Breaking boundaries: Ticagrelor monotherapy in high-risk patients.

Atherosclerotic plaque formation is a leading cause of arterial thrombosis that significantly impacts global health by instigating major adverse cardiovascular events (MACE) like myocardial infarction (MI) and stroke. Platelets are central to this process, leading to the development of antiplatelet therapies, to mitigate MACE risks. The combination of aspirin with a potent P2Y inhibitor known as dual antiplatelet therapy (DAPT) is the standard for post-percutaneous coronary intervention (PCI) aimed at reducing ischemic events.

Twelve-month clinical outcomes of "nano-crush technique" for the treatment of bifurcation lesions using ultra-thin (60 µm) sirolimus-eluting coronary stents.

Background: Provisional stenting is preferred for bifurcation lesion; however, certain anatomical substrate does require two stents as a part of dedicated stent technique. Here, the present study evaluated outcomes of ultra-thin (60 µm) Supra family sirolimus-eluting stent (SES) (Sahajanand Medical Technologies Limited, Surat, India) for dedicated bifurcation lesions using nano-crush technique at 12 months angiographic follow-up.

Methods: This was prospective, single-center observational study which enrolled patients with de novo bifurcation lesion and underwent angioplasty with Supra family SES using nano-crush technique at a tertiary care center in India, between March-2017 and February-2019.

Expert Opinion on P2Y12 Inhibitors Use in Management of Acute Coronary Syndromes: Focus on Ticagrelor.

Ticagrelor is a potent, oral P2Y12 inhibitor used as a part of dual antiplatelet therapy (DAPT) in acute coronary syndromes (ACS). New evidence has emerged for its use in ACS, which may be crucial for the Indian context. This brought together nearly 150 experts in ACS management across the country who reviewed the current evidence and discussed the same through a series of 10 meetings on an online platform.

Nano-crush technique in narrow-angle (<70°) bifurcation: bench test, CT reconstruction, fluid dynamics, and clinical outcomes.

Background: Bifurcation stenting techniques are still refining and under testing. Nano-crush is a novel technique which allow minimum protrusion of side branch struts at the ostium. To demonstrate the efficacy of Nano-crush technique in narrow-angle bifurcation (<70°) using bench test model, 3D reconstruction of the stent structure, computational fluid dynamics study and a clinical follow-up.

Percutaneous coronary intervention of severely/moderately calcified coronary lesions using single-burr rotational atherectomy: A retrospective study.

Objective: This study evaluates the safety and efficacy of percutaneous coronary intervention in moderately and severely calcified coronary lesions, which are either not crossed or dilated using a Scoreflex balloon at nominal pressure, using single-burr rotational atherectomy (burr-artery ratio, ≤0.6) followed by scoring balloon dilatation (balloon-artery ratio, 0.9).

Two chair test: a substitute of 6 min walk test appear cardiopulmonary reserve specific.

Background: A simple and efficient exercise test possible in a small space is welcome to supplement 6 min walk test (6MWT) that demands a 100 feet corridor to perform.

Methods: The proposed two chair test (2CT) makes a person to sit and move five times between two chairs placed face to face at 5 feet apart and note the changes in pulse-rate (PR) and arterial oxygen saturation (SpO) at every 10 s for 2 min after that. Comparison of the post-exercise measurements (PR and SpO) with a repeat performance in same patients was done for reproducibility and doing the same after 6MWT and 2CT in another set of patients was meant for for acceptability.

A novel “nano-crush” technique for the management of coronary bifurcation lesions: in vitro bench test analysis and preliminary report on real-world clinical evaluation in patients with one-year angiographic follow-up.

Aims: Although provisional stenting with a single drug-eluting stent has proven clinical efficacy in the treatment of bifurcation stenosis, some patients may require two stents. We propose a novel technique, called "nano-crush", which is easy to perform and can be used in all bifurcation angles.

Methods And Results: The feasibility of the nano-crush technique was confirmed in an in vitro bench test and intravascular ultrasound (IVUS) study.

Angioplasty of unprotected left main coronary stenosis: Real world experience of a single-operator group from eastern India.

Background: Coronary artery bypass graft surgery is the standard treatment of unprotected left main coronary stenosis (ULMCA). However, in the real world scenario, many of these patients are unfit for CABG or prefer angioplasty as an alternative when offered the choice.

Methods: A total of 86 clinically stable patients with ULMCA stenosis who were unfit or unwilling for CABG underwent PCI with DES at two tertiary care centers in Kolkata.

Safety of Prasugrel in Indian patients - multicentric registry of 1000 cases.

Background: Clopidogrel has been the only available antiplatelet drug used along with aspirin in patients of ACS. In recent years 2 new antiplatelet drugs (Prasugrel and Ticagrelor) have become available. Prasugrel in the dose of 10 mg OD has been found to be more efficacious but with increased risk of major bleeding.

Clopidogrel resistance: the way forward.

Clopidogrel, a second generation thienopyridine has been the mainstay of ACS (Acute Coronary Syndrome) treatment for more than a decade. Clopidogrel Resistance has been associated with increased mortality in ACS patients with an increase in number of Stent Thrombosis. This review article tries to find out the causes of Clopidogrel Resistance, the main factors involving it, Laboratory evaluation of Clopidogrel Resistance.

Impact of angiographic & procedural factors on the treatment of ostial LAD or LC(x) disease.

Aims & Objectives: This study was designed to evaluate the impact of angiographic & procedural factors on MACE after DES deployment in ostial lesions of LAD & LC(x). PATIENTS, MATERIALS & METHODS: 65 patients with ostial disease of LAD or LC(x) underwent PCI using DES. In 56 patients the stent was placed perfectly at the ostium & in 9 patients the LMCA was covered as per protocol.

Thrombosuction with export aspiration catheter during PCI in acute MI.

The angiographic demonstration of thrombus laden LAD in a ventilated young man with IABP (to combat cardiogenic shock) demanded thrombosuction. Following thrombosuction no significant lesion was visible that could have mandated PTCA-Stenting. Follow-up coronary angiography in this hyperhomocysteinaemic young subject after one and a half month revealed normal coronaries.

Importance of ischaemic time as a predictor of LV systolic function in Indians.

Objective: Sucessful reperfusion therapy in AMI improves LV systolic function. Success in thrombolytic therapy is directly related to the ischaemic time. Our aim in the present study was to observe the importance of ischaemic time as a predictor of left ventricular systolic function in patients undergoing PPCI.

Revascularization of left main bifurcation lesions by "Mini-Crush technique" in a subject on haemodialysis.

A 75 old diabetic, hypertensive subject with chronic kidney disease stage V (on haemodialysis) had Acute Coronary Syndrome. Coronary angiography revealed bifurcation lesion of the distal Left Main Coronary Artery involving the origins of LAD & LCx, CABG was denied because of comorbidites, old age and unwillingness of the patient to face the risk of surgery. The LM bifurcation was treated in "Mini-Crush technique" resulting in TIMI-III flow and there was uneventful post-interventional recovery without MACE.