Cafri C
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This document discusses a case of bifurcation PCI using a radial approach. A 59-year-old male presented with NSTEMI due to one-vessel coronary artery disease involving a bifurcation lesion. The intervention team used a sheathless 7.5F guiding catheter via the radial artery to deliver kissing stents to both branches of the bifurcation lesion, achieving successful outcomes. The conclusion is that sheathless guiding catheters allow complex bifurcation PCI procedures traditionally requiring femoral access to now be performed via the radial approach.
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Dzavik V 201111
This document discusses the transradial approach for unprotected left main PCI. It recommends the transradial approach due to its safety advantages over transfemoral access. It provides guidance on guide catheter selection for different left main lesion locations and sizes. It emphasizes avoiding ad hoc PCI and using appropriate hemodynamic support for patients with reduced left ventricular function.
Balkin J
This document discusses considerations for treating bifurcation lesions in the radial artery. It covers classifying the type of lesion, the importance of operator experience, and choosing an appropriate guide catheter and guide wires. The document recommends letting the operator do what they are comfortable with and planning treatment for the main vessel and side branch at the beginning. It describes the British Bifurcation Study approach of pretreating vessels and stenting the main vessel with or without protecting the side branch. The document shows examples of complex bifurcation cases and techniques for treatment including stenting the side branch and main vessel, using kissing balloons, and potential long-term outcomes.
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This document discusses the learning curve associated with trans-radial procedures. It notes that the trans-radial approach is more challenging due to the small artery size, risk of spasm, and anatomical variation. Several studies characterized the learning curve, finding that operators improved with experience. The right radial approach has a steeper learning curve than the left. Operators were more successful with trans-radial PCI after 50-100 cases. Proper patient selection, technique, and experience were noted to help overcome challenges associated with the trans-radial learning curve.
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This document provides guidance on performing percutaneous coronary interventions (PCIs) using the transradial approach. It discusses:
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1) Evidence from clinical trials showing lower mortality, lower bleeding rates, and shorter hospital stays with transradial compared to transfemoral access.
2) Tips for patient selection, accessing the radial artery, engaging coronary arteries, and successfully completing interventions.
3) How to manage complications like bleeding and spasm. The overall recommendation is that transradial should become the default access approach, especially for higher risk cases, if the operator takes time to learn the technique.Aminian A - AIMRADIAL 2013 - Glidesheath slender
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Meerkin D - AIMRADIAL 2014 - Structural diseaseInternational Chair on Interventional Cardiology and Transradial Approach
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2) The primary endpoint is target lesion failure at 1 year and secondary endpoints include in-hospital and 30-day target lesion failure as well as angiographic and imaging outcomes.
3) Subgroup analyses will evaluate outcomes in patients with complex lesion characteristics like bifurcations or small vessels.
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The document discusses some of the challenges of the transradial approach for coronary procedures. It notes that anatomical variations can occur in around 23% of cases, including radial artery tortuosity, stenosis, hypoplasia, and abnormal origins. Success rates for transradial procedures range from 83-96.7%, but can be lower for certain variations like arteria lusoria. It also discusses techniques for overcoming challenges like vascular loops and spasm, and notes there is a learning curve associated with the transradial approach.
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This document discusses the history and current evidence regarding transradial catheterization. Some key points:
- Transradial catheterization began in the 1920s but became more widely used starting in the late 1980s and 1990s.
- Studies have shown that radial access reduces access site bleeding complications compared to femoral access, especially in high-risk patients. It also improves patient comfort and allows for shorter hospital stays.
- Radial access should be the preferred approach over femoral for experienced operators, according to ESC revascularization guidelines. While there is a steep learning curve, radial access can be used for all procedures including bifurcation PCI.
- Disadvantages include a longer procedural time initially and risks of radial
Cafri C
This study compared outcomes of 140 patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts via the transradial approach versus 70 patients undergoing PCI of saphenous vein grafts via the transfemoral approach. The transradial group had a lower rate of bleeding complications compared to the transfemoral group (7% vs 21%, p<0.01), with similar rates of angiographic success (90% vs 81%, ns) and no reflow (6% vs 9%, ns). The study supports broader use of the transradial approach for saphenous vein graft intervention due to its association with fewer bleeding complications compared to the transfemoral approach.
Gilchrist IC - AIMRADIAL 2015 - Transradial in breast cancer
Gilchrist IC - AIMRADIAL 2015 - Transradial in breast cancerInternational Chair on Interventional Cardiology and Transradial Approach
Transradial catheterization can be performed safely in breast cancer survivors on the same side as their breast cancer surgery or radiation treatment without increasing the risk of lymphedema or other complications. A retrospective review found no cases of lymphedema or radial access complications in 42 procedures performed ipsilaterally, and only 2 hematomas in 92 procedures performed contralaterally or via femoral access. While the study did not include formal lymphedema measurements, it suggests transradial catheterization can be considered for breast cancer survivors without pre-existing lymphedema. Further research is still needed to evaluate risks in those with lymphedema.Kwan TW - AIMRADIAL 2014 Technical - Selection of catheters
Kwan TW - AIMRADIAL 2014 Technical - Selection of cathetersInternational Chair on Interventional Cardiology and Transradial Approach
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This document summarizes a presentation on CTO PCI in patients with multiple vessel disease and low left ventricular ejection fraction (LVEF). The presentation discusses:
1. The importance of assessing viability and ischemia before revascularization.
2. The need for hemodynamic support, particularly when using retrograde approaches.
3. Tips for procedural success including using the easiest CTO first and considering staged procedures.
4. The debate around complete vs. incomplete revascularization and factors to consider.
5. The importance of clinical and angiographic follow-up given the risk of restenosis in this complex patient group.
Cohen MG 201111
The document provides guidance on patient setup and arterial access for right and left radial cardiac catheterization. It recommends using a board to position the patient comfortably, accessing from the right or left radial artery, using hydrophilic sheaths to prevent spasm, anticoagulating patients, and administering a spasmolytic cocktail. It emphasizes that training staff is important for successful radial procedures.
Gilchrist IC - AIMRADIAL 2015 - Right heart catheterization
Gilchrist IC - AIMRADIAL 2015 - Right heart catheterizationInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses performing right heart catheterization through radial venous access. It begins by providing the historical context of using the radial artery for cardiac access. It then notes that radial venous access provides a safer alternative to traditional femoral access. The document outlines the steps for radial venous access, including using ultrasound to locate veins, placing a heparin lock, and potential troubleshooting steps if access is difficult. It emphasizes that with practice, being skilled at both arterial and venous radial access techniques can improve safety and efficiency during cardiac procedures.Burzotta F 201111
Diagnostic and Guide Catheter Choices and Manipulation from the Radial Artery for Native and Graft Vessels
Bertrand OF - AIMRADIAL 2014 - Patent hemostasis
Bertrand OF - AIMRADIAL 2014 - Patent hemostasisInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses issues with patent hemostasis as the standard of care for transradial procedures. It notes that while patent hemostasis aims to prevent radial artery occlusion (RAO), the definition of RAO is unclear and methods to assess hemostasis and RAO vary. Studies have found patent hemostasis fails in about 25% of cases and may not impact hematoma or pseudoaneurysm rates. The document examines different hemostasis protocols and their impacts on RAO in various studies and practices. It concludes that while RAO prevention should be a quality goal, standardization is needed on definitions, assessment methods, and optimal hemostasis protocols given variability in results.High Class Interventions
This document discusses guide catheter choice for coronary angioplasty. It summarizes that: diagnostic catheters are typically 5F or 6F, with shapes including JL4, JR4, and Tiger; guide catheters for the left typically include extra backup sizes of 3.5F or 4F for men and 3F or 3.5F for women, and the right typically uses a JR4 shape or AL1/AL0.75 for upsloping vessels; vein grafts and LIMA procedures use JR4, AL1, or multipurpose shapes; and common guide catheter brands mentioned are Cordis Vista, Medtronic Launcher, and Boston Mach 1.
Plante S
This document summarizes a study conducted at Southlake Regional Health Centre (SRHC) comparing the rates of radial artery occlusion (RAO) between patients receiving bivalirudin versus heparin during transradial coronary procedures. 400 consecutive patients undergoing coronary angiography +/- PCI via radial access were included. 200 received IV bivalirudin during PCI while 200 controls undergoing angiography alone received IV heparin. RAO rates at 4-6 week follow up were low in both groups and not statistically significant, though slightly higher in the heparin group. The study suggests delayed administration of anticoagulation as per the SRHC protocol is safe and results in low RAO rates during transradial procedures.
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Ruzsa Z - AIMRADIAL 2015 - Transradial treatment of erectile dysfunctionInternational Chair on Interventional Cardiology and Transradial Approach
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The document discusses optimizing transradial interventions and managing complications. It begins by emphasizing the importance of patient selection based on anatomy, using proper techniques to avoid failure, and anticipating common and rare complications. Several key points are covered, including assessing hand collateral arteries using tests like the modified Allen's test before proceeding. Anatomical variations that could impact access are reviewed. Causes of access failure like radial artery loops and spasm are described. Technical tips for successful cannulation include using a small needle and guidewire, followed by a vasodilator "cocktail" to prevent spasm. Severe spasm is identified as a rare but preventable complication.
Kandzari DE 201305
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Intravascular lithotripsy: not an eccentric option for eccentric calcium
1) The GISE-SHOCKCALCIUM REGISTRY aims to evaluate the efficacy and safety of coronary lithotripsy for treating severe calcified lesions by enrolling 2000 patients across 50 sites in Italy.
2) The primary endpoint is target lesion failure at 1 year and secondary endpoints include in-hospital and 30-day target lesion failure as well as angiographic and imaging outcomes.
3) Subgroup analyses will evaluate outcomes in patients with complex lesion characteristics like bifurcations or small vessels.
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Ikari Y - AIMRADIAL 2015 - Carotid artery stentingInternational Chair on Interventional Cardiology and Transradial Approach
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Dangoisse V - AIMRADIAL 2014 - Distal buddy in jailInternational Chair on Interventional Cardiology and Transradial Approach
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The document discusses some of the challenges of the transradial approach for coronary procedures. It notes that anatomical variations can occur in around 23% of cases, including radial artery tortuosity, stenosis, hypoplasia, and abnormal origins. Success rates for transradial procedures range from 83-96.7%, but can be lower for certain variations like arteria lusoria. It also discusses techniques for overcoming challenges like vascular loops and spasm, and notes there is a learning curve associated with the transradial approach.
Alaswad K - AIMRADIAL 2015 - Chronic total occlusion
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Use of transradial approach for chronic total occlusion (CTO) percutaneous coronary intervention (PCI)Delewi R - AIMRADIAL 2015 - Radial artery occlusion
Delewi R - AIMRADIAL 2015 - Radial artery occlusionInternational Chair on Interventional Cardiology and Transradial Approach
This study evaluated the incidence of radial artery occlusion (RAO) in 339 patients who underwent a second cardiac catheterization or percutaneous coronary intervention (PCI) using the radial artery approach within 1 year of a previous radial procedure. The incidence of RAO was low at 1.5%, occurring in 5 patients. Risk factors for the cases of RAO included the use of a 6 French catheter and having undergone multiple prior radial procedures. The study concludes that contemporary techniques including slender catheters, manual bandages, and new P2Y12 inhibitors result in low rates of RAO.Radial access interventions pros,cons and evidense
This document discusses the history and current evidence regarding transradial catheterization. Some key points:
- Transradial catheterization began in the 1920s but became more widely used starting in the late 1980s and 1990s.
- Studies have shown that radial access reduces access site bleeding complications compared to femoral access, especially in high-risk patients. It also improves patient comfort and allows for shorter hospital stays.
- Radial access should be the preferred approach over femoral for experienced operators, according to ESC revascularization guidelines. While there is a steep learning curve, radial access can be used for all procedures including bifurcation PCI.
- Disadvantages include a longer procedural time initially and risks of radial
Cafri C
This study compared outcomes of 140 patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts via the transradial approach versus 70 patients undergoing PCI of saphenous vein grafts via the transfemoral approach. The transradial group had a lower rate of bleeding complications compared to the transfemoral group (7% vs 21%, p<0.01), with similar rates of angiographic success (90% vs 81%, ns) and no reflow (6% vs 9%, ns). The study supports broader use of the transradial approach for saphenous vein graft intervention due to its association with fewer bleeding complications compared to the transfemoral approach.
Gilchrist IC - AIMRADIAL 2015 - Transradial in breast cancer
Gilchrist IC - AIMRADIAL 2015 - Transradial in breast cancerInternational Chair on Interventional Cardiology and Transradial Approach
Transradial catheterization can be performed safely in breast cancer survivors on the same side as their breast cancer surgery or radiation treatment without increasing the risk of lymphedema or other complications. A retrospective review found no cases of lymphedema or radial access complications in 42 procedures performed ipsilaterally, and only 2 hematomas in 92 procedures performed contralaterally or via femoral access. While the study did not include formal lymphedema measurements, it suggests transradial catheterization can be considered for breast cancer survivors without pre-existing lymphedema. Further research is still needed to evaluate risks in those with lymphedema.Kwan TW - AIMRADIAL 2014 Technical - Selection of catheters
Kwan TW - AIMRADIAL 2014 Technical - Selection of cathetersInternational Chair on Interventional Cardiology and Transradial Approach
The document discusses selection of diagnostic catheters for transradial cardiac catheterization. It describes different catheter options for cannulating the left and right coronary arteries from the radial approach. The Judkins catheters and Tiger/Jacky catheters are commonly used and each has advantages and disadvantages. Factors such as access site, vascular anatomy, and operator experience influence catheter selection. Tips are provided for navigating tortuous anatomy and engaging coronary arteries from the radial approach.Alfredo R. Galassi - How to deal with very LVEF: the last remaining option to...
This document summarizes a presentation on CTO PCI in patients with multiple vessel disease and low left ventricular ejection fraction (LVEF). The presentation discusses:
1. The importance of assessing viability and ischemia before revascularization.
2. The need for hemodynamic support, particularly when using retrograde approaches.
3. Tips for procedural success including using the easiest CTO first and considering staged procedures.
4. The debate around complete vs. incomplete revascularization and factors to consider.
5. The importance of clinical and angiographic follow-up given the risk of restenosis in this complex patient group.
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The document provides guidance on patient setup and arterial access for right and left radial cardiac catheterization. It recommends using a board to position the patient comfortably, accessing from the right or left radial artery, using hydrophilic sheaths to prevent spasm, anticoagulating patients, and administering a spasmolytic cocktail. It emphasizes that training staff is important for successful radial procedures.
Gilchrist IC - AIMRADIAL 2015 - Right heart catheterization
Gilchrist IC - AIMRADIAL 2015 - Right heart catheterizationInternational Chair on Interventional Cardiology and Transradial Approach
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Diagnostic and Guide Catheter Choices and Manipulation from the Radial Artery for Native and Graft Vessels
Bertrand OF - AIMRADIAL 2014 - Patent hemostasis
Bertrand OF - AIMRADIAL 2014 - Patent hemostasisInternational Chair on Interventional Cardiology and Transradial Approach
This document discusses issues with patent hemostasis as the standard of care for transradial procedures. It notes that while patent hemostasis aims to prevent radial artery occlusion (RAO), the definition of RAO is unclear and methods to assess hemostasis and RAO vary. Studies have found patent hemostasis fails in about 25% of cases and may not impact hematoma or pseudoaneurysm rates. The document examines different hemostasis protocols and their impacts on RAO in various studies and practices. It concludes that while RAO prevention should be a quality goal, standardization is needed on definitions, assessment methods, and optimal hemostasis protocols given variability in results.What's hot (20)
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Gilchrist IC - AIMRADIAL 2015 - Transradial in breast cancer
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This document summarizes a study conducted at Southlake Regional Health Centre (SRHC) comparing the rates of radial artery occlusion (RAO) between patients receiving bivalirudin versus heparin during transradial coronary procedures. 400 consecutive patients undergoing coronary angiography +/- PCI via radial access were included. 200 received IV bivalirudin during PCI while 200 controls undergoing angiography alone received IV heparin. RAO rates at 4-6 week follow up were low in both groups and not statistically significant, though slightly higher in the heparin group. The study suggests delayed administration of anticoagulation as per the SRHC protocol is safe and results in low RAO rates during transradial procedures.
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This document summarizes a program called "Restoring the Urban Youth" that aims to instill a sense of urgency in students to get an education and help their community. The program keeps students in the same cohort for all four years of high school and teaches classes like college courses, using class discussion, group projects, technology, and high standards. It teaches students to "rise and resist" through community-focused projects using critical thinking skills. The program has found success in both student and faculty retention. A charter school using this program's approach is being built in Oakland and is set to open in 2015.
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The Adélie penguin lives along rocky coastlines in Antarctica, feeding on small crustaceans and fish. It has black and white plumage with distinctive white eye-rings, stands 30-64 inches tall, and the student finds its lack of crests and white eye-rings to be particularly cute.
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A empresa de tecnologia anunciou um novo sistema operacional para computadores pessoais. O novo sistema operacional terá recursos aprimorados de segurança e privacidade para proteger os usuários. Além disso, o sistema operacional contará com uma interface simplificada e intuitiva para tornar a experiência do usuário mais agradável.
Choosing catheters & guidewires
The document discusses materials useful to have in stock for vascular surgery cases, including 3 types of guide wires, 4 diagnostic catheters, sheaths, balloons and stents, and peripheral stent grafts. It provides details on the types and uses of guide wires, catheters, sheaths, and other tools. Key catheters mentioned are Headhunter, Cobra, Motarjeme and Simmons. It recommends having 3 types of guide wires and answers questions about the most useful catheters and number of guide wire types needed.
Guiding catheter in coronary intervention
1. Guide catheters provide support for advancing devices into coronary arteries and injecting contrast for visualization. Their selection depends on factors like coronary anatomy, aortic root size, and desired level of support.
2. Common guide catheters include the Judkins, Amplatz, and extra-backup guides. The Judkins provides balanced support while the Amplatz offers firm passive support. Long tip catheters provide coaxial support and manipulation.
3. Achieving proper coaxial alignment and maintaining backup support are important for device delivery and preventing complications. Catheter size, curves, and deep seating techniques impact the level of passive versus active support provided.
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The document discusses coronary guidewires, which are used to access and cross coronary lesions during angioplasty procedures. It provides a brief history of angioplasty and guidewire development. The key components and characteristics of guidewires are described in detail, including core material, tapering, tip design, coil placement, covers, coatings, and how these influence flexibility, torque, and other performance factors. Common guidewire classifications and specific guidewire models are also mentioned along with guidance on optimal guidewire positioning and potential complications.
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This document summarizes the techniques used at the presenter's center for treating bifurcation lesions through radial versus femoral access. It provides examples of bifurcation cases treated through radial access using provisional stenting or two-stent techniques. The conclusions state that most bifurcations can be treated through radial access but femoral access may be considered if backup support is suboptimal or simultaneous implantation of two stents is needed, such as for conventional mini-crush or V stenting.6d13ad17-73dc-4a10-9b7b-f5e806dcdf2f.pdf
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Op cab
OP CAB (off-pump coronary artery bypass) involves bypass grafting without the use of cardiopulmonary bypass. It was first performed in the 1960s but later eclipsed by on-pump CABG using cardiopulmonary bypass. Interest in OP CAB resumed in the 1980s due to certain advantages over on-pump CABG like reduced blood loss, renal dysfunction, and short-term neurological complications. While both techniques are effective, studies have found OP CAB may reduce certain risks but be more technically challenging with a longer learning curve compared to on-pump CABG. Current indications for OP CAB include patients aged 70 or older, low ejection fraction, previous cardiac surgery, or comorbidities affecting the risk of
Friday 0920 - mashayekhi - case1
This case involves treating a long CTO of the right coronary artery (RCA) using an antegrade approach in a 71-year-old man with various cardiovascular risk factors and symptoms. The doctor evaluates options for guiding catheter size and wire strategies like single wire, parallel wires, or IVUS-guided re-entry. An initial angiogram is performed. The doctor discusses when a retrograde strategy may be preferable and outlines treatment options for stenting the complex lesion involving the bifurcation.
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Dzavik V - AIMRADIAL 2014 - Radial artery size
Dzavik V - AIMRADIAL 2014 - Radial artery sizeInternational Chair on Interventional Cardiology and Transradial Approach
This document describes a study that aimed to identify reliable predictors of radial artery size to help minimize the risk of radial artery occlusion from cardiac catheterization procedures. The study found that wrist circumference, male sex, and non-South Asian ancestry are independent predictors of larger radial artery size. Based on these factors, the study developed the "GRASP radial artery size prediction score" to predict radial artery diameter with reasonable accuracy and help operators choose the best arterial access approach or sheath size for a patient.Updated vascular topic cvc
This document summarizes the surgical technique and complications of central venous catheters for hemodialysis. It discusses the basic concepts, pre-operative evaluation including imaging of central veins, catheter insertion technique, and perioperative and long-term care and complications. The best site for catheter placement is the right internal jugular vein to minimize risks of kinking and central vein stenosis. Ultrasound and fluoroscopy guidance are recommended for accurate placement and tunneling of cuffed catheters. Major perioperative risks include pneumothorax, hemothorax, and nerve injury, while long-term complications consist of infection, thrombosis, stenosis, and catheter malfunction.
Intravascular lithotripsy (ivl) for peripheral arterial disease
There are a number of observations that suggest IVL produces
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E-case04 Tummalapalli aimradial20170922 Bailout
E-case04 Tummalapalli aimradial20170922 BailoutInternational Chair on Interventional Cardiology and Transradial Approach
This document summarizes a case of a 55-year-old male who presented with chest pain and shortness of breath. He was diagnosed with a STEMI and underwent a PCI where two lesions in his LAD were stented. Attempts to visualize his RCA from the femoral approach were unsuccessful. He developed cardiogenic shock and was transferred for consideration of CABG. A second attempt from the femoral approach also failed to visualize the RCA. A left radial approach successfully opened the anomalous RCA via PCI, resolving the cardiogenic shock. The patient was ultimately discharged to a rehabilitation facility.journal1.pptx
This document discusses a study on transcatheter closure of ventricular septal defects (VSDs) in small children weighing less than 10 kg. VSDs are a common type of congenital heart defect. While traditionally treated with open heart surgery, catheter-based closure has emerged as a less invasive alternative. The study examines using the left ventricular mid-cavity approach for delivering closure devices in these small children. Of the 35 patients studied, closure was successful in 32 cases with no major complications at intermediate follow up of 8.7 months on average. The left ventricular approach resulted in less hemodynamic compromise and risk of aortic regurgitation compared to the standard antegrade approach.
Haemodialysis access surgeries
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This document discusses complications that can occur during percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). It provides information on recognizing, preventing, and managing various complications including perforations, dissections, radiation exposure, contrast-induced nephropathy, and trapped equipment. Specific techniques are outlined for dealing with complications involving the septal channels, donor arteries, and aortic root. The importance of being prepared with the proper equipment and reversing anticoagulation at the right time is emphasized.
carotid stenosis and carotid artery stenting- un update
Carotid artery stenting is an alternative to carotid endarterectomy for treating carotid artery stenosis. The document discusses the indications for and procedures involved in carotid revascularization. It summarizes several key studies comparing stenting to endarterectomy. For symptomatic patients, stenting was found to be non-inferior to surgery with the risk of stroke or death below 6%. Recent advances discussed include new embolic protection devices, stent designs like double layer mesh stents, and the transradial approach to reduce manipulation of complex aortic arches. Overall the document provides an overview of carotid stenting procedures and updates on recent technology improvements aimed at reducing risks.
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.The DECRA trial
1) The DECRA trial investigated whether early decompressive craniectomy improved outcomes for patients with severe traumatic brain injury and refractory intracranial hypertension compared to standard care.
2) Patients who underwent early craniectomy had decreased intracranial pressure and shorter time on ventilators and in the ICU compared to standard care.
3) However, patients who received early craniectomy were more likely to have an unfavorable outcome, with 70% having functional disability or death, compared to 51% of patients receiving standard care.
Venous Bullet Embolization Presentation Final.pptx
This case report describes a rare instance of retrograde venous embolization of a bullet fragment from a gunshot wound to the right ventricle. A 23-year-old male presented with shock after sustaining a single GSW to the right chest without exit wound. Exploratory surgery found a bullet wound to the right ventricle. Fluoroscopy located an opaque object in the right pelvis. Further surgery extracted a bullet from the right common iliac vein, demonstrating retrograde venous embolization. The patient recovered well without complications. The report reviews literature on bullet embolization management, which varies from extraction to observation depending on factors like time of presentation and location.
Aorto iliac interventions
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Advances in ped card
Recent advances in interventional pediatric cardiology include improving existing techniques such as atrial septal defect closure and balloon valvuloplasty, developing new methods like percutaneous pulmonary valve replacement, and exploring hybrid procedures combining surgery and catheterization. New devices now allow closure of defects that were previously not suitable for catheter procedures. Stenting has expanded the options for treating lesions like coarctation of the aorta. Overall, interventional techniques are helping manage more complex congenital heart disease with less invasive approaches.
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This document summarizes the evidence from multiple randomized clinical trials that support a Class IA recommendation for the use of radial artery access (TRA) over femoral artery access (TFA) for cardiac catheterization procedures. The data show that TRA is associated with lower rates of major vascular complications and major bleeding compared to TFA, with numbers needed to treat of 21 and 47 respectively. TRA may also reduce mortality in patients with acute coronary syndrome, with a number needed to treat of 100. Both the 2018 AHA guidelines and ESC/EACTS guidelines were updated to strongly recommend a radial-first approach in light of the overwhelming data demonstrating benefits of TRA over TFA.PCI & AimRadial 2018 | Best practices in same day discharge - Ivo Bernat
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This document discusses best practices for same day discharge after cardiac procedures. It provides an overview of the history and evidence supporting same day discharge. Key points include:
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This document summarizes the findings of a study analyzing 19,482 left main stem percutaneous coronary intervention (LMS-PCI) procedures from the British Cardiovascular Intervention Society National Database between 2007-2014:
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Cafri C
- 1. Bifurcation PCI using a Radial Approach Carlos Cafri, MD Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva , Israel
- 2. The Case • Male, 59 years old • Family history of CAD, HTN, type II DM • Current presentation – One month of exertional angina and shortness of breath – Admitted due to recurrent chest pain and troponin elevation: NSTEMI
- 3. The Case • Coronary angiography within 24 hours of admission – Right radial artery – 6F universal diagnostic catheter (Optitorque: 6F- BLK) – Single vessel disease
- 4. The Bifurcation n True Bifurcation: Medina 1.1.1 Large Diagonal Branch: Large diameter: >2.5 mm Large territory n 60 ° angle between branches
- 5. Possible Strategies • Single Vessel Stenting/ Provisional Stenting • Two Vessel Stenting
- 6. Decision • Data – Randomized trials: Cactus,Nordic, BBC – Observational trials • Consensus – European Bifurcation Club Meeting • Feeling – “Optical-Limbic Reflex” • Access Site
- 7. The Decision : “Access Site” – Paradigm: • “It is really hard to perform two vessel stenting via the transradial approach” • “Through the radial approach try to do provisional stenting”
- 8. Why? • Transradial PCI is performed with 6 F guiding catheter • A 6 French guide catheter allows simultaneous crossing of: • Two balloons • Balloon and stent • A 6 French guide catheter never allows simultaneous crossing with two stents
- 9. Non Compatible Techniques with 6F Guiding Catheter
- 10. Our case: What could do? • Provisional Stenting – Predilate both branches – Stent implantation in the LAD – Probably side branch compromise – Stenting side branch if flow is reduced or chest pain occurs
- 11. Our case: What could do? • Change the access site : – Femoral artery – 7 French – “Pay the price” • New puncture • Bleeding risk • Discomfort
- 12. Our case: What could do? – 7 French guiding catheter • Possible • Selective : Men, large radial, first radial cath, no previous spasm • Complicated: Spasm, bleeding and radial occlusion
- 14. Our case. What could we do? • Sheathless guiding catheter
- 16. Innovations in Guiding Catheters
- 17. Our case: What we did • Exchange 6F sheath to 7.5 F sheathless guiding • Heparin: 9000 U. • Two wires: ATW- Whisper • Kissing balloon: 2 x 15mm • Two stents delivery: Promus 2.75 x 18mm; 2.5 x 12mm • Mini-crush technique • Diagonal stent deployment • LAD stent deployment • Final kissing balloon with a non compliant balloon
- 29. Conclusions • Implementation of 7 F. Guiding catheters or sheath less guiding catheters during transradial PCI allows simultaneous delivery of two stents. • All the existing strategies creates for the angioplasty treatment of challenging bifurcation lesions can be performed through the radial approach