. Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea Carotid Stenosis and Stroke ~25% of stroke is due to carotid disease, the reminder
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome
Quality ID #345 (NQF 1543): Rate of Asymptomatic Patients Undergoing Carotid Artery Stenting (CAS) Who Are Stroke Free or Discharged Alive National Quality Strategy Domain: Effective Clinical Care 2018
More informationStroke prevention in asymptomatic carotid stenosis. ΛΙΛΛΗΣ ΛΕΩΝΙΔΑΣ Καρδιολόγος Επιστημονικός Συνεργάτης Α Καρδιολογικής Κλινικής ΑΠΘ ΠΓΝΘ ΑΧΕΠΑ
Stroke prevention in asymptomatic carotid stenosis ΛΙΛΛΗΣ ΛΕΩΝΙΔΑΣ Καρδιολόγος Επιστημονικός Συνεργάτης Α Καρδιολογικής Κλινικής ΑΠΘ ΠΓΝΘ ΑΧΕΠΑ Σεμινάρια Ομάδων Εργασίας Ελληνικής Καρδιολογικής Εταιρείας
More informationUpdate : Carotid Stenting and Current Trial Data
Update : Carotid Stenting and Current Trial Data J. Michael Bacharach, MD, MPH, FACC, FSCAI Section Head, Vascular Medicine and Vascular Intervention North Central Heart Institute, Sioux Falls, South Dakota
More informationHybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case
Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case Chernyavskiy M.,MD,PhD, Chernova D., Zherdev N., Chernov A. Almazov National Medical Research Centre, St.Petersburg, Russia
More informationEvidence-Based Management of CAD: Last Decade Trials and Updated Guidelines
Evidence-Based Management of CAD: Last Decade Trials and Updated Guidelines Enrico Ferrari, MD Cardiac Surgery Unit Cardiocentro Ticino Foundation Lugano, Switzerland Conflict of Interests No conflict
More informationTCAR: TransCarotid Artery Revascularization Angela A. Kokkosis, MD, RPVI, FACS
TCAR: TransCarotid Artery Revascularization Angela A. Kokkosis, MD, RPVI, FACS Assistant Professor of Surgery Director of Carotid Interventions Division of Vascular & Endovascular Surgery Stony Brook University
More informationIntroduction to Peripheral Arterial Disease. Stacey Clegg, MD Interventional Cardiology August
Introduction to Peripheral Arterial Disease Stacey Clegg, MD Interventional Cardiology August 20 2014 Outline (and for the ABIM board exam * ** ***) Prevalence* Definitions Lower Extremity: Aorta*** Claudication***
More informationSimultaneous Acute ST Elevation Myocardial Infarction And Acute Left Subclavian Artery Thrombosis
Simultaneous Acute ST Elevation Myocardial Infarction And Acute Left Subclavian Artery Thrombosis Chee Yang CHIN, MBChB, MRCP(UK) C.W.L. Chin, P.T.L. Chiam, R.S. Tan National Heart Centre Singapore 26
More informationCarotid stenosis management: CAS or CEA? Yaoguo Yang, Chen Zhong Beijing Anzhen Hospital,China
Carotid stenosis management: CAS or CEA? Yaoguo Yang, Chen Zhong Beijing Anzhen Hospital,China Disclosure Speaker name:... I have the following potential conflicts of interest to report: Consulting Employment
More informationOptimal testing for coronary artery disease in symptomatic and asymptomatic patients
Optimal testing for coronary artery disease in symptomatic and asymptomatic patients Alexandre C Ferreira, MD Clinical Chief of Cardiology Jackson Health System Director, Interventional Cardiology Training
More informationCarotid Artery Stenosis
Evidence-Based Approach to Carotid Artery Stenosis Seong-Wook Park, MD Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea Carotid Artery Stenosis Carotid
More informationCarotid Artery Stenting Today: A Few Updating Remarks
Carotid Artery Stenting Today: A Few Updating Remarks Camilo R. Gomez, MD, MBA Director, Alabama Neurological Institute Birmingham, Alabama Disclaimer & Warning Company Pharmaceutical BMS-Sanofi-Aventis
More informationDiabetes and Occult Coronary Artery Disease
Diabetes and Occult Coronary Artery Disease Mun K. Hong, MD, FACC, FSCAI Director, Cardiac Catheterization Laboratory & Interventional Cardiology St. Luke s-roosevelt Hospital Center New York, New York
More informationCarotid Artery Revascularization: Current Strategies. Shonda Banegas, D.O. Vascular Surgery Carondelet Heart and Vascular Institute September 6, 2014
Carotid Artery Revascularization: Current Strategies Shonda Banegas, D.O. Vascular Surgery Carondelet Heart and Vascular Institute September 6, 2014 Disclosures None 1 Stroke in 2014 Stroke kills almost
More informationQuando rivascolarizzare il paziente anziano con stenosi coronariche paucisintomatiche
Quando rivascolarizzare il paziente anziano con stenosi coronariche paucisintomatiche Fabrizio Tomai, MD, FCC, FESC Dept. Cardiovascular Sciences Interventional Cardiology Unit European Hospital - urelia
More informationTips and Tricks for CAS T-CAR
Tips and Tricks for CAS T-CAR H.-H. Eckstein, M. Kallmayer Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich,, Germany Disclosures Collaborator
More informationMedical Therapy for Peripheral Artery Disease
Medical Therapy for Peripheral Artery Disease Beau M. Hawkins, MD, FSCAI University of Oklahoma Health Sciences Center, Oklahoma City, OK Sahil A. Parikh, MD, FSCAI Columbia University Medical Center,
More informationDisclosures. State of the Art Management of Carotid Stenosis. NIH funding for clinical trials Consultant for Scientia Vascular and Medtronic
State of the Art Management of Carotid Stenosis Mark R. Harrigan, MD UAB Stroke Center Professor of Neurosurgery, Neurology, and Radiology University of Alabama, Birmingham Disclosures NIH funding for
More informationClinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE)
Clinical trial and real-world outcomes of an endovascular iliac aneurysm repair with the GORE Iliac Branch Endoprosthesis (IBE) Jan MM Heyligers, PhD, FEBVS Consultant Vascular Surgeon The Netherlands
More informationUpdate on the only remaining Carotid Multicenter Randomised International Trial in the World:ACST-2
Update on the only remaining Carotid Multicenter Randomised International Trial in the World:ACST-2 Alison Halliday MD Professor of Vascular Surgery University of Oxford Disclosure Statement of Financial
More informationBULgarian Carotid Artery Stenting versus Surgery Study (BULCASSS): Randomized single center trial
BULgarian Carotid Artery Stenting versus Surgery Study (): Randomized single center trial Ivo Petrov, M. Konteva, H. Dimitrov, K. Kichukov Tokuda Hospital Sofia Cardiology Department Background Carotid
More informationCarotid Artery Disease and What s Pertinent JOSEPH A PAULISIN DO
Carotid Artery Disease and What s Pertinent JOSEPH A PAULISIN DO Goal of treatment of carotid disease Identify those at risk of developing symptoms Prevent patients at risk from developing symptoms Prevent
More informationLong-Term Outcomes of Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting versus Solely Carotid Endarterectomy
Ann Thorac Cardiovasc Surg 2012; 18: 228 235 doi: 10.5761/atcs.oa.12.01928 Original Article Long-Term Outcomes of Synchronous Carotid Endarterectomy and Coronary Artery Bypass Grafting versus Solely Carotid
More informationLarry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
More informationSafety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD
Safety of Single- Versus Multi-vessel Angioplasty for Patients with AMI and Multi-vessel CAD Mun K. Hong, MD Associate Professor of Medicine Director, Cardiovascular Intervention and Research Weill Cornell
More information2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Outcome
Measure #344: Rate of Carotid Artery Stenting (CAS) for Asymptomatic Patients, Without Major Complications (Discharged to Home by Post-Operative Day #2) National Quality Strategy Domain: Effective Clinical
More information- Lecture - Recommandations ESC : messages importants P. MEYER (Saint Laurent du Var) - Controverse - Qui doit faire l'angioplastie périphérique?
- Lecture - Recommandations ESC : messages importants P. MEYER (Saint Laurent du Var) - Controverse - Qui doit faire l'angioplastie périphérique? Un chirurgien E. DUCASSE (Bordeaux) Un interventionnel
More informationDisclosures. CREST Trial: Summary. Lecture Outline 4/16/2015. Cervical Atherosclerotic Disease
Disclosures Your Patient Has Carotid Bulb Stenosis and a Tandem Intracranial Stenosis: How Do SAMMPRIS and Other Evidence Inform Your Treatment? UCSF Vascular Symposium 2015 Steven W. Hetts, MD Associate
More informationCarotid Artery Stenting Versus
Carotid Artery Stenting Versus Carotid Endarterectomy Seong-Wook Park, MD, PhD, FACC,, Seoul, Korea Stroke & Carotid artery stenosis Stroke & Carotid artery stenosis Cerebrovascular disease is one of the
More informationRegistry Assessment of Peripheral Interventional Devices (RAPID)
Registry Assessment of Peripheral Interventional Devices (RAPID) Adding Data Sources May 2, 2018 W. Schuyler Jones, MD Duke Clinical Research Institute Duke Heart Center Disclosures Research Grants: Agency
More informationFor Personal Use. Copyright HMP 2013
Original Contribution Staged Carotid Artery Stenting and Coronary Artery Bypass Surgery Versus Isolated Coronary Artery Bypass Surgery in Concomitant Coronary and Carotid Disease Seyed Ebrahim Kassaian,
More informationClinical Considerations for CTO
38 RCTs Clinical Considerations for CTO 18,000 pts Revascularization Whom to treat, Who derives benefit and What can we achieve? David E. Kandzari, MD FACC, FSCAI Director, Interventional Cardiology Research
More informationCan Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO!
Can Angiographic Complete Revascularization Improve Outcomes for Patients with Decreased LV Function? NO! Young-Hak Kim, MD, PhD Heart Institute, University of Ulsan College of Medicine Asan Medical Center,
More informationPredictors of restenosis and cardiovascular events in patients undergoing percutaneous angioplasty for subclavian/innominate artery stenosis
Predictors of restenosis and cardiovascular events in patients undergoing percutaneous angioplasty for subclavian/innominate artery stenosis Tadeusz Przewlocki, Anna Kablak Ziembicka, Piotr Pieniazek,
More informationDiagnostic, Technical and Medical
Diagnostic, Technical and Medical Approaches to Reduce CABG Related Stroke Pieter Kappetein, Michael Mack, M.D. Dept Thoracic Surgery, Rotterdam, The Netherlands Baylor Healthcare System Dallas, TX Background
More informationContemporary Management of Carotid Disease What We Know So Far
Contemporary Management of Carotid Disease What We Know So Far Ammar Safar, MD, FSCAI, FACC, FACP, RPVI Interventional Cardiology & Endovascular Medicine Disclosers NONE Epidemiology 80 % of stroke are
More informationImpact of the Aortic Arch on Stent Performance
Impact of the Aortic Arch on Stent Performance GianLuca Faggioli Vascular Surgery Alma Mater Studiorum UniversitY of Bologna ACST-2 Indications for carotid stenting: a preview of the potential derived
More informationCurrent Role of Renal Artery Stenting in Patients with Renal Artery Stenosis
Current Role of Renal Artery Stenting in Patients with Renal Artery Stenosis Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Etiology Fibromuscular
More informationPAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler Jones, MD September 14, 2016
PAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler, MD September 14, 2016 Interventional Cardiology and Cath Labs Disclosures Research Grants: Agency for Healthcare Research
More informationUPMC HAMOT CAROTID ARTERY DISEASE WHERE DO WE GO FROM HERE?
UPMC HAMOT CAROTID ARTERY DISEASE WHERE DO WE GO FROM HERE? Richard W. Petrella M.D. FACP,FACC,FASCI DEPARTMENT CHAIRMAN CVM&S UPMC HAMOT MEDICAL CENTER 1 LEARNING OBJECTIVES REVIEW THE RISK FACTORS FOR
More informationHow to Choose Between Carotid Stenting and Carotid Endarterectomy for Stroke Prevention
How to Choose Between Carotid Stenting and Carotid Endarterectomy for Stroke Prevention Christopher J. White MD, MSCAI Chief of Medical Services, Professor and Chairman of Medicine Ochsner Medical Center
More informationVivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine
Vivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine Institute The Oregon Clinic Disclosure I declare that neither
More informationAlma Mater Studiorum Università di Bologna
Alma Mater Studiorum Università di Bologna S.Orsola-Malpighi, Bologna, Italia Chirurgia Vascolare The volume of cerebral ischaemic lesion predicts the outcome after symptomatic carotid revascularisation
More informationSevere Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative
Severe Aortic Valve Disease: TAVR in Four Ages and Four Etiologies Age 25 y/o Congenital, 50 y/o Bicuspid, 75 y/o Rheumatic, 100 y/o Degenerative Samin K. Sharma, MD, FACC, FSCAI Director Clinical & Interventional
More informationOBJECTIVES. New Twist To Old Disease: Cardiovascular Update /9/2017. Prevention Pre-operative Coronary Artery Disease
New Twist To Old Disease: Cardiovascular Update 2017 Sridevi R Pitta, M.D.,MBA, F.S.C.A.I., R.P.V.I Medical Director for STEMI, Medical Director for CV Quality Council, Interventional Cardiologist & Endovascular
More informationESC Heart & Brain Workshop
ESC Heart & Brain Workshop The role of vascular surgeon in stroke prevention Barbara Rantner, MD, PhD, Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria Supported by Bayer,
More information8/28/2018. Pre-op Evaluation for non cardiac surgery. A quick review from 2007!! Disclosures. John Steuter, MD. None
Pre-op Evaluation for non cardiac surgery John Steuter, MD Disclosures None A quick review from 2007!! Fliesheret al, ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and are for Noncardiac
More informationCarotid Ddisease, Carotid IMT and Risk of Stroke
Carotid Ddisease, Carotid IMT and Risk of Stroke TATJANA RUNDEK, MD PhD Professor of Neurology, Epidemiology and Public Health Director, Clinical translational Division Department of Neurology, Miller
More informationSurgical Treatment of Carotid Disease
Department of Cardiothoracic & Vascular Surgery McGovern Medical School / The University of Texas Health Science Center at Houston Surgical Treatment of Carotid Disease The Old, the New, and the Future
More informationFinal Clinical and Angiographic Results From a Nationwide Registry of FIREBIRD Sirolimus- Eluting Stent: Firebird In China (FIC) Registry (PI R. Gao)
The Microport FIREBIRD Polymer-based Sirolimus- Eluting Stent Clinical Trial Program Update: The FIC and FIREMAN Registries Junbo Ge, MD, FACC, FESC, FSCAI On behalf of Runlin Gao (FIC PI) and Haichang
More informationCarotid Revascularization
Options for Carotid Disease Carotid Revascularization Wayne Causey, MD 2 nd Year Vascular Surgery Fellow Best medical therapy, Carotid Endarterectomy, and Carotid Stenting Who benefits from best medical
More informationPost-op Carotid Complications A Nursing Perspective of What to Watch Out for
Post-op Carotid Complications A Nursing Perspective of What to Watch Out for By Kariss Peterson, ARNP Swedish Medical Center Inpatient Neurology Team 1 Post-op Carotid Management Objectives Review the
More informationJoshua A. Beckman, MD. Brigham and Women s Hospital
Peripheral Vascular Disease: Overview, Peripheral Arterial Obstructive Disease, Carotid Artery Disease, and Renovascular Disease as a Surrogate for Coronary Artery Disease Joshua A. Beckman, MD Brigham
More informationPCIs on Intermediate Lesions NCDR Cath-PCI Registry
Practical Application Of Coronary Physiology in The Cath Lab Talal T Attar, MD, MBA, FACC PCIs on Intermediate Lesions NCDR Cath-PCI Registry Fraction of stenoses 50-70% treated with PCI without further
More informationEvolving Challenges in the Evaluation and Treatment of Lower Extremity PAD -- The Peripheral Academic Research Consortium (PARC)
Evolving Challenges in the Evaluation and Treatment of Lower Extremity PAD -- The Peripheral Academic Research Consortium (PARC) W. Schuyler Jones, MD FACC Director, Adult Cardiac Catheterization Laboratory
More informationReview of clinical carotid stent procedural & long-term outcomes in. symptomatic asymptomatic. patients
Review of clinical carotid stent procedural & long-term outcomes in symptomatic asymptomatic patients 1 Conflict of Interest Statement Within the past 12 months, I or my spouse have had a financial interest/arrangement
More informationThe PARADIGM Study. Jagiellonian University Dept. of Cardiac & Vascular Diseases. John Paul II Hospital, Krakow, Poland
Prospective evaluation of All-comer percutaneous carotid revascularization In symptomatic and increased-risk asymptomatic carotid artery stenosis using CGuard Micronet-covered embolic prevention stent
More informationEndovascular and Hybrid Treatment of TASC C & D Aortoiliac Occlusive Disease
Endovascular and Hybrid Treatment of TASC C & D Aortoiliac Occlusive Disease Arash Bornak, MD FACS Vascular & Endovascular Surgery University of Miami Miller School of Medicine No disclosure BACKGROUND
More informationDESPITE CURRENT LEVEL 1 EVIDENCE THE OUTLOOK FOR AN UPSURGE IN CAROTID STENTING (CAS) IS BRIGHT FRANK J. VEITH LINC LEIPZIG JANUARY 27, 2015
DESPITE CURRENT LEVEL 1 EVIDENCE THE OUTLOOK FOR AN UPSURGE IN CAROTID STENTING (CAS) IS BRIGHT FRANK J. VEITH LINC - 2015 LEIPZIG JANUARY 27, 2015 Disclosure Speaker name: FRANK J. VEITH DESPITE SOME
More informationEndovascular vs Surgical Carotid Revascularisation
Endovascular vs Surgical Carotid Revascularisation Lessons Learned from Clinical Trials and How I Approach it in My Practice Ramon L. Varcoe, MBBS, MS, FRACS, PhD Associate Professor of Vascular Surgery
More informationPeripheral Arterial Disease: Who has it and what to do about it?
Peripheral Arterial Disease: Who has it and what to do about it? Seth Krauss, M.D. Alaska Annual Nurse Practitioner Conference September 16, 2011 Scope of the Problem Incidence: 20%
More informationTIA SINGOLO E IN CRESCENDO: due diversi scenari della rivascolarizzazione urgente carotidea
TIA SINGOLO E IN CRESCENDO: due diversi scenari della rivascolarizzazione urgente carotidea R. Pini, G.L. Faggioli, M. Gargiulo, E. Pisano, A. Pilato, E. Gallitto, C. Mascoli, L.M. Cacioppa, A. Vacirca,
More informationUpgrade of Recommendation
Challenges in LM PCI Decision-making process for stenting Young-Hak Kim, MD, PhD, Heart Institute, University of Ulsan College of Medicine Asan Medical Center, Seoul, Korea Upgrade of Recommendation for
More informationFFR-CT Not Ready for Primetime
FFR-CT Not Ready for Primetime Leslee J. Shaw, PhD, MASNC, FACC, FAHA, FSCCT R. Bruce Logue Professor of Medicine Co-Director, Emory Clinical CV Research Institute Emory University School of Medicine Atlanta,
More informationInternal carotid artery near-total occlusions: Is it justified to operate on them?
Internal carotid artery near-total occlusions: Is it justified to operate on them? Christos D. Liapis Professor (Em) of Vascular Surgery Athens University Medical School Director Vascular & Endovascular
More informationWilliam A. Gray MD System Chief of Cardiovascular Services, Main Line Health President, Lankenau Heart Institute Wynnewood, PA USA
William A. Gray MD System Chief of Cardiovascular Services, President, Wynnewood, PA USA What are the possible causes of stroke in CAS? Operator error Technique (balloon sizing, wire misadventure, EPD
More informationCEA and cerebral protection Volodymyr labinskyy, MD
CEA and cerebral protection Volodymyr labinskyy, MD VA Hospital 7/26/2012 63 year old male presents for the vascular evaluation s/p TIA in January 2012 PMH: HTN, long term active smoker, Hep C PSH: None
More informationManagement of cardiovascular disease - coronary interventions -
Master Classes in Preventive Cardiology I Management of diabetes in patients with CVD European Heart House Management of cardiovascular disease - coronary interventions - Francesco Cosentino MD, PhD, FESC
More information