Assessment of the role and investigation particularities (comparative and complementary aspects, hierarchies, preferential indication) adapted to the context of a global cardiovascular (CV) evaluation, including clinical elements, non-invasive and invasive imagistic examination in order to estimate the cardiovascular risk (CVR) and to define the revascularization therapeutic strategy in patients with critical leg ischemia (CLI). Complete and accessible evaluation involves accessible means of investigation like clinical exam, electrocardiogram, cardiac biomarkers, arterial, cardiac, and carotid ultrasonography which could be affordable in all cardiovascular departments. Non-invasive stress tests, coronary and arterial cervical angiography imaging leads in selected cases and where is possible to the identification of significant coronary and/or carotid lesions potential responsible for cardiac and cerebrovascular events after vascular surgery. The evaluation algorithm allows better risk stratification of patients with CLI in high and intermediate CVR. The “poly-arterial” status in patients with CLI changes the intervention management with a more intensive pre-operative medical treatment, while the coronary and the carotid arteries revascularization might precedes the peripheral arterial revascularization procedures, in order to reduce the CV risk status.
Part of the book: Peripheral Arterial Disease
Left ventricular (LV) lead positioning is one of the main contributors to the cardiac resynchronization therapy (CRT) response. Conventional left ventricular (LV) lead implantation faces several difficulties, which may ultimately affect lead stability and performance. Several imaging techniques have been proposed to overcome all these obstacles including multimodality cardiac imaging to help in preprocedural or intraprocedural identification of the latest activated areas of the LV. Emerging pacing strategies like LV multisite and multipoint pacing may help deliver an enhanced response to CRT, but prospective trials are warranted to confirm the superiority of this approach.
Part of the book: Cardiac Diseases and Interventions in 21st Century