Gerardi, Donato (2023) New insights for medical and interventional treatment in CAD and PAD patients. [Tesi di dottorato]

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Abstract

In this thesis we present a summary of the activities carried out in the last 3 years. In the period we have been committed in clinical and interventional activities in the “San Carlo” Regional Hospital, Potenza, Italy, as a full-time MD assigned to the Cardiology Unit. The main areas of interest have been the following: • interventional cardiology, mainly involved in percutaneous coronary intervention (PCI) in elective and emergent procedures as a reference center of the regional network for myocardial infarction “rete IMA”; • inpatient and outpatient clinical assistance; • hospital referral for the diagnosis and treatment of patients with chronic coronary syndrome (CCS); • hospital referral for cardiac assessment and management of patients undergoing non-cardiac surgery. During the period in exam, our research was targeted to different areas but we always kept the focus both on coronary artery disease (CAD) and peripheral artery disease (PAD) and, in general, on multisite atherosclerotic disease (MSAD), which defines subjects at very high cardiovascular risk. We have generally analyzed “real-world” populations that reflect daily clinical practices in order to provide further insights respect to the highly controlled subject enrolled in clinical trials (RCTs). We evaluated the predictors of adherence to medical therapy after acute coronary syndrome (ACS), which constitutes an important issue for the prognosis improvement after cardiovascular events; and safety and efficacy of potent P2Y12-inhibitors in an elderly (>75 year old), real-world population with ACS undergoing percutaneous coronary intervention (PCI), a subgroup slightly represented in RCTs. In the field of PAD, we have examined the long-term results of the DAART (directional atherectomy and antirestenotic therapy) technique for the percutaneous treatment of common femoral artery (CFA) disease. We also report in this thesis a summary of the invited commentaries and literature reviews about PAD and MSAD; we have directed particular attention to carotid artery stenting (CAS) through the novel dual-layer stents and the different protection systems that can be used in this procedure. During these years we also had the opportunity to study the permanent pacemaker implantation (PPMI) after TAVI with a balloon-expandable valve and a high implantation technique.

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