User:Mrwikimed/sandbox

This is my sandbox.

Workplan:

These are several additions and edits I would like to add to the angioplasty article:

Uses section:

Coronary Angioplasty: indicated for coronary artery disease such as unstable angina, NSTEMI, STEMI and spontaneous coronary artery perforation. Chhabra L, Zain MA, Siddiqui WJ. Angioplasty. [Updated 2019 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499894/

PCI for stable coronary disease has been shown to significantly relieve symptoms such as angina, or chest pain, thereby improving functional limitations and quality of life.

reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5880567/

Angioplasty

Mortality rates are lower after a CABG compared to PCI in patients with multivessel disease especially with comorbid conditions such as diabetes. reference: PMID: 29478841

Renal Artery Angioplasty: Systematic review suggests there is a weak recommendation for renal artery angioplasty in patients with renal artery stenosis and flash edema or congestive heart failure. Reference: PMID: 22455866

Venous angioplasty: Systematic review suggests there is a weak recommendation for deep venous stenting to treat obstructive chronic venous disease. Reference: PMID: 26464055

New section:

Chronic Limb Threatening Ischemia

The bypass versus angioplasty in severe ischemia of the leg (BASIL) trial investigated bypass surgery first compared to angioplasty first in select patients with severe lower limb ischemia who were candidates for either procedure. The BASIL trial found that angioplasty was associated with less short term morbidity compared with bypass surgery, however long term outcomes favor bypass surgery. Reference: PMID: 16325694

Based on the BASIL trial, the ACCF/AHA guidelines recommend balloon angioplasty only for patients with a life expectancy of 2 years or less or those who do not have an autogenous vein available. For patients with a life expectancy greater than 2 years of life, or who have an autogenous vein, a bypass surgery could be performed first. PMID: 21963765

Angioplasty can be used in advanced peripheral artery disease to relieve the claudication, or leg pain, that people classically experience.

reference: https://www.ncbi.nlm.nih.gov/books/NBK519606/

Carotid artery stenting:

CAS

Although carotid endarterectomy (CEA) is typically preferred over carotid artery stenting (CAS), stenting is indicated in select patients with radiation-induced stenosis or a carotid lesion not suitable for surgery. reference: PMID: 29422277

Venous angioplasty:

Angioplasty is used to treat dialysis access stenosis, with drug-coated balloon angioplasty proving to have better 6-month and 12 month patency than conventional balloon angioplasty. Reference PMID: 31445651

Angioplasty is occasionally used to treat subclavian vein stenosis caused by thoracic outlet syndrome following thoracic outlet decompression. PMID: 15472583

 Contraindications:

Percutaneous transluminal coronary angioplasty (PTCA) is contraindicated in patients with left main coronary artery disease, due to the risk of spasm of the left main coronary artery during the procedure. Also, PTCA is not recommended if there is less than 70% stenosis of the coronary arteries, as the stenosis it is not deemed to be hemodynamically significant below this level. ncbi.nlm.nih.gov/books/NBK535417/

Techniques section:

Transradial Approach vs. Transfemoral approach. reference: https://www.ncbi.nlm.nih.gov/books/NBK499894/

Transradial artery access (TRA) and transfemoral artery access (TFA) are two techniques for percutaneous coronary intervention.

Transradial approach is the technique of choice for management of acute coronary syndrome as it has significantly lower incidence of bleeding and vascular complications compared with the transfemoral approach. TRA also has a mortality benefit for high risk ACS patients and high risk bleeding patients. TRA was also found to have improved quality of life, as well as decreased healthcare costs and resourses. Reference: https://www.ahajournals.org/doi/full/10.1161/HCV.0000000000000035

Risks and Complications section:

Systematic review of patients with Aortoiliac Occlusive Disease (AIOD) identifies distal embolization, access site hematomas, pseudoaneurysms, arterial ruptures and arterial dissections as potential adverse outcomes of angioplasty. Reference: PMID: 20598474

I want to add:

Cerebral Hyperperfusion Syndrome leading to stroke is a serious complication of carotid artery angioplasty with stenting. Reference: PMID: 30196814

Coated vs. Uncoated:

Systematic review finds that among patients with femoropopliteal arterial occlusive disease, drug-eluting balloon angioplasty had significantly less restenosis, late lumen loss and target lesion revascularization at both short term and midterms follow-up compared to uncoated balloon angioplasty. Reference: PMID: 27478005

Drug-eluting balloon angioplasty has significantly less restenosis, late lumen loss and target lesion revascularization at both short term and midterm follow-up compared to uncoated balloon angioplasty.

A systematic review finds that although angioplasty of the femoropopliteal artery with paclitaxel-coated stents and balloons significantly reduces rates of vessel restenosis and target lesion revascularization, it was also found to have increased risk of death. reference:PMID: 30561254

Recovery section:

I want to add:

A systematic review finds concomitant use of Clopidogrel and Proton Pump Inhibitors following coronary angiography is associated with significantly higher adverse cardiovascular complications such as MACEs, stent thrombosis and myocardial infarction. Long-term mortality is not significantly different, though. Reference: PMID: 28056809

Dual antiplatelet therapy (DAPT) is recommended for 1 month following bare metal stent placement, for 3 months following a second generation drug-eluting stent placement, and for 6-12 months following a first generation drug-eluting stent placement. It is important to consider each patient's cardiac conditions and bleeding risk when determining the amount of time DAPT should be continued.

https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2016/03/25/14/56/2016-acc-aha-guideline-focused-update-on-duration-of-dapt

Reference: Chhabra L, Zain MA, Siddiqui WJ. Angioplasty. [Updated 2019 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Exercise-based rehabilitation following percutaneous coronary intervention has shown improvement in recurrent angina, total exercise time, ST-segment decline, and maximum exercise tolerance. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356037/

 History Section:

The initial form of angioplasty was 'plain old balloon angioplasty' (POBA) without stenting, until the invention of bare metal stenting in the mid-1980s to prevent the early restenosis observed with POBA.

Bare metal stents were found to cause in-stent restenosis as a result of neointimal hyperplasia and stent thrombosis, which led to the invention of drug-eluting stents with anti-proliferative drugs to combat in-stent restenosis.

Reference: Chhabra L, Zain MA, Siddiqui WJ. Angioplasty. [Updated 2019 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Peer review for Alcoholic Hepatitis:

-The lead is strong and concise.

-Signs and Symptoms section: second paragraph seems more relevant to the pathophysiology, perhaps consider moving it to that section. Also, clarification on final sentence about alcoholic steatonecrosis - it seems to be referring to the previous few sentences, but clarification would be helpful.

-The illustration for the Pathogenesis of alcoholic liver injury is relevant and detailed, and I believe that a written explanation would be helpful to clarify for many readers.

-I see links to modified Maddrey's discriminant function score, MELD score and Child-Pugh score - perhaps a brief description of these scoring systems can be added to this article

-Strong Management section

Overall, strong work!