Management of Acute Pulmonary Embolism: Consensus Statement for Indian Patients

Pulmonary embolism (PE) is an important cause of morbidity and mortality among hospitalized patients. Although the exact epidemiology of PE is not known in India, Some of the studies show that more frequently it is missed and not managed appropriately leading to significant cardiovascular morbidity and mortality. Justification and purpose: Indian guidelines for the diagnosis and treatment of acute PE are not yet formulated. The objective of this consensus statement is to propose a diagnostic and management approach for acute PE in India.

PROCESS

A working group of 15 experts in the management of acute PE (cardiologists, pulmonologist, haematologist, emergency specialist and intensivists). This consensus statement makes recommendations for diagnosis and management for PE based on literature review, including Indian data.

Stenting of the right internal mammary artery graft and right coronary artery via a femoral approach

We describe a case of balloon angioplasty and stenting of the right internal mammary artery (RIMA) graft anastomosis and the native right coronary artery through an in situ RIMA graft using two Bard XT stents (USCI Division of C.R. Bard, Inc., Billerica, Massachusetts). This case illustrates the feasibility of transluminal angioplasty and stenting of RIMA grafts and the native coronary artery using a femoral artery approach.

Early experience with the Bard XT stent

The Bard XT stent is a new generation balloon expandable intracoronary stent. It has several unique design advantages. Between October 1996 and November 1997, 127 Bard XT stents of various length were deployed in 93 patients with 109 lesions. According to the American College of Cardiology (ACC) and American Heart Association (AHA) classifications 7 lesions were type A, 38 were type B1, 43 were type B2 and 21 were type C [Ellis et al.: Circulation 82:1193-1202, 1990]. Stent delivery was successful in 98% of attempts. Angiographic success was achieved in 98% of 109 lesions. Procedural success was achieved in 94% of 93 patients. Minimal luminal diameter (MLD) increased from 0.91+/-0.34 mm to 3.03+/-0.44 mm and percentage diameter stenosis reduced from 69.1+/-11.07 to 9.96+/-6.81. Complications occurred in four patients. One patient had intracranial hemorrhage, one patient had subacute thrombosis and two patients died postprocedure. Patients were followed for a period of 1 to 14 months (average 7+/-4 months) for major cardiac events and clinical restenosis. The Bard XT stent is a user-friendly device which provided excellent angiographic results and short-term clinical outcome in selected cases. Further study is required to evaluate effects on restenosis.