Question

write a literature review on PCIs Using DESs vs Fibrinolytic Therapy

Answer 1

Percutaneous coronary intervention with drug eluting stent

Percutaneous coronary intervention (PCI) is a minimally invasive nonsurgical procedure performed to improve blood flow in one or more segments of the coronary circulation. Coronary revascularization with PCI primarily involves the use of balloon angioplasty and intracoronary stenting with either drug-eluting stents (DES) or bare metal stents (BMS); other tools to improve coronary blood flow include atherectomy and radiation.

DES reduce the rate of restenosis and (accordingly) target lesion revascularization compared with BMS, which are no longer commonly used. The majority of DES consist of a metallic alloy stent, a polymer coating (which may be durable or bioabsorbable), and an antirestenotic drug that is mixed within the polymer and is released over a period of weeks to months after implantation to reduce the local proliferative healing response. DES types currently approved in the United States for use in the coronary circulation are shown in a table.

This topic will present an overview of the use of stents and DES in particular, including issues related to stent deployment, periprocedural medication use, and a few procedural and safety issues.

Fibrinolytic Therapy

Fibrinolytic therapy, also known as thrombolytic therapy, is used to lyse acute blood clots by activating plasminogen, resulting in the formation of plasmin, which cleaves the fibrin cross-links causing thrombus breakdown.

Fibrinolytic therapy is used in the treatment of a ST segment elevation myocardial infarction (STEMI), acute stroke and other less common indications such as pulmonary embolism and acute deep venous thrombosis.

During STEMI, fibrinolytic therapy must be instituted within 24 hours of symptom onset. After this time frame, fibrinolytic therapy is contraindicated and likely will not be effective. Note that fibrinolytic therapy is always given simultaneously with anticoagulation using unfractionated heparin or low molecular weight heparin.

Contraindications: When the decision to treat a patient experiencing a STEMI with fibrinolytic therapy is made, because primary PCI is not available in a timely fashion, contraindications must be considered; suspected aortic dissection, active bleeding (excluding menses) or a bleeding diathesis are contraindications to fibrinolytic therapy.