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By Pedro A. Lemos, Visit Amazon's Paul Schoenhagen Page, search results, Learn about Author Central, Paul Schoenhagen, , Alexandra Lansky

The instruments helpful for properly picking out advanced coronary lesions and plaques. the information required to competently diagnose infrequent sickness development and styles. With Diagnostic equipment within the Cardiac Catheterization Laboratory, all the crucial diagnostic modalities you would like within the lab are at your fingertips. This new strength in cardiology is the premiere reference advisor to complex scientific methods and the really good stipulations that each interventional heart specialist encounters. It depicts the bizarre and distinctive occasions within the catheterization lab and offers the information required of clinicians that is going past the basic equipment and methods. Key issues mentioned comprise: promising new know-how, together with machines and distinction brokers intracardiac strain and circulate size, and shunt detection qualitative and quantitative angiography intravascular ultrasound, derived equipment, and intracardiac ultrasonography optical coherence and multidetector-computed tomography electromechanical mapping (NOGA process) baseline review and healing tracking medical purposes of quantitative coronary angiography pre-procedure making plans and intra-procedure of CTO remedy

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Circulation 1999; 99:1945–1950. 15. Gibson CM, Dotani MI, Murphy SA, et al. Correlates of coronary blood flow before and after percutaneous coronary intervention and their relationship to angiographic and clinical outcomes in the RESTORE trial. Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis. Am Heart J 2002; 144:130–135. 16. Gibson CM, Murphy SA, Morrow DA, et al. Angiographic perfusion score: An angiographic variable that integrates both epicardial and tissue level perfusion before and after facilitated percutaneous coronary intervention in acute myocardial infarction.

FUTURE DIRECTIONS While the last 25 years has been the era of the “open artery hypothesis” there is growing recognition that epicardial artery patency is necessary but not sufficient to assure good clinical outcomes. Clearly, the best outcomes are present when both epicardial and myocardial perfusion are restored. We must now incorporate the evaluation of myocardial perfusion into our clinical practice as both a measure of treatment efficacy and as a predictor of clinical outcome. We must shift the paradigm away from relying solely on “coronary angiography” towards the emerging technique of “myocardial angiography” where we assess both epicardial and myocardial perfusion.

9,10 Recently, delayed contrast–enhanced magnetic resonance imaging (DE-MRI) has emerged as a new reference method for infarct characterization. 1). Importantly, several of these proposed predictors relate to angiographic features of the CTO and should therefore be assessed during diagnostic catheterization. 3 Functional rather than absolute occlusions Functional occlusions should be differentiated from true chronic total occlusions as they have a significantly higher angioplasty success rate. 12 Functional occlusions are lesions whereby there is slow antegrade (TIMI 1) flow through the occlusion but without complete opacification of the distal coronary bed.

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