Overview
To achieve optimal long-term clinical results after percutaneous coronary intervention (PCI), adequate deployment of stents is essential. Thorough expansion of the stent and full apposition of stent struts against the vessel wall are determining factors for preventing stent thrombosis and restenosis for bare-metal as well as drug-eluting stents (DES). Standard coronary angiography is limited in assessing accurate vessel size and characterizing tissues and calcium load. Therefore, stent underexpansion frequently occurs after stent deployment.
Post-dilation is often performed to achieve optimal stent expansion and reduce stent malapposition of stent struts, aiming to reduce stent thrombosis and restenosis both short term as long term. However, there are limited studies that have explored the effect of post-dilatation for stent optimization on clinical outcomes. As a result of the restricted evidence, there is no consensus whether post-dilatation should be used routinely in clinical practice and the extent to which post-dilatation is being utilized remains unclear.
For this reason, the OPTIMIZE PCI was designed, a national registry-based quality improvement project to implement a liberal post-dilatation strategy in multiple PCI centers in the Netherlands. As part of the OPTIMIZE-PCI, a retrospective observational analysis will eventually be conducted to evaluate whether adopting this strategy has led to improved clinical outcomes after PCI in terms of major adverse cardiac events.
Description
Among physical therapies, in recent years particular interest has been focused on the laser (Light Amplification through the Stimulated Emission of Radiation), which exploits the biological effects induced by electromagnetic emission, consisting of increased mitochondrial oxidation, which facilitates the formation of adenosine triphosphate (ATP), increased cellular metabolism, and blood circulation, with rapid absorption of edema and removal of exudates. These actions induce significant anti-inflammatory, proliferative, and analgesic effects on various orthopedic conditions. So far, low-energy lasers have been used in rehabilitative treatments. Currently, there is growing interest in using high-energy lasers, which have a greater ability to penetrate deeply into the tissues and to biostimulate the affected area.The first studies investigating the effects of high-energy laser in this pathology provide interesting results. Medina-Porqueres et al. in 2017 published a study protocol for high-energy laser treatment in rhizarthrosis, which involved randomization to experimental treatment or placebo, but to date the results have not been disclosed. Cantero-Téllez and colleagues (2020) treated 43 patients with rhizarthrosis, randomizing them to an experimental group (high-energy laser) or placebo. They found a remission of pain at the end of high-energy laser treatment, noting, however, that the benefits subsided within 12 weeks. Guo and colleagues (2023) also randomized 42 patients with rhizarthrosis to high-energy laser treatment with occupational therapy guidance or to short-wave treatment and orthosis; their experience has shown that experimental treatment with high-energy laser allowed for improvement in pain and pinch function of the thumb at 12 weeks. The aim of our study is to further investigate the therapeutic effectiveness of high-energy laser treatment in hand osteoarthritis.
Eligibility
Inclusion Criteria:
- All patients \>18 years old who undergo PCI for any indication are included in the register of the Netherlands Heart Registration and therefore included in the final analysis of this project
Exclusion Criteria:
\- If a patient has multiple PCIs within 365 days, only the first procedure is included.
