INTERVENTNA RADIOLOGIJA -VASKULARNA-

#"!ela
Dilatacije krvnih s !"va #TA$ #T%A$ #TRA Inreventne &r"ce! re na src E'("li)acije A&likacije lek"va Vasc lar access &r"ce! res

DILATA%IJA KRVNI* SUDOVA #TA

50%

75%

75%

95%

Relationship between reduction in diameter and cross-sectional area angiographic view (diameter) histologic view (cross-sectional area)

Arnett EN, Isner JM, Redwood DR, et al. Ann Intern Med 1979;91:350

First Balloon Angioplasty

Andreas Gruntzig 1976

First POBA 25 Year Follow-up

DILATA%IJA KRVNI* SUDOVA #TA

+al"n !ilatacije Stent"vi

DILATA%IJA KRVNI* SUDOVA #TA

DILATA%IJA KRVNI* SUDOVA #TA

Balloon Angioplasty Bare etal stents

1977 199! 2$$2

"rug-#luting stents

CABG

PCI

OR

DILATA%IJA KRVNI* SUDOVA #TA

Stent"vi

Na (al"n

Sa'",ire-i

.le/i(ilit0

%tent Ar&'ite&ture
(losed (ell
#r"
*"'"1ene" s$ s0''etric e/&ansi"n Ra!ial stren1th G""! 2"r calci2ie!$ eccentric "r a"rt"-"stial lesi"ns

Open (ell
#r"
.le/i(ilit0$ 4all a&&"siti"n Si!e (ranch access .le/i(ilit0

%"n
Less 2le/i(le$ less 1""! 3all a&&"siti"n

%"n
In-h"'"1ene" s e/&ansi"n S (-"&ti'al ra!ial stren1th

)'e Platelet* t'e ene y o+ t'e inter,entionist-

Antiagrega&iona-P./F/0A1)/21A Anti3oagulantna Fi4rinoliti53a terapi6a-)#.AP/7%1A

Antiagrega&iona-P./F/0A1)/21A

56 As&irin$ ASA 76 %l"&i!"1rel$ #lavi/ 86 Anta1"nisti II+ III A rece&t"ra$ Re"&r"$ A1ra9stat

Antiagrega&iona-terapi6a
Je!n"str ka Dv"str ka Tr"str ka

Anti3oagulantna- 'eparin

Anti3oagulantna- sintro * ,ar+arin Sintr"' (el"n1s t" the 2a'il0 "2 an antic"a1 lant !r 16 Sintr"' &revents the n"r'al 2"r'ati"n "2 2act"rs II$ VII$ I: an! :$ an! this &revents (l""! cl"ts 2r"' 2"r'in16

Anti3oagulantna- sintro * ,ar+arin

INR; #T <test= > #T <n"r'al=

%linicians !esirin1 thera&e tic antic"a1 lati"n 'a0 ai' 2"r a hi1her INR - in 'an0 cases ran1in1 2r"' 7-8

Fi4rinoliti53a terapi6a* a&ilise

56 t#A (in!s t" 2i(rin "n the s r2ace "2 the cl"t 76 Activates 2i(rin-(" n! &las'in"1en 86 #las'in is cleave! 2r"' the &las'in"1en ass"ciate! 3ith the 2i(rin ?6 .i(rin '"lec les are (r"ken a&art (0 the &las'in an! the cl"t !iss"lves

Fa&tors /n+luen&ing %tent )'ro 4osis

%tent )'ro 4ogeni&ity

0esion Fa&tors

Patient Fa&tors

Pro&edural Fa&tors

ACC/AHA guidelines for therapy, cont&d

I IIa IIb III

A/!S"#$I% Antiplatelet

Initial conser'ati'e strategy% ASA for all patients

A B C B

Clopidogrel should be added to ASA and anticoagulant therapy as soon as possible and administered for at least 1 month Clopidogrel should be administered ideally for 1 year In patients with recurrent ischemic discomfort despite ASA, clopidogrel, and anticoagulant therapy, it is reasonable to add a GP IIb/IIIa antagonist before diagnostic angiography It is reasonable to add a GP IIb/IIIa antagonist to anticoagulant and oral antiplatelet therapy

Anderson JL et al. Circulation. 2007;116:803-77.

ACC/AHA guidelines for oral antiplatelet therapy

2rug Initial $ed "8 2uring PCI 7ec&d initial medical treatment Aspirin 16(54() mg nonenteric formulation !o additional treatment

A/!S"#$I% 2osing of
After PCI 2ischarge

!o initial medical treatment 16(54() mg nonenteric formulation .$S% 16(54() mg 01 mo, S#S% 4 mo, P#S% 6 mo1 then ASA /)5 16( mg indefinitely .$S% 16(54() mg 01 mo, S#S% 4 mo, P#S% 6 mo1 then ASA /)516( mg indefinitely .$S% /) mg 01 mo and ideally up to 1 yr1 2#S% /) mg 01 yr3

Clopidogrel

-oading dose% 4**56** mg $aintenance dose% /) mg

Second loading dose 4** mg may be gi'en

-oading dose% 4**56** mg

.$S% /) mg 01 mo and ideally up to 1 yr1 2#S% /) mg 01 yr3

"iclopidine

-oading dose% )** mg $aintenance dose% ()* mg bid

!o additional treatment

-oading dose% )** mg

$aintenance dose% ()* mg bid +duration same as clopidogrel,

$aintenance dose% ()* mg bid +duration same as clopidogrel,

3In patients who are not at high ris9 of bleeding1 .$S : bare5 metal stent, 2#S : drug5eluting stent, P#S : paclita8el5eluting stent, S#S : sirolimus5eluting stent

Anderson JL et al. Circulation. 2007;116:803-77.

DILATA%IJA KRVNI* SUDOVA #TAD"!atna "&re'a

R"ta(lat"r

DILATA%IJA KRVNI* SUDOVA #TAD"!atna "&re'a

R"ta(lat"r

Aterekt"'ija

DILATA%IJA KRVNI* SUDOVA #TAD"!atna "&re'a

..R

DILATA%IJA KRVNI* SUDOVA #TAD"!atna "&re'a

IVUS

K"aksijalna tehnika

DILATA%IJA KRVNI* SUDOVA #TA-

KO@#LIKA%IJE Rane
Tr"'(")a Disekcija

Kasne
Resten")e

KO@#LIKA%IJE-tr"'(")a

KO@#LIKA%IJE-!isekacija

KO@#LIKA%IJE-r &t ra

KO@#LIKA%IJE-resten")a

KO@#LIKA%IJE-resten")a

E@+OLIAA%IJE
The &r"ce! re is a 'ini'all0 invasive alternative t" s r1er06 The & r&"se "2 e'("li)ati"n is t" &revent (l""! 2l"3 t" an area "2 the ("!0$ 3hich e22ectivel0 can shrink a t '" r "r (l"ck an ane r0s'6

T '"r

#artikli Krvni s ! Kateter

Li9 i! e'("lic a1ents i"ns

3ill &"l0'eri)e i''e!iatel0 &"n c"ntact 3ith

Scler"sin1 a1ents - These 3ill har!en the en!"thelial linin1 "2 vessels6
The0 re9 ire '"re ti'e t" react than the li9 i! e'("lic a1ents6 There2"re$ the0 cann"t (e se! 2"r lar1e "r hi1h-2l"3 vessels6 ethan"l The alc"h"l !"es nee! s"'e ti'e t" !enat re &r"teins "2 the en!"theli ' an! activate the c"a1 lati"n s0ste' t" ca se a (l""! cl"t6

#artic late e'("lic a1ents - These are "nl0

se! 2"r &reca&illar0 arteri"les "r s'all arteries6 1el2"a' - Te'&"raril0 "ccl !es vessels 2"r 2ive 3eeks6 #"l0vin0l alc"h"l <#VA= - These are &er'anent a1ents6 The0 are tin0 (alls BC-57CCD ' in si)e6 The &articles are n"t 'eant t" 'echanicall0 "ccl !e a vessel6 Instea! the0 ca se an in2la''at"r0 reacti"n6 Un2"rt natel0$ the0 have a ten!enc0 t" cl '& t"1ether since the (alls are n"t &er2ectl0 r" n!6 The cl '& can se&arate a 2e3 !a0s later$ 2ailin1 as an e'("lic a1ent6 @echanical "ccl si"n !evices - These 2it in all vessels6 c"ils - These are se! 2"r AV.$ ane r0s's6 The0 are ver0 1""! 2"r 2ast2l"3in1 vessels (eca se the0 i''e!iatel0 cl"t the vessel6 !etacha(le (all""n - Treats AV. an! ane r0s's6 These (all""ns are si'&l0 i'&lante! in a tar1et vessel$ then 2ille! 3ith saline thr" 1h a "ne-3a0 valve6

In!ikacije

- he'"ra1ije - ane ri)'e - t '"ri - AV 'al2"r'acije

A!vanta1es @ini'all0 invasive N" scarrin1 @ini'al risk "2 in2ecti"n N" "r rare se "2 1eneral anesthetic .aster rec"ver0 ti'e *i1h s ccess rate c"'&are! t" "ther &r"ce! res #reserves 2ertilit0 an! anat"'ical inte1rit0

Disa!vanta1es User !e&en!ent s ccess rate Risk "2 e'("li reachin1 health0 tiss e N"t s ita(le 2"r ever0"ne Rec rrence '"re likel0

- TE*NIKA - @ATERIJALI
-@AKRO -@IKRO -TEENI -#OLI@ERI -.AR@AKOAKTIVNI

Pre embolizacije

Posle embolizacije

Pre embolizacije

Posle embolizacije

Posle embolizacije

Pre embolizacije

Posle embolizacije

Embolizacija meningeoma

Vena cava filter

TRO@+OLIAA

FANTOVI AA DIJALIAU

K !a i!e IR
56 #"("lj,anje "( ke interventnih ra!i"l"1a ele'enti'a "sn"vn"1 kliniGk"1 ra!a i ne1e ("lesnika6 Interventni ra!i"l")i tre(a !a ( ! s&re'ni )a "tvaranje "!eljenja i klinika )a "v 'e!icinsk "(last6 76 #ri'ena kliniGki "rijetnisanih &r"1ra'a s&ecijali)acije IR k"ja '"He !a "stane "kvir ra!i"l"1ije ili !a ( !e &re&")nata ka" &"se(na s&ecijalistiGka 1rana6 86 #"("lj,anje "&,te1 &")navanja ,ta je IR &"& laciji k"je je vrl" nisk"6 ?6 +"lji "!n"s sa !ija1n"stiGk"' ra!i"l"1ij"' k"ja 2 n!a'entaln" '"ra "stati najsr"!nija 'e!icinska 1rana t"k"' "( ke IR !"'inantna (a)iGna !isci&lina6 B6 Event lana &r"'ena i'ena IR k"ja -e eli'inisati na)iv ra!i"l"1ija k"ji s 1eri,e !ija1n"stiGki servis i vesti na)iv en!"l 'inalna hir r1ija6