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Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention (PCI) of de-novo coronary artery lesion by using Bioabsorbable Vascular Scaffold (BVS) ABSORB stents eluting Everolimus. Methods: Total 16 patients were enrolled in this very preliminary study of BVS absorb. Among them, Male: 11 and Female: 5. Total 20 stents were deployed. Mean age were for Male: 56 yrs, for Female: 60 yrs. Associated coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history (FH) for CAD and Smoking. Patients were followed up clinically. Results: Among the study group; 13 (81%) were Dyslipidemic, 10(62.5%) were hypertensive; 6 (37.5%) patients were Diabetic, FH 3(18.75%), and 2(18%) were all male smoker. Female patients were more obese [Body Mass Index (BMI) M 25: F 27] and developed CAD in advance age. A common stented territory was for left anterior descending artery (LAD): 6 (37.5%), left circumflex artery (LCX) 5 (25%), right coronary artery (RCA) 6(37.5%). One patient had both LCX and LAD stenting. Total 3 patients had double/overlapping stent in RCA lesion. Territory wise distributions of BVS ABSORB stent were for LAD 6(30%), RCA 9 (45%), and LCX 5 (25%). There was no periprocedural or postprocedural complication. Conclusion: BVS ABSORB Everolimus eluting vascular scaffold showed favorable clinical outcome without any major cardiac events (acute or late stent thrombosis, MI or death) over a period of 9 month. Thus, BVS ABSORB would be favorable alternative to other available drug eluting metallic stents.
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Background: Aim of the study was to evaluate the primary procedural success of percutaneous coronary intervention of unprotected left main coronary artery stenosis using either Bare-metal stents or drug eluting stent. Methods: Total 33 patients were enrolled in this very preliminary non-randomized prospective cohort study. Among them, Male: 25 and Female: 8. Total 35 stents were deployed. Mean age were for Male: 59 yrs, for Female: 62 yrs. Associated coronary artery diseases risk factors were dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive family history for coronary artery diseases and smoking. Results: Among the study group; 26 (78%) were Dyslipidemic, 24(70%) were hypertensive; 17 (51.5%) patients were Diabetic, 11(33%) were smoker and 7(21%) patients had family history of Ischaemic heart disease. Female patients were more obese (BMI M 26: F 27) and developed coronary artery diseases in advance age. Common stented territory were left main: 20 (60%), Left main to left anterior descending artery 7 (22%) and Left main to left circumflex artery 6 (18%). Average length and diameter of stent was 3.5 and 18 mm respectively. Stent used: Bare Metal Stent 5 (15%), Drug Eluting Stent: 28 (85%). Among the different Drug Eluting Stents, Everolimus eluting stents were 11 (39.3%), Sirolimus eluting 10(35.7%), Paclitaxel eluting 3 (10.7%), Biolimus eluting 3 (10.7%) and Zotarolimus eluting1 (3.6%). In the present study, overall survival outcome was 94% (31 patient), mortality of cardiac cause 3% (1 patient) and 1 patient (3%) died of hepatocellular carcinoma. Conclusion: Our study has shown that percutaneous coronary intervention of the unprotected left main is a safe and effective alternative to Coronary Artery Bypass Graft (CABG).
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Background: Aim of the study was to evaluate the primary procedural success of slender PCI via transradial approach using either Bare-metal stents (BMS) or Drug Eluting Stent (DES). Methods: Total 10 patients were enrolled in this very preliminary study. Among them, Male: 8 and Female: 2. Clinical presentation were Ant MI: 4 (40%), Inf. MI: 2 (20%), Angina II-III: 3 (30%), and NSTEMI: 1 (10%). Total 10 stents were deployed. Mean age were for Male: 44yrs, for Female: 55yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Among the study group; 9 (90%) were Dyslipidemic, 5 (50%) were hypertensive; 6 (60%) patients were Diabetic, FH 6 (6%) and 8(63%) were all male smoker. Female patients were more obese (BMI M 24: F 27) and developed CAD in advance age. Common stented territory were LAD: 5 (50%) followed by RCA: 3 (30%) and LCX: 2 (20%). Average length and diameter of stent for LAD, RCA and LCX were 3.25, 3.16, 2.5 and 21.4, 20.3, 20 respectively. Stent used: BMS 3 (30%), Everolimus 5 (50%), Sirolimus 1(10%) and Zotarolimus 1(0.75%). Less contrast used (49.5ml), reduced radiation exposure (4727Gym2) and less fluoroscopy time (193 sec) with overall no procedural complication were observed. Conclusion: Our study has shown that the slender PCI via radial artery with a 5F guide catheter is safe with no procedural complication. It is also associated with less radiation exposure, less fluoroscopy time, good backup support and quick mobilization of patient.
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Background: Coronary artery disease (CAD) in Bangladeshi population is diffuse in nature with small caliber arteries. Now a day, these are treated, by PCI with stent deployment, often multiple in a single coronary artery. However, long term data on In-stent re-stenosis (ISR) in multiple or overlapping stent in single coronary artery in these patients is not yet available. Therefore, the aim of our present study was to assess long-term outcome of stent patency or the development of ISR of varieties stent in single vessel territory. Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the 3-36 months preceding the study for the quantifying period of 2007-2011. Total 51 patients (male: 42, Female: 9) who had multiple stents in one coronary artery were included in this study. Average age was Male: 57; Female:61. Average study period was 3.1 ± 2.4yrs. Results: Our results show that, among the total studied population 82.4% (42) were male and 17.6% (9) were female. Total 114 stent were deployed in 54 vessels of 51 patients. Territory wise distribution of deployed stent was LAD 52(45.6%), RCA 42 (36.8%) and LCX 20(17.5%). Stent used were BMS 45(39.5%), DES 69(60.5%). Re-look Coronary Angiogram (CAG) revealed that Significant ISR (ISR>60%) developed in BMS 8(17.8%) and DES 8(11.5%). Among the different DES the development of significant ISR were in Sirolimus 1(3.2%), Paclitaxel 4(16%), Everolimus 3 (30%). Conclusion: Our study has shown that deployment of multiple stents in a single artery territory (either separately or as overlapping) is safe and has reasonably lower degree of ISR, even when BMS was used. As a whole BMS shows higher degree of ISR than to DES for an average period of follow up of 3.1 yrs.
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Background: Aim of the study was to assess the safety of the trans-radial Percutaneous coronary intervention (PCI) than conventional Trans-femoral approach by using either Bare-metal stents (BMS) and or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent. Also to see its safety in regards of procedural time, quick mobilization, less complication and less radiation exposure. Methods: Total 117 patients were randomized from a total of 538 patients who had PCI at our center in the quantifying period. Total 130 stent deployed in 117 patients. Among the patients, Male: 100 and Female:17 . Mean age were for Male: 55yrs, for Female:57yrs . Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Our study shows 21.7% had trans-radial PCI. Among the study group; 72 (61.5%) were Dyslipidemic, 75 (64.1%) were hypertensive: 47(40.2%) patients were Diabetic, FH 29 (24.8%) and 33(33%) were all male smoker. Female patients were more obese (BMI M 27: F 29) and developed CAD in advance age. Common stented territory were LAD 51 (43.6%) followed by RCA 41 (35%) and LCX 27(23%). Average length and diameter of stented vessel were almost same in all territory. Territory wise multiple or overlapping stenting was done in LAD 3 (6 stents), RCA 1(2stents), LCX 4 (10 stents). Stent used: BMS 37 (28.5%), Sirolimus 41(31.5%), Paclitaxel 27 (21%), Everolimus 22 (16.9%), Biolimus 2 (1.5%) and Zotarolimus 1(0.75%). Less Procedural time, reduced radiation exposure, no procedural complication and overall better patient comfort were observed. Conclusion: Our study has revealed that trans-radial PCI is safe with reduced radiation exposure, quick mobilization of patient and no procedural complication in all the case, indicates it can be done routinely as an alternative to conventional Trans-femoral approach.
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Background: Data of stent patency or the development of ISR in multiple or overlapping stent in a single vessel territory of Bangladeshi diabetic (DM) patient population is not yet available. Therefore, the aim of our present study was to assess primarily the long-term stent patency of varieties of stent in patient with Diabetes Mellitus (DM) and Non-diabetes Mellitus (NDM). Methods: Patients were prospectively selected from, who underwent coronary angiogram at our hospital for further evaluation of their previous PTCA in the e”36 months preceding the study for the quantifying period of 2007-2011. Total 51 (11%) patients (male: 41, Female: 10) from a total 461 patients were included in this study who has multiple or overlapping stent in single vessel territory. Total 32 (62.7%) patients included into the DM group with an average age of 57 yrs and in the NDM were 19 (37.3%) with 58 yrs. Average ISR period was 3.1 ± 2.4 yrs. Results: Our result shows that total 70 stent were deployed in 33 vessels of DM patient and 44 stent in 21 vessel of Non-DM patient. Territory wise total number of deployed stent in patient of DM: NDM were in LAD 34 (48.6%): 18(41%), RCA 16 (22.8%): 4 (9%) and LCX 20(28.6%): 22(55%). Stent used in DM: NDM; were BMS 21 (30%): 22(50%), Sirolimus 24(34.3%): 10(22.7%), Paclitaxel 17(24.3%):8(18.2%), Everolimus 6(8.6%):4(9.1%)%). Re-look coronary angiogram (CAG) revealed that increased number of in-stent restenosis occurred more in patient with Diabetes [DM 10(31.3%) vs NDM 5(26.3%)]. Significant ISR (ISR>60%) in DM patient treated with for BMS were 4 (36.4%), for Paclitaxel 3(42.3%), for Sirolimus 1(9.1%). Average stent size and length were almost same in both groups for any coronary territory. Conclusion: Our study has revealed that increased number of ISR were more in patient with diabetes (DM) in a single artery territory when multiple stents were used either separately or as overlapping. Among the stent used, Sirolimus shows better patency with reduced ISR than Paclitaxel and other limus eluting stent for an average period of follow up of 3.1 yrs.
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Objective: Aim of our study was to evaluate the safety and survival outcome of Primary PCI (pPCI) in patients with Acute Myocardial infarction in our hospital setting. Methods: Total 30 (Female 5; Male 25) patients were enrolled in this study who were brought in to our hospital with STEMI. Average age was, Male 56, Female 52. Primary PCI was performed after transferring patient from Emergency Department (ED) to Cardiac Catheterization laboratory. Cardiovascular risk factors among the studied population were Dyslipidemia, Diabetes Mellitus, Hypertension, Smoking and Family History. Results: Primary PCI either with Bare Metal Stent (BMS) or Drug Eluting Stent (Sirolimus-eluting stent or Paclitaxel stent) were performed in total 13 LAD lesion and 15 RCA lesion and 2 LCX lesion. BMS used were 66.7%, Sirolimus 20% and Paclitaxel-eluting stent 13.3%. Total 2 patients expired but due to hemorrhagic CVA and refractory heart failure. At presentation, ECG evidenced diagnosis were Acute Anterior Wall MI : 12 (40%), Inferior MI: 16 (53%), Infero-Posterior MI: 2 (6.7%). Our study showed that Primary PCI increases the higher survival outcome 28 (93.3%) out of 30 patients with acute MI. Conclusion: Our present study revealed that revascularization by Primary PCI showed safety and better percentage of In-hospital and 30-days survival outcome in patients with Acute myocardial infarction in our hospital setting.
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Background: Aim of our present study was to evaluate the extent of Renal Artery Stenosis(RAS) in patients with Coronary Artery disease (CAD) in context of Bangladesh demographic distribution. Methods: Total 100 patients with renal artery disease were randomized from a pool of 1200 patients who were underwent routine diagnostic coronary angiogram for the evaluation of extent of their CAD. Renal arteries were studied at the same time. Among the patients, Male: 64 and Female:36 . Mean age were for Male:62yrs , for Female: 58 yrs . Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking. Results: Our study results show 100 patients (12% of the sample) had RAS lesion out of total 1200 patient who underwent routine CAG. Sex distribution is male 64 (64%), Female 36 (36%). Among the study group; 79 (79%) were hypertensive; 57 (57%) were Dyslipidemic, 54 (54%) patients were Diabetic, 27 (27%) were smoker (all male) and 18(18%) were having positive FH for CAD. Female patients were more obese and developed CAD in advanced age (male: 53.5 Versus Female:64 yrs). We found that the Prevalence’s of RAS is more in patients with TVD (43%), followed by DVD (10%) and SVD (10%), Minor to mod CAD (14%) and angiographically normal coronaries (23%). Significant (>50% Stenosis) Left renal artery stenosis were found in 27 patient and 23 had significant Right renal artery stenosis. Total 8 patents had significant both renal artery stenosis. Conclusion: Renal artery stenosis is one of the most important peripheral vascular disease, needing to be diagnosed early and subsequent intervention to keep continuity of renal blood flow. In the present study, we found that the significant association of Renal Artery Stenosis in patients with CAD. Incidence of RAS is more in patients with TVD. Therefore, we recommend routine Renal angiogram during coronary angiography.
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Background: Aim of the study was to evaluate the primary in-hospital success and 30-days survival outcome of PCI in patients with CTO lesions, using either Bare-metal stents (BMS) or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent in our hospital setting. Methods: Total 50 patients were randomized as per the definition of CTO, from a total of 400 patients who had PCI at our center in the quantifying period. After the guidewire crossing and the balloon dilation, measurement of the culprit lesion was done by using Siemens QCA measuring system. Among the patients, Male: 41 and Female: 9. Mean age were for Male: 53.3yrs, for Female: 64.4 yrs. Associated CAD risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking. Results: Our study results show 50 patients (12.5%) had CTO lesion out of total 400 PCI procedures. Sex distribution in male 41 (82%), Female 9 (18%). Among the study group; 38 (76%) were Dyslipidemic, 31 (62%) were hypertensive; 20 (40%) patients were Diabetic, 9 (22%) were all male smoker, 5 (10%) were having positive FH for CAD. Female patients were more obese and developed CAD in advance age (male: 53.5 Versus Female: 64.4 yrs). Average diameter of stented vessel was greater in RCA than LAD and LCX. We found that the incidences of CTO lesions were more in LAD territory 20 (40%) followed by RCA 17 (34%) and LCX 13(26%). Single vessel Disease (SVD) in 45 (90%) patients was more common type of CTO lesion followed by Double vessel disease (DVD) in 5(10%). Post procedural, in-hospital and 30 days survival out comer was 100% in our present study. Conclusion: Our study has revealed that PCI in patients with CTO lesions has increased inhospital and 30 days survival outcome, are treated with BMS or DES. The incidence of CTO lesion is more common in male than in female. Female are developing heart disease in advance age and are more obese.