Precision medicine in Non-coronary vessel disease

2019/09/16 22:19:50
Precision medicine in Non-coronary vessel disease

Take home messages in “Peripheral Artery Disease”

1. Peripheral artery disease is a marker for systemic atherosclerosis disease and increase the risk of coronary and cerebrovascular disease morbidity and death
2. Patients with pheripheral artery disease have 4 times increase of myocardial infarction and 2-3 times of stroke.
3. Issue to be concerned before carotid stenosis revascularization :
- Symptomatic vs Asymptomatic
- Patient’s condition
- High risk carotid including aortis arch anatomy
4. Revascularization of asymptomatic vertebral artery stenosis is not indicated, irrespective of the degree of severity.
5. Routine revascularization is not recommended in RAS secondary to atherosclerosis.
6. Lower extremity artery disease
- Intermittent claudication : Goal to provide relief of symptoms
- Critical limb ischemia : Goal to promote limb survival

Take home messages in “Coarctation of Aorta”

7. Don’t forget to feel the pulse and measure the blood pressure in lower extremities in adolescents or young adults with hypertension.
8. Pulse wave Doppler at descending aorta is necessary tool to detect coarctation of aorta.
9. Non- surgical modality is a useful alternative.
10. Unrepaired or repaired coarctation of aorta require lifetime follow up.

Take home messages in “Takayasu’s Arteritis”

11. Takayasu’s arteritis : diagnosis depends on physician and carefully physical exam
12. ESR(low sensitivity) and non-invasive imaging(CTA/MRA +/- PET) of whole aorta is helpful to evaluate activity of disease
13. Early diagnosis and long term treat with immunosuppressive : Reduced complication and progression of disease.
14. Severe cardiovascular manifestation : Increased heart failure, morbidity and mortality.
15. Multidisciplinary tyeam is needed : Rheumatologist/vascular radiologist/interventionist/vascular surgeon.