interventional cardiology fellowship curriculum - Winthrop University ...

Restenosis: The Clinical Issues
Since the inception of percutaneous transluminal coronary angioplasty (PTC A) almost 25
years ago, percutaneous coronary revascularization has been an increasingly attractive
alternative to surgical revascularization and medical therapy for coronary artery disease
(CAD). Currently, well over 1 million percutaneous coronary intervention (PCI)
procedures are performed each year worldwide, with the majority of cases being
performed in North America and Western Europe, and the rate doubles every 5 to 8 years.
Despite the steady and continuous advancement in the field of interventional cardiology,
restenosis remains an important limitation of percutaneous coronary revascularization.
Prior to the advent of drug-eluting stents, about one quarter of procedures were performed
in lesions that were previously treated with PCI. Considering that more than 700,000
cases were performed in the United States annually at that time, this translated to a cost
of $3.5 billion/year for the treatment of restenosis. In 2003, drug-eluting stents became
available, after studies confirmed their significant reduction in the development of
restenosis. There is no question that drug-eluting stents have been a breakthrough,
resulting in the treating of more complex lesions and reducing the need for repeat
procedures over the ensuing year. However, over the past year, it has become clear that
these stents also carry a somewhat higher risk of late thrombosis.
Fellows will understand the pathophysiology of restenosis, the various methods of treating
and prevention restenosis, the risks and benefits of drug-eluting stents, and the challenges
in developing next generation stents to combat restenosis while preserving a higher safety
profile.
Endovascular Options for Peripheral Arterial Occlusive and Aneurysmal
Disease
By the first quarter of the twenty-first century, diseases of the vascular tree will surpass
infectious pathologies as the number one cause of death worldwide. In the United States
alone, cardiovascular disease or stroke was listed as a primary or contributing cause in
1.4 million deaths in 1999, or about 60% of all deaths that year. With demographic trends
toward more aged populations, not only quantity, but quality of life issues are coming to
the fore as well. The prevalence of intermittent claudication ranges from about 1% for
people ages 40 to 44 years up to almost 7% for those 70 years old and above. Worldwide,
the burden of lower limb amputations, which is a multifactorial problem, ranges from 120
per million population in Western Finland to 500 per million in the United Kingdom
annually. In the United States, there are more than 400,000 hospitalizations for peripheral
arterial disease (PAD) and close to 80,000 amputations annually.
26 Revised : 8/23/09
6/30/10