MEDtalks with Dr KK Aggarwal
Now an ultra-thin stent
Often doctors are blamed for putting a costly stent. The government does not differentiate between different stents. The smallest-sized DES currently available is 2.25 mm. Patients with CAD in vessels <2.25 mm are currently managed with bare-metal stents, oversizing with a 2.25-mm DES, or plain old balloon angioplasty, as drug-eluting balloons are not yet available.
Now the first prospective study of a 2.0-mm drug-eluting stent (DES) met its primary end point and was associated with a reassuringly low rate of clinical events in patients with CAD in very small coronary vessels. The 12-month target lesion failure rate was 5%. In addition, there was zero stent thrombosis with the investigational 2.0-mm zotarolimus-eluting stent (Resolute Onyx, Medtronic). This dedicated size of Resolute Onyx allows for the successful treatment of lesions involving extremely small vessels, thereby fulfilling an important unmet clinical need. The mean reference vessel diameter (RVD) in the RESOLUTE ONYX 2.0 mm Clinical Study was 1.91 mm.
Now with all stents in NLEM will the companies introduce the 2.0 stent in India market and if so will they be able to match the current Indian capped prise?
Lightening injury and cricket
Sorry for 21-year-old aspiring cricketer who died on the spot after he was struck by lightning coupled with thundershowers during practice at the Calcutta Cricket Academy here. The club members did CPR but after seeing no response, took him to Ramakrishna Mission Seva Pratishthan where he was declared dead. I hope CPR was continued on the way.
Lightning injuries are responsible for an average of 300 injuries and 100 deaths per year in the United States. 30 percent of those struck by lightning die and up to 74 percent of survivors may have permanent disabilities. Two-thirds of lightning-associated deaths occur within one hour of injury and are generally due to a fatal arrhythmia or respiratory failure.
Prolonged CPR should be undertaken following electrical injury regardless of the initial rhythm, since most victims are young and good outcomes have been noted even among patients with asystole. Usual triage priorities are reversed if multiple victims are present: patients without signs of life are treated first.
Lightning injury (asystole, DC current) can result in clinical signs typically associated with severe brain injury (fixed and dilated pupils) but which may not accurately reflect the patient's neurologic status. Therefore, prolonged CPR is indicated.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO