The many roles of urgent catheter interventions: from myocardial infarction to acute stroke and pulmonary embolism

ABSTRACT

Introduction

Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality.

Areas covered

The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity – myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided.

Expert opinion

Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.

KEYWORDS:

• Percutaneous
• catheter
• intervention
• myocardial infarction
• ischemic stroke
• pulmonary embolism

Article highlights

• Cardiovascular diseases are the most significant worldwide cause of morbidity and mortality, contributing to one-third of all deaths.

• The global prevalence of cardiovascular diseases is constantly increasing.

• Mini-invasive interventions in acutely ill patients usually increase the chance of a quick return to independent life.

• Primary percutaneous coronary intervention is a well-established method for treating acute myocardial infarction with ST-segment elevations.

• Transcatheter interventions for acute stroke are concentrated in centers of excellence, but we believe in their expansion into routine clinical practice.

• Intensive research on transcatheter therapy of pulmonary embolism with promising results is currently underway.

Declaration of interest

V Kočka reports proctoring for Medtronic, lecture fees from Medtronic, Abbott Vascular, Philips, and Terumo. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This article was supported by the Charles University Research project (260530/SVV/2020), the Charles University Research Centre program (no. UNCE/MED/002), and by project INTERCARDIS (project EU Nr. CZ.02.1.01/0.0/0.0/16_026/0008388).