01 aimradial2016 thu IC Gilchrist
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1) The document discusses the lack of evidence supporting the routine use of Allen's test or oximetry prior to radial artery catheterization to predict ischemic complications. 2) While Allen's test and oximetry are commonly used as part of the procedure, the evidence shows they have no predictive value and normal vs. abnormal results do not correlate with risk. 3) The document recommends refocusing attention on techniques like oximetry and plethysmography after the procedure to guide hemostasis and minimize radial artery occlusion, rather than using pre-procedure testing to predict complications.
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01 Gilchrist aimradial20170921 Allen or not
01 Gilchrist aimradial20170921 Allen or notInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses whether performing Allen's test or oximetry is still necessary prior to performing radial artery catheterization. It notes that there is no class I evidence or randomized data to support the significance of an abnormal Allen's test result or its predictive value. Studies have found no differences in outcomes between patients with normal versus abnormal Allen's test results. The document concludes that there is no evidence that pre-procedural testing of dual circulation prevents ischemic complications, and that focus should instead be on techniques to guide patent hemostasis after transradial procedures to minimize radial artery occlusion.Metis Project 3: Predicting Heart Disease Diagnosis
This document evaluates a classification algorithm to sensitively diagnose coronary artery disease (CAD) in men and women. It uses features from a heart disease dataset to train several models. A Gaussian Naive Bayes model proved best with a recall of 80% for men and 81% for women. For men, the most influential features were age over 55, resting heart rate under 140 bpm, and resting blood pressure over 220 mmHg. For women, the most important features were cholesterol over 275 mg/dL, peak heart rate under 150 bpm, and peak blood pressure over 240 mmHg.
Economics of screening for atherosclerosis final
This document discusses screening for atherosclerosis and the different perspectives on it from cardiac imaging experts, practicing physicians, patients, and academic professors. It also addresses the two key questions around screening: whether a screening strategy provides good value for the cost and if the healthcare budget can support providing it to patients. The document outlines clinical trials showing statin therapy for prevention can reduce deaths, heart attacks, procedures and costs over 5 years. However, widespread screening raises concerns about overburdening the healthcare system. Identifying high-risk patients for sudden cardiac death also presents a screening paradox in balancing potential benefits with large screening populations.
15 aimradial2016 thu V Alfaro
15 aimradial2016 thu V AlfaroInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a case study of a patient who experienced radial artery occlusion after undergoing coronary angiography. Key details include:
- A female patient experienced radial artery occlusion 4 years after angiography, with symptoms of pain and abnormal feeling in her right arm and hand.
- Ultrasound confirmed occlusion of the right radial artery with normal ulnar flow.
- The occlusion was successfully reopened by passing a guidewire retrograde through the ulnar artery and superficial radial palmar arch, then performing subintimal recanalization and balloon angioplasty.
- A stent was then deployed in the distal radial artery, with post-dilation to ensure patency. The procedure combined both antegrade and retro16 aimradial2016 thu A Lux case
16 aimradial2016 thu A Lux caseInternational Chair on Interventional Cardiology and Transradial Approach
1) A 56-year-old male presented with right forearm pain and swelling two weeks after a transradial angiography.
2) Ultrasound and angiography revealed an occluded right radial artery and incomplete palmar arch.
3) Attempts to recanalize the radial artery failed, but angioplasty of the deep palmar arch and interdigital arteries improved blood flow and provided relief from symptoms. Long term follow up showed persistent mild complaints but good collateral blood flow.01 aimradial2016 thu2 B Speiser
01 aimradial2016 thu2 B SpeiserInternational Chair on Interventional Cardiology and Transradial Approach
This document provides guidance on transradial catheterization procedures. It defines ideal candidates, contraindications, and pre-procedure assessment criteria. It describes how to prepare the radial and femoral sites, including administering numbing agents and positioning the patient's arm. The benefits of transradial procedures and post-procedure care instructions are also outlined. Key steps like the Barbeau test to assess dual hand circulation and monitoring pulse oximetry and waveforms after hemostasis device placement are emphasized to help ensure patient safety and procedure success.20 aimradial2016 fri SB Pancholy
20 aimradial2016 fri SB PancholyInternational Chair on Interventional Cardiology and Transradial Approach
This document describes the PROPHET-II clinical trial which evaluated the effect of ulnar artery compression during radial artery hemostasis on reducing radial artery occlusion rates. The trial randomized 3000 patients undergoing transradial cardiac catheterization to either patent hemostasis alone or patent hemostasis with additional ulnar compression. The primary endpoint was 30-day radial artery occlusion as assessed by ultrasound. Results found a significantly lower occlusion rate in the group that received ulnar compression compared to the patent hemostasis alone group, demonstrating ulnar compression may help reduce radial artery occlusion when performed during transradial procedures.17 aimradial2016 thu A Katona Case
17 aimradial2016 thu A Katona CaseInternational Chair on Interventional Cardiology and Transradial Approach
A 53-year-old woman presented with chest pain from a recent myocardial infarction. During a coronary angiography, her stent became damaged during unsuccessful deployment. Multiple attempts to retrieve the damaged stent directly or by pulling it with a balloon failed. While waiting for a surgeon, the physician was able to grab and extract the damaged stent using tweezers through the left radial artery approach. The radial approach allowed for extraction of the damaged stent without further circulation problems.Recommended
01 Gilchrist aimradial20170921 Allen or not
01 Gilchrist aimradial20170921 Allen or notInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses whether performing Allen's test or oximetry is still necessary prior to performing radial artery catheterization. It notes that there is no class I evidence or randomized data to support the significance of an abnormal Allen's test result or its predictive value. Studies have found no differences in outcomes between patients with normal versus abnormal Allen's test results. The document concludes that there is no evidence that pre-procedural testing of dual circulation prevents ischemic complications, and that focus should instead be on techniques to guide patent hemostasis after transradial procedures to minimize radial artery occlusion.Metis Project 3: Predicting Heart Disease Diagnosis
This document evaluates a classification algorithm to sensitively diagnose coronary artery disease (CAD) in men and women. It uses features from a heart disease dataset to train several models. A Gaussian Naive Bayes model proved best with a recall of 80% for men and 81% for women. For men, the most influential features were age over 55, resting heart rate under 140 bpm, and resting blood pressure over 220 mmHg. For women, the most important features were cholesterol over 275 mg/dL, peak heart rate under 150 bpm, and peak blood pressure over 240 mmHg.
Economics of screening for atherosclerosis final
This document discusses screening for atherosclerosis and the different perspectives on it from cardiac imaging experts, practicing physicians, patients, and academic professors. It also addresses the two key questions around screening: whether a screening strategy provides good value for the cost and if the healthcare budget can support providing it to patients. The document outlines clinical trials showing statin therapy for prevention can reduce deaths, heart attacks, procedures and costs over 5 years. However, widespread screening raises concerns about overburdening the healthcare system. Identifying high-risk patients for sudden cardiac death also presents a screening paradox in balancing potential benefits with large screening populations.
15 aimradial2016 thu V Alfaro
15 aimradial2016 thu V AlfaroInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a case study of a patient who experienced radial artery occlusion after undergoing coronary angiography. Key details include:
- A female patient experienced radial artery occlusion 4 years after angiography, with symptoms of pain and abnormal feeling in her right arm and hand.
- Ultrasound confirmed occlusion of the right radial artery with normal ulnar flow.
- The occlusion was successfully reopened by passing a guidewire retrograde through the ulnar artery and superficial radial palmar arch, then performing subintimal recanalization and balloon angioplasty.
- A stent was then deployed in the distal radial artery, with post-dilation to ensure patency. The procedure combined both antegrade and retro16 aimradial2016 thu A Lux case
16 aimradial2016 thu A Lux caseInternational Chair on Interventional Cardiology and Transradial Approach
1) A 56-year-old male presented with right forearm pain and swelling two weeks after a transradial angiography.
2) Ultrasound and angiography revealed an occluded right radial artery and incomplete palmar arch.
3) Attempts to recanalize the radial artery failed, but angioplasty of the deep palmar arch and interdigital arteries improved blood flow and provided relief from symptoms. Long term follow up showed persistent mild complaints but good collateral blood flow.01 aimradial2016 thu2 B Speiser
01 aimradial2016 thu2 B SpeiserInternational Chair on Interventional Cardiology and Transradial Approach
This document provides guidance on transradial catheterization procedures. It defines ideal candidates, contraindications, and pre-procedure assessment criteria. It describes how to prepare the radial and femoral sites, including administering numbing agents and positioning the patient's arm. The benefits of transradial procedures and post-procedure care instructions are also outlined. Key steps like the Barbeau test to assess dual hand circulation and monitoring pulse oximetry and waveforms after hemostasis device placement are emphasized to help ensure patient safety and procedure success.20 aimradial2016 fri SB Pancholy
20 aimradial2016 fri SB PancholyInternational Chair on Interventional Cardiology and Transradial Approach
This document describes the PROPHET-II clinical trial which evaluated the effect of ulnar artery compression during radial artery hemostasis on reducing radial artery occlusion rates. The trial randomized 3000 patients undergoing transradial cardiac catheterization to either patent hemostasis alone or patent hemostasis with additional ulnar compression. The primary endpoint was 30-day radial artery occlusion as assessed by ultrasound. Results found a significantly lower occlusion rate in the group that received ulnar compression compared to the patent hemostasis alone group, demonstrating ulnar compression may help reduce radial artery occlusion when performed during transradial procedures.17 aimradial2016 thu A Katona Case
17 aimradial2016 thu A Katona CaseInternational Chair on Interventional Cardiology and Transradial Approach
A 53-year-old woman presented with chest pain from a recent myocardial infarction. During a coronary angiography, her stent became damaged during unsuccessful deployment. Multiple attempts to retrieve the damaged stent directly or by pulling it with a balloon failed. While waiting for a surgeon, the physician was able to grab and extract the damaged stent using tweezers through the left radial artery approach. The radial approach allowed for extraction of the damaged stent without further circulation problems.04 aimradial2016 thu S Bartus
04 aimradial2016 thu S BartusInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses trends in vascular access sites for coronary procedures. It notes that radial access has significantly increased over time in many countries, now accounting for over 75% of procedures in some registries. Some benefits of radial access include lower mortality, major adverse cardiac and cerebrovascular events, major bleeding, and vascular complications compared to femoral access. However, it also notes there is a paradoxical increase in vascular complications with femoral access as radial access has become more prevalent. This may be due to adverse patient characteristics now associated more with femoral procedures. Overall, while radial access appears beneficial, patient factors remain an important determinant of outcomes. Operator experience with femoral access is still important.21 aimradial2016 thu S Alonso
21 aimradial2016 thu S AlonsoInternational Chair on Interventional Cardiology and Transradial Approach
This pilot study examined whether 3 hours of radial compression after a radial artery catheterization procedure is as effective as 6 hours of compression. 112 patients undergoing radial procedures received either 3 hours (n=63) or 6 hours (n=49) of compression. The primary endpoint was access site bleeding requiring prolonged compression. Secondary endpoints included major bleeding, hematoma size, and modified Barbeau test responses. Preliminary results found no significant differences in bleeding rates between the 3 hour and 6 hour groups. While the 3 hour group trended toward more bleeding with lower heparin doses, larger studies are still needed to achieve sufficient statistical power. The study demonstrates 3 hour compression may be as effective as 6 hours, but more research is required05 aimradial2016 thu S Sindberg ACCESS-1
05 aimradial2016 thu S Sindberg ACCESS-1International Chair on Interventional Cardiology and Transradial Approach
The ACCESS-I study randomized 1000 patients scheduled for radial angiography or angioplasty to either a Terumo® Glidesheath Slender TM (Slender) or a Terumo® standard sheath. The study found that patients who received the slender sheath reported less pain during sheath insertion, with a median VAS score of 1 versus 2 for the standard sheath (p=0.02). However, no differences were found between the sheaths for pain during the procedure, use of sedatives or analgesics, success of the radial procedure, or patency of the radial artery after the procedure.17 FFR Bertrand OF aimradial2016 - post-pci FFR
17 FFR Bertrand OF aimradial2016 - post-pci FFRInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation on the impact of post-PCI FFR (fractional flow reserve) measurements on clinical outcomes. It describes a case study where FFR was measured before and after PCI in two arteries of an 83-year-old man. The presentation reviews studies showing that post-PCI FFR values above 0.90 are associated with lower rates of revascularization and major adverse cardiac events. It concludes that the exact clinical impact of post-PCI FFR needs more demonstration but the ongoing PREDICT registry aims to clarify this by measuring post-PCI FFR in all patients and following their outcomes over two years.10 FFR Berry C aimradial2016 - FAME trials
10 FFR Berry C aimradial2016 - FAME trialsInternational Chair on Interventional Cardiology and Transradial Approach
1. The FAME and FAME-2 trials showed that FFR-guided percutaneous coronary intervention (PCI) led to better long-term outcomes compared to angiography-guided PCI alone.
2. Five-year follow up data from the FAME trial confirmed the benefits of FFR-guided revascularization.
3. European Society of Cardiology guidelines recommend FFR-guided decision making for revascularization in stable coronary artery disease based on the evidence from the FAME trials.11 aimradial2016 fri V Dangoisse
11 aimradial2016 fri V DangoisseInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a technique using two 5F guiding catheters and two transradial arterial accesses to perform left main coronary artery PCI. Five cases are presented where this "double wrist-double guide" technique was used. The main points are:
1) The technique allows manipulation with two smaller guiding catheters instead of one larger catheter, avoiding potential radial artery compromise while maintaining back-up support and multi-wire capabilities.
2) Preliminary results found the technique was as efficient and successful as using a single larger arterial access and guiding catheter.
3) An unexpected discovery was that manipulating two balloons ("X-kiss" pattern) during the procedure may result in better stent strut07 aimradial2016 fri2 P Montorsi
07 aimradial2016 fri2 P MontorsiInternational Chair on Interventional Cardiology and Transradial Approach
Transradial access for carotid artery stenting with proximal protection devices can be technically challenging but is safe and effective according to the presenter's experience. Of 382 carotid stenting procedures performed between 2012-2014, 267 used radial/brachial access and 76 used the Mo.Ma proximal protection system through radial/brachial access. The first attempt failure rate was 34.6% primarily due to sharp carotid artery bifurcation angles and device stiffness. Modified techniques including removing the Mo.Ma mandrel and using two guidewires improved the technical success rate to 98.6% with only 1.3% requiring conversion to a femoral approach. Periprocedural complications were low at 1.3% with no deaths06 aimradial2016 fri2 A Noor
06 aimradial2016 fri2 A NoorInternational Chair on Interventional Cardiology and Transradial Approach
A 57-year-old male presented with lower urinary tract symptoms refractory to medical therapy. He was referred for transradial prostate artery embolization as an alternative to transurethral resection of the prostate due to risks of complications. Bilateral prostatic arteries were selectively catheterized and embolized using Embozene particles via a microcatheter system. Cone beam CT confirmed treatment. The patient experienced decreased symptoms with no complications. Prostate artery embolization is a promising minimally invasive option for patients seeking to avoid surgery or retrograde ejaculation.11 aimradial2016 fri2 T Kwan
11 aimradial2016 fri2 T KwanInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the transpedal approach for peripheral interventions. The transpedal approach involves accessing the pedal or tibial arteries in the foot retrogradely to perform endovascular interventions for conditions like chronic total occlusions in the leg arteries. Some key advantages of the transpedal approach are that it allows dual access for complex interventions, avoids complications associated with femoral access, and can be used when recanalizing total occlusions from above has failed. The document reviews various studies demonstrating the safety, feasibility and clinical outcomes of the transpedal approach.Shapiro T 201110
This document discusses Lankenau Medical Center's transition from femoral to radial artery access for cardiac catheterization procedures. It describes how the medical center trained physicians and staff, increased radial artery procedures over time, and significantly reduced major vascular complications as a result of the transition. Rates of radial artery procedures grew from 10% in early 2010 to over 75% in 2011. The medical center's vascular complication rate dropped from 0.91% prior to the transition to 0% after adopting radial artery access.
Leon MB - Current perspectives
Leon MB - Current perspectivesInternational Chair on Interventional Cardiology and Transradial Approach
Martin B. Leon discusses current perspectives on transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention. TRA use has increased significantly in recent years due to several advantages over transfemoral access, including reduced bleeding and vascular complications. However, TRA still requires a learning curve and is best performed by high-volume operators to maximize benefits. While TRA may become the preferred access site for over 50% of cases in the next 5-10 years, both transfemoral and TRA skills will remain important for interventional cardiologists.Cohen MG 201305
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
Zelizko M
Transradial Access is the Best Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome with ST Elevation: Results from the RIVAL Trial, SCAAR Registry and Czech NRKI Registry
Teirstein P - Transitioning to radial
Teirstein P - Transitioning to radialInternational Chair on Interventional Cardiology and Transradial Approach
1) Transitioning to radial access for cardiac catheterization procedures is growing at Scripps Clinic, with over 50% of procedures now being done radially.
2) However, it can be difficult for experienced interventionalists who are used to femoral access to learn new radial techniques. They have busy practices and may be hesitant to take on new complications.
3) While radial access has advantages for patients like reduced bleeding risks, it also has limitations compared to femoral access for complex cases that require multiple devices or backup support through large guide catheters. Radial access may not always be the best choice.Jolly S 201111
The RIVAL trial compared outcomes of radial versus femoral access in over 7,000 patients undergoing angiography or percutaneous coronary intervention. It found that radial access was associated with a lower risk of major vascular complications compared to femoral access, but found no differences in rates of death, myocardial infarction, stroke, or major bleeding. Radial access provided benefits regardless of operator or center volume. The study demonstrated that with experience, radial access can be performed as safely as femoral access in a variety of clinical settings.
RIVAL trial - Summary & Results
http://www.theheart.org/web_slides/1215405.do
A head-to-head comparison of Radial vs Femoral Access for Coronary Intervention (RIVAL)
Wilcox JN - AIMRADIAL 2013 - Medtronic perspective
Wilcox JN - AIMRADIAL 2013 - Medtronic perspectiveInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses Medtronic's strategy to address global healthcare needs by developing new therapies and technologies, expanding access through globalization, and optimizing costs and efficiencies. Medtronic aims to become a healthcare solutions provider by improving clinical outcomes, expanding access to care, and translating the clinical value of its products into economic benefits. The document provides examples of Medtronic technologies like its Integrity and Resolute Integrity drug-eluting stents and the Symplicity renal denervation system. It also outlines Medtronic's portfolio and programs to facilitate adoption of transradial access procedures.Team of rivals powerpoint
1) Lincoln was re-elected in November 1864 and led his administration, including Secretary of State William Seward and the volatile Secretary of War Edwin Stanton, through the final year of the Civil War.
2) Lincoln's leadership inspired dedication among his cabinet, including Seward and Stanton, despite disagreements, and influenced views on emancipation within the government.
3) In his second inaugural address on March 4, 1865, Lincoln called for peace and restoration of the Union while upholding emancipation, to an estimated crowd of 50,000.
Techniques of Vascular acess for Cardiac Catheterization
Vascular acess, cardiac catheterization, femoral artery puncture, vascular acess route, radial artery catheterization
Gilchrist IC - AIMRADIAL 2015 - Still need Allen test?
Gilchrist IC - AIMRADIAL 2015 - Still need Allen test?International Chair on Interventional Cardiology and Transradial Approach
1) Prior studies have found no class I evidence or randomized data to support performing Allen's test or oximetry prior to radial artery catheterization.
2) Performing Allen's test has been considered a ritual or standard practice without clear data on its predictive value or significance.
3) A recent study found no differences in outcomes between patients with normal, intermediate, or abnormal Allen's test results, suggesting there is no risk from an abnormal test.
4) The focus should be on oximetry-plethysmography and techniques to guide hemostasis after radial procedures to minimize radial artery occlusion, not on pre-procedural testing for dual circulation.Gilchrist IC - AIMRADIAL 2014 - Allen's test
Gilchrist IC - AIMRADIAL 2014 - Allen's testInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the practice of performing Allen's test or oximetry prior to radial artery catheterization. It summarizes that:
1) There is no Class I evidence or randomized data showing the predictive value of Allen's test, and the significance of an abnormal test is unclear.
2) A study found no differences in outcomes between patients with normal, intermediate, or abnormal Allen's tests, suggesting no risk from an abnormal test.
3) Recommendations are that there is no evidence to support performing Allen's test or testing for dual circulation to prevent ischemic complications of transradial catheterization. Attention should instead focus on techniques to guide hemostasis after the procedure.More Related Content
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04 aimradial2016 thu S Bartus
04 aimradial2016 thu S BartusInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses trends in vascular access sites for coronary procedures. It notes that radial access has significantly increased over time in many countries, now accounting for over 75% of procedures in some registries. Some benefits of radial access include lower mortality, major adverse cardiac and cerebrovascular events, major bleeding, and vascular complications compared to femoral access. However, it also notes there is a paradoxical increase in vascular complications with femoral access as radial access has become more prevalent. This may be due to adverse patient characteristics now associated more with femoral procedures. Overall, while radial access appears beneficial, patient factors remain an important determinant of outcomes. Operator experience with femoral access is still important.21 aimradial2016 thu S Alonso
21 aimradial2016 thu S AlonsoInternational Chair on Interventional Cardiology and Transradial Approach
This pilot study examined whether 3 hours of radial compression after a radial artery catheterization procedure is as effective as 6 hours of compression. 112 patients undergoing radial procedures received either 3 hours (n=63) or 6 hours (n=49) of compression. The primary endpoint was access site bleeding requiring prolonged compression. Secondary endpoints included major bleeding, hematoma size, and modified Barbeau test responses. Preliminary results found no significant differences in bleeding rates between the 3 hour and 6 hour groups. While the 3 hour group trended toward more bleeding with lower heparin doses, larger studies are still needed to achieve sufficient statistical power. The study demonstrates 3 hour compression may be as effective as 6 hours, but more research is required05 aimradial2016 thu S Sindberg ACCESS-1
05 aimradial2016 thu S Sindberg ACCESS-1International Chair on Interventional Cardiology and Transradial Approach
The ACCESS-I study randomized 1000 patients scheduled for radial angiography or angioplasty to either a Terumo® Glidesheath Slender TM (Slender) or a Terumo® standard sheath. The study found that patients who received the slender sheath reported less pain during sheath insertion, with a median VAS score of 1 versus 2 for the standard sheath (p=0.02). However, no differences were found between the sheaths for pain during the procedure, use of sedatives or analgesics, success of the radial procedure, or patency of the radial artery after the procedure.17 FFR Bertrand OF aimradial2016 - post-pci FFR
17 FFR Bertrand OF aimradial2016 - post-pci FFRInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a presentation on the impact of post-PCI FFR (fractional flow reserve) measurements on clinical outcomes. It describes a case study where FFR was measured before and after PCI in two arteries of an 83-year-old man. The presentation reviews studies showing that post-PCI FFR values above 0.90 are associated with lower rates of revascularization and major adverse cardiac events. It concludes that the exact clinical impact of post-PCI FFR needs more demonstration but the ongoing PREDICT registry aims to clarify this by measuring post-PCI FFR in all patients and following their outcomes over two years.10 FFR Berry C aimradial2016 - FAME trials
10 FFR Berry C aimradial2016 - FAME trialsInternational Chair on Interventional Cardiology and Transradial Approach
1. The FAME and FAME-2 trials showed that FFR-guided percutaneous coronary intervention (PCI) led to better long-term outcomes compared to angiography-guided PCI alone.
2. Five-year follow up data from the FAME trial confirmed the benefits of FFR-guided revascularization.
3. European Society of Cardiology guidelines recommend FFR-guided decision making for revascularization in stable coronary artery disease based on the evidence from the FAME trials.11 aimradial2016 fri V Dangoisse
11 aimradial2016 fri V DangoisseInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a technique using two 5F guiding catheters and two transradial arterial accesses to perform left main coronary artery PCI. Five cases are presented where this "double wrist-double guide" technique was used. The main points are:
1) The technique allows manipulation with two smaller guiding catheters instead of one larger catheter, avoiding potential radial artery compromise while maintaining back-up support and multi-wire capabilities.
2) Preliminary results found the technique was as efficient and successful as using a single larger arterial access and guiding catheter.
3) An unexpected discovery was that manipulating two balloons ("X-kiss" pattern) during the procedure may result in better stent strut07 aimradial2016 fri2 P Montorsi
07 aimradial2016 fri2 P MontorsiInternational Chair on Interventional Cardiology and Transradial Approach
Transradial access for carotid artery stenting with proximal protection devices can be technically challenging but is safe and effective according to the presenter's experience. Of 382 carotid stenting procedures performed between 2012-2014, 267 used radial/brachial access and 76 used the Mo.Ma proximal protection system through radial/brachial access. The first attempt failure rate was 34.6% primarily due to sharp carotid artery bifurcation angles and device stiffness. Modified techniques including removing the Mo.Ma mandrel and using two guidewires improved the technical success rate to 98.6% with only 1.3% requiring conversion to a femoral approach. Periprocedural complications were low at 1.3% with no deaths06 aimradial2016 fri2 A Noor
06 aimradial2016 fri2 A NoorInternational Chair on Interventional Cardiology and Transradial Approach
A 57-year-old male presented with lower urinary tract symptoms refractory to medical therapy. He was referred for transradial prostate artery embolization as an alternative to transurethral resection of the prostate due to risks of complications. Bilateral prostatic arteries were selectively catheterized and embolized using Embozene particles via a microcatheter system. Cone beam CT confirmed treatment. The patient experienced decreased symptoms with no complications. Prostate artery embolization is a promising minimally invasive option for patients seeking to avoid surgery or retrograde ejaculation.11 aimradial2016 fri2 T Kwan
11 aimradial2016 fri2 T KwanInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the transpedal approach for peripheral interventions. The transpedal approach involves accessing the pedal or tibial arteries in the foot retrogradely to perform endovascular interventions for conditions like chronic total occlusions in the leg arteries. Some key advantages of the transpedal approach are that it allows dual access for complex interventions, avoids complications associated with femoral access, and can be used when recanalizing total occlusions from above has failed. The document reviews various studies demonstrating the safety, feasibility and clinical outcomes of the transpedal approach.Shapiro T 201110
This document discusses Lankenau Medical Center's transition from femoral to radial artery access for cardiac catheterization procedures. It describes how the medical center trained physicians and staff, increased radial artery procedures over time, and significantly reduced major vascular complications as a result of the transition. Rates of radial artery procedures grew from 10% in early 2010 to over 75% in 2011. The medical center's vascular complication rate dropped from 0.91% prior to the transition to 0% after adopting radial artery access.
Leon MB - Current perspectives
Leon MB - Current perspectivesInternational Chair on Interventional Cardiology and Transradial Approach
Martin B. Leon discusses current perspectives on transradial access (TRA) for cardiac catheterization and percutaneous coronary intervention. TRA use has increased significantly in recent years due to several advantages over transfemoral access, including reduced bleeding and vascular complications. However, TRA still requires a learning curve and is best performed by high-volume operators to maximize benefits. While TRA may become the preferred access site for over 50% of cases in the next 5-10 years, both transfemoral and TRA skills will remain important for interventional cardiologists.Cohen MG 201305
This document provides guidance on starting a successful transradial cardiac catheterization program. It discusses how the author started their program during fellowship by attending courses and enrolling patients in clinical trials. It highlights advantages of transradial access such as reduced access complications, earlier ambulation, and improved patient comfort. The document also reviews data demonstrating reduced bleeding and improved outcomes with transradial compared to transfemoral access. Overall, it presents a case for transradial access and provides tips for establishing a successful transradial program.
Zelizko M
Transradial Access is the Best Access for Percutaneous Coronary Intervention in Acute Coronary Syndrome with ST Elevation: Results from the RIVAL Trial, SCAAR Registry and Czech NRKI Registry
Teirstein P - Transitioning to radial
Teirstein P - Transitioning to radialInternational Chair on Interventional Cardiology and Transradial Approach
1) Transitioning to radial access for cardiac catheterization procedures is growing at Scripps Clinic, with over 50% of procedures now being done radially.
2) However, it can be difficult for experienced interventionalists who are used to femoral access to learn new radial techniques. They have busy practices and may be hesitant to take on new complications.
3) While radial access has advantages for patients like reduced bleeding risks, it also has limitations compared to femoral access for complex cases that require multiple devices or backup support through large guide catheters. Radial access may not always be the best choice.Jolly S 201111
The RIVAL trial compared outcomes of radial versus femoral access in over 7,000 patients undergoing angiography or percutaneous coronary intervention. It found that radial access was associated with a lower risk of major vascular complications compared to femoral access, but found no differences in rates of death, myocardial infarction, stroke, or major bleeding. Radial access provided benefits regardless of operator or center volume. The study demonstrated that with experience, radial access can be performed as safely as femoral access in a variety of clinical settings.
RIVAL trial - Summary & Results
http://www.theheart.org/web_slides/1215405.do
A head-to-head comparison of Radial vs Femoral Access for Coronary Intervention (RIVAL)
Wilcox JN - AIMRADIAL 2013 - Medtronic perspective
Wilcox JN - AIMRADIAL 2013 - Medtronic perspectiveInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses Medtronic's strategy to address global healthcare needs by developing new therapies and technologies, expanding access through globalization, and optimizing costs and efficiencies. Medtronic aims to become a healthcare solutions provider by improving clinical outcomes, expanding access to care, and translating the clinical value of its products into economic benefits. The document provides examples of Medtronic technologies like its Integrity and Resolute Integrity drug-eluting stents and the Symplicity renal denervation system. It also outlines Medtronic's portfolio and programs to facilitate adoption of transradial access procedures.Team of rivals powerpoint
1) Lincoln was re-elected in November 1864 and led his administration, including Secretary of State William Seward and the volatile Secretary of War Edwin Stanton, through the final year of the Civil War.
2) Lincoln's leadership inspired dedication among his cabinet, including Seward and Stanton, despite disagreements, and influenced views on emancipation within the government.
3) In his second inaugural address on March 4, 1865, Lincoln called for peace and restoration of the Union while upholding emancipation, to an estimated crowd of 50,000.
Techniques of Vascular acess for Cardiac Catheterization
Vascular acess, cardiac catheterization, femoral artery puncture, vascular acess route, radial artery catheterization
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Wilcox JN - AIMRADIAL 2013 - Medtronic perspective
Wilcox JN - AIMRADIAL 2013 - Medtronic perspective
Techniques of Vascular acess for Cardiac Catheterization
Techniques of Vascular acess for Cardiac Catheterization
Similar to 01 aimradial2016 thu IC Gilchrist
Gilchrist IC - AIMRADIAL 2015 - Still need Allen test?
Gilchrist IC - AIMRADIAL 2015 - Still need Allen test?International Chair on Interventional Cardiology and Transradial Approach
1) Prior studies have found no class I evidence or randomized data to support performing Allen's test or oximetry prior to radial artery catheterization.
2) Performing Allen's test has been considered a ritual or standard practice without clear data on its predictive value or significance.
3) A recent study found no differences in outcomes between patients with normal, intermediate, or abnormal Allen's test results, suggesting there is no risk from an abnormal test.
4) The focus should be on oximetry-plethysmography and techniques to guide hemostasis after radial procedures to minimize radial artery occlusion, not on pre-procedural testing for dual circulation.Gilchrist IC - AIMRADIAL 2014 - Allen's test
Gilchrist IC - AIMRADIAL 2014 - Allen's testInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses the practice of performing Allen's test or oximetry prior to radial artery catheterization. It summarizes that:
1) There is no Class I evidence or randomized data showing the predictive value of Allen's test, and the significance of an abnormal test is unclear.
2) A study found no differences in outcomes between patients with normal, intermediate, or abnormal Allen's tests, suggesting no risk from an abnormal test.
3) Recommendations are that there is no evidence to support performing Allen's test or testing for dual circulation to prevent ischemic complications of transradial catheterization. Attention should instead focus on techniques to guide hemostasis after the procedure.Ablation in Atrial Fibrillation: anticoagulation therapy: journal club ,may,2017
Ablation in Atrial Fibrillation: anticoagulation therapy: journal club ,may,2017Sackler's faculty of medicine . Tel-Aviv.Uni
Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non–vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non–vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation.40 Years of Progress
This document provides a brief history of progress in cancer research and treatment over the past 40 years. It summarizes key developments such as the discovery of hormone therapy and targeted therapies in the late 19th/early 20th centuries. It describes the founding of ASCO in 1964 and milestones such as establishing chemotherapy as potentially curative. Major trials in the 1990s-2000s established tamoxifen and ovarian ablation's benefits. Targeted therapies like imatinib revolutionized treatment. Biomarkers like HER2 and genomic assays improved prognostication and prediction of benefit. Immunotherapies like ipilimumab demonstrated durable responses. Despite advances, cancer remains challenging with over half a million annual deaths in the US. The document
Pruebas radiologicas a evitar American College of Radiology.
1. Don't perform imaging for uncomplicated headaches unless there are specific risk factors indicating structural disease, as imaging rarely changes management or outcomes. Clinical screens can effectively detect such risk.
2. Don't image for suspected pulmonary embolisms without moderate or high pre-test probability, as imaging has limited value for patients very unlikely to have significant disease based on criteria.
3. Avoid routine admission or preoperative chest x-rays for ambulatory patients with unremarkable histories and exams, as they rarely change management.
Choosing a prosthetic valves in aortic valve replacement surgery
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The Department of Emergency Medicine at Carolinas Medical Center is passionate about education! Dr. Michael Gibbs is a world-renowned clinician and educator and has helped guide numerous young clinicians on the long path of Mastery of Emergency Medical Care. With his oversight, the EMGuideWire team aim to help augment our understanding of emergent imaging. You can follow along with the EMGuideWire.com team as they post these educational, self-guided radiology slides or you can also use this section to learn more in-depth about specific conditions and diseases. This Radiology Reading Room pertains to Aortic Dissection and is brought to you by Matthew Cravens, MD, Tyler Siekmann, MD, and Shelby Hixson, PA. It is has special guest editor: Bryant Allen, MD
MedReg+1 Bhuva ECGs
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Drs. Claire Milam and Alyssa Thomas are Emergency Medicine Residents and interested in medical education. With the guidance of Dr. Michael Gibbs, a notable Professor of Emergency Medicine, they aim to help augment our understanding of emergent imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Malignant Pneumothorax
• Lung Mass
• Retained Bullet
• Cavitary Lesion
• Pleural Effusion
• Mucus Plug with Atelectasis
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Vasc Med-2016-Hale-1358863X15624025
This study examined the impact of sarcopenia on long-term mortality in 200 patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Sarcopenia, defined as low skeletal muscle mass, was assessed on pre-operative CT scans. Patients with sarcopenia had significantly higher mortality rates than those without sarcopenia (76% vs 48%, p=0.016). On multivariate analysis, sarcopenia, hypertension, and older age were independent predictors of mortality following EVAR. The presence of sarcopenia on CT may help predict long-term survival in AAA patients undergoing EVAR.
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With 100 peer-reviewed publications, SuperSonic Imagine’s proprietary ShearWave™ Elastography (SWE™) is the most clinically studied shear-wave based elastography for breast lesion characterization.
In this all new webinar, we will walk you through a literature review that will help you to familiarize yourself with clinical research results related to the use of ShearWave™ Elastography (SWE™) within breast ultrasound imaging.
Central Adiposity and Mortality after First-Ever Acute Ischemic Stroke
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
1 s2.0-s0378512216303371-main
The document analyzes the expression of sex hormone receptors in abdominal aortic aneurysms (AAA). It finds that the expression of the androgen receptor (AR) is higher in AAA tissue compared to unaffected aortic tissue, while the expression of estrogen receptor beta (ERβ) is lower. The expression profile of sex hormone receptors is similar in men and women with AAA. This suggests that sex hormone activity may be associated with aneurysm development, with higher AR expression and lower ERβ expression playing a role.
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A presentation by Mareike Körber at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
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Myburgh on Fluids ICN NSW 2015
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El Dr. José Viña, uno de los mejores investigadores españoles, apuesta por la suplementación nutricional como única vía para realizar una verdadera dieta equilibrada.
Ross Procedure Cryo5
The presentation gives an Overview of ROSS operation and delves in to depth in 3 key areas as follows:
1. Our experience
2. Special situations
3. RVOT Reconstruction with xenografts
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Intra-Aortic_Balloon_Pumps-2014-1jltbfe.ppt
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This document discusses accessing the right heart and central venous system through the radial vein as a safer alternative to traditional femoral access. It provides tips for establishing venous access through the forearm, including using ultrasound or no-touch technology to locate veins and heparin locks to improve efficiency. Challenges like low venous pressure, valves, and junctions are addressed. Images demonstrate techniques for navigating the radial artery into the right atrium, including using flushes of saline. Potential contraindications like arm trauma or breast cancer are noted. The document argues learning both arterial and venous radial techniques will improve cardiologist skills and safety.PCI & AimRadial 2018 | Radial Artery Puncture - Ian C Gilchrist
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This document discusses techniques for radial artery puncture for cardiovascular procedures. It notes that the radial artery is smaller in diameter than the femoral artery. Successful radial access requires correctly positioning and securing the wrist. Ultrasound guidance can help find and access the radial artery, especially for trainees. The initial puncture approach can be anterior wall only or use a counterpuncture technique. Sheath size, length, and coating impact radial artery spasm and occlusion. Cocktails including nitroglycerine and calcium channel blockers are commonly used but acid in the cocktail may damage the artery if felt by the patient.PCI & AimRadial 2018 | Post-PCI FFR: Time is coming - Olivier F. Bertrand
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This document summarizes a presentation given by Dr. Olivier Bertrand on post-PCI FFR measurement. It discusses studies showing that a post-PCI FFR of 0.90 or higher is associated with lower rates of re-PCI and major adverse cardiac events. It then outlines the proposed PREDICT randomized study to evaluate whether routine post-PCI FFR measurement can guide PCI strategy and completion. The study would measure FFR after successful PCI in all-comers and randomize patients to clinical follow-up alone or with guidance from the post-PCI FFR results. The goal is to establish if physiology-guided PCI optimization can improve outcomes and reduce costs.PCI & AimRadial 2018 | Lessons from iFR-SWEDEHEART and DEFINE-FLAIR - Hitoshi...
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1. The document discusses the use of physiology in acute coronary syndrome (ACS) patients, including trials evaluating fractional flow reserve (FFR) and index myocardial resistance (IMR) measurements.
2. Several trials showed that FFR-guided revascularization in multivessel disease STEMI patients reduced major cardiac events compared to culprit-only PCI or medical therapy. Ongoing trials are further evaluating FFR in ACS.
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This document discusses using fractional flow reserve (FFR) to evaluate ambiguous left main coronary artery disease. It presents a case of an 82-year-old woman with chest pain and a recent stent in the circumflex artery. FFR measurements of the left main and left anterior descending artery were 0.64, indicating significance. Intravascular ultrasound also suggested significance. The left main and proximal left anterior descending artery were stented, and post-procedure FFR measurements improved. The document reviews evidence that FFR can safely guide decisions about revascularization of ambiguous left main lesions.PCI & AimRadial 2018 | FFR-CT - Colin Berry
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This document summarizes a presentation on CT-derived fractional flow reserve (FFR-CT). It discusses how FFR-CT increases the positive predictive value of coronary CT angiography (CTCA). Several landmark studies are summarized that evaluated the diagnostic accuracy of FFR-CT compared to CTCA. The PACIFIC trial findings showing high diagnostic accuracy of FFR-CT are described. Ongoing and upcoming clinical trials using FFR-CT like PRECISION and DECISION are mentioned. Novel applications of FFR-CT for biomechanics analysis and PCI planning are presented. Finally, new methods like user-generated CT-FFR that may reduce processing time are introduced, though accuracy needs further evaluation.PCI & AimRadial 2018 | Image based FFR during coronary angiography - Hitoshi...
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1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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01 aimradial2016 thu IC Gilchrist
- 1. Do We Still Need Allen or Oximetry Prior to Radial Approach? Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Penn State’s Hershey Medical Center Heart & Vascular Institute Hershey, PA USA Nothing to disclose
- 2. The Myth 20th U.S. edition of Gray's Anatomy of the Human Body, Gray plate 1237:1918 (public domain) Circulation 2006;113;e6-e7 icg 2016
- 3. Ritual ritual rit·u·al (rĭch'ōō-əl) n. A detailed act or series of acts carried out by an individual (doctor) to relieve anxiety or to forestall the development of anxiety. The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.Mayan Mural image of a Mayan Warrior and a captive. Licensed: Vital Imagery Ltd icg 2016
- 4. Reality Permission: Gunther von Hagens' BODY WORLDS, Institute for Plastination, Heidelberg, Germany, www.bodyworlds.com Permission: Ian Gilchrist 2013 icg 2016
- 5. Infarction Despite Allen Singh K, Abunassar J, So DY. J Am Coll Cardiol Intv 2016;9:e21–2. icg 2016
- 6. J Trauma. 2006;61:468–470. Allen’s Test & Arterial Lines No Class I evidence No randomized data for meta-analysis No standard definition of abnormal Significance of abnormal is unclear No predictive value …performance of an Allen test before radial artery cannulation should not be considered a “standard of care”. CONCLUSION Visuals unlimited icg 2016
- 7. Transradial Allen’s Test Built on assumption of predictability Refined with oximetry Touted as a ritual at many courses Labeled standard of care without data Not used by many long standing operators Ischemic complications remain rare & not related icg 2016
- 8. J Am Coll Cardiol 2014;63:1833–41 203 Normal: 83 Intermediate:80 Abnormal: 60 Allen’s Test Thumb capillary lactate Thumb plethysmography Ulnar frame count Handgrip strength test Discomfort ratings Testing Baseline 1 Day 1 Month 1 Year Follow Up Conclusion: No differences between the groups to suggest a risk from an abnormal Allen’s Test icg 2016
- 9. RADAR Results Handgrip Discomfort Lactate J Am Coll Cardiol 2014;63:1833–41 icg 2016
- 10. Allen’s/Barbeau Association Abnormal Allen’s Normal Allen’s J Am Coll Cardiol 2014;63:1833–41 DC BA Intermediate Allen’s icg 2016
- 11. Is there a Role for Collateral Testing? Image from: http://www.pcronline.com/eurointervention/tools-and-techniques/radial-approach-for-percutaneous-coronary-intervention/ icg2014 icg 2016
- 12. Risk, Benefits & Alternatives icg 2016
- 13. Practice Recommendations There is no evidence to support utility to Testing for Dual Circulation for pre-procedural triage for transradial catheterization to prevent ischemic complications. We need to refocus our attention on the use of oximetry- plethysmography & other techniques to guide patent hemostasis once the transradial procedure is completed to minimize radial artery occlusion. Bertrand OF, Carey PC, Gilchrist IC. Allen or no Allen: that is the question! J Am Coll Cardiol. 2014;63(18):1842-4. icg 2016